{ "Contributors": "MIMIC", "Source": "MIMIC-IV", "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/", "Categories": [ "Summarization" ], "Definition": [ "Summarize the CT imaging diagnostics' detailed findings for the Abdomen into a concise conclusion." ], "Reasoning": [], "Input_language": [ "English" ], "Output_language": [ "English" ], "Instruction_language": [ "English" ], "Domains": [ "Medicine", "Clinical Reports", "CT", "Abdomen" ], "Positive Examples": [], "Negative Examples": [], "Instances": [ { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A left adrenal nodule measures 2.6 x 2.4 cm, not substantially\nchanged from prior study, and remains incompletely characterized on this exam.\nThe right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted with minimal residual adjacent fat stranding,\nimproved from the prior study, but no definite evidence for acute\ndiverticulitis is seen. There is extraluminal tracking of rectal contrast\nfrom the sigmoid colon into the vaginal cuff compatible with a colovaginal\nfistula (37:602, 2:61). No fluid collections are seen. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy. No adnexal\nabnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Rectally administered contrast opacifies a colovaginal fistula tracking\nfrom the sigmoid colon to the vaginal cuff, likely as a sequelae of prior\nepisodes of diverticulitis.\n2. Sigmoid diverticulosis with mild residual adjacent fat stranding, improved\nfrom the previous exam, with no convincing evidence for acute diverticulitis.\n3. Similar left adrenal lesion when compared with prior CT studies dating back\nto ___, likely benign, but incompletely characterized on this exam." }, { "input": "LOWER CHEST: There is mild atelectasis at the lung bases, bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild central intrahepatic and\nextrahepatic biliary ductal dilatation is mildly increased from ___.\nThe CBD measures 8 mm (previously 7 mm). The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThe kidneys contain multiple simple cysts, bilaterally. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is severe dilation of loops of small bowel in the left\nupper quadrant (up to 5.3 cm) and mid abdomen with a transition to\ndecompressed small bowel in the right lower quadrant (series 602, image 26). \nThere may be a second more proximal transition point (series 602, image 17). \nNo mesenteric free fluid or free air. The appendix is surgically absent.\n\nPELVIS: The urinary bladder is not well seen. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Severe compression deformities are noted throughout the lower thoracic\nand upper lumbar spine, unchanged from ___. There has been interval\nkyphoplasty of the L2 vertebral body. The patient is status post bilateral\nfemoral ORIF. There is diffuse bony demineralization.\n\nSOFT TISSUES: Enhancing tract is noted at the site of prior G-tube placement\n(series 2, image 33).", "output": "1. Findings concerning for small-bowel obstruction with a focal transition to\ndecompressed small bowel in the right lower abdomen." }, { "input": "LOWER CHEST: 4 mm right lower lobe pulmonary nodule is overall unchanged\nsince at least ___ (series 2, image 2). Bibasilar atelectasis is mild. No\npleural effusion. No pericardial effusion. Coronary artery calcifications\nare moderate.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral cortical hypodensities are too small to accurately characterize on\nCT but are statistically likely cysts, unchanged. No concerning focal renal\nlesion. No hydronephrosis. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is relatively decompressed with a G-tube within\nthe lumen. There is a small amount of soft tissue swelling at the site of G\ntube insertion. Bowel loops are dilated and filled with fluid and air all the\nway to the rectum. No transition point. This most likely reflects ileus. No\npneumatosis, pneumoperitoneum, or intra-abdominal drainable fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Multiple compression fractures throughout the lower thoracic and lumbar\nspine are unchanged from the prior exam. 2 internal fixation screws of the\nright femoral neck appear intact. Intra medullary nail in the left proximal\nfemur is also unchanged. No suspicious lytic or sclerotic osseous lesion. No\nacute fracture.\n\nSOFT TISSUES: Soft tissue edema and small amount of subcutaneous emphysema at\nthe site of G-tube insertion.", "output": "1. Diffuse dilation of bowel without a transition point is most likely\nsecondary to ileus.\n2. Soft tissue swelling and tiny amount of subcutaneous emphysema at the G\ntube insertion site. No intraabdominal fluid collection.\n3. Multiple vertebral body compression deformities, similar to ___." }, { "input": "LOWER CHEST: The visualized lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions on this noncontrast exam. There is mild\nintrahepatic biliary dilatation. The CBD is again dilated to 1.4 cm,\nunchanged from prior exam. The gallbladder is surgically absent\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nfocal renal lesions or hydronephrosis. There is a 12 mm nonobstructing stone\nin the left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass surgery\nand partial colectomy. Otherwise, visualized loops of small large bowel are\nnormal in appearance. There is no evidence of mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is mild calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions \nThere is a 5.7 x 2.1 x 4.9 cm fluid collection in the subcutaneous soft tissue\nof the anterior abdomen at the site of the prior fluid collection. An area of\nfluid density seen immediately deep to this fluid collection within the\nintraperitoneal cavity may represent fluid within an loop of bowel, but it\ncould also represent intraperitoneal extension of the fluid collection.", "output": "1. Fluid collection measuring 5.7 x 2.1 x 4.9 cm in the subcutaneous soft\ntissue of the anterior abdomen at the site of the prior fluid collection. An\narea of fluid density seen immediately deep to this fluid collection within\nthe intraperitoneal cavity may represent fluid within an loop of bowel, but it\ncould also represent intraperitoneal extension of the fluid collection. \nFollow-up imaging recommended; Ultrasound may be helpful.\n\n2. Status post Roux-en-Y gastric bypass surgery and partial colectomy.\n\n3. 12 mm nonobstructing stone in the left kidney.\n\nRECOMMENDATION(S): Ultrasound may distinguish intraperitoneal fluid\ncollection from fluid filled bowel loop (see impression #1)\n\nNOTIFICATION: Findings were communicated to the patient's team at 1:30 a.m.\non ___ in person." }, { "input": "LOWER CHEST: The imaged lung bases are clear aside from mild bibasilar\natelectasis. Heart size is normal with no pericardial effusion. There is no\npleural effusion.\n\nABDOMEN: The liver is normal in attenuation with no focal hepatic lesions. \nThe portal and hepatic veins are patent. The gallbladder is normal. The\npancreas is normal in attenuation and bulk. The spleen is normal in size and\nattenuation. The adrenal glands are morphologically normal bilaterally. The\nkidneys enhance and excrete contrast symmetrically.\n\nThe distal esophagus, stomach, proximal small bowel are normal. Mild\nthickening involving a long segment of the distal ileum extending to the\nterminal ileum is noted with a small amount of adjacent free fluid and small\nadjacent reactive lymph nodes. There is no resultant obstruction. The\nappendix is normal. The cecum and colon are normal. There is no evidence of\ncolitis or diverticula.\n\nThere is mild lymphadenopathy in the right lower quadrant. There is trace\nfluid in the mesentery abutting the terminal ileum, as well as in the right\nhemipelvis.\n\nPELVIS: Urinary bladder, prostate, and seminal vesicles are normal. There is\nno pelvic lymphadenopathy.\n\nVESSELS: No significant atherosclerotic calcification of the abdominal aorta\nor branch vessels. No aneurysm.\n\nBONES: No concerning osseous lesions. No fracture. No evidence of\nsacroiliitis.", "output": "1. Mild wall thickening involving a long segment of the distal ileum with\ntrace free fluid and no signs of resultant obstruction. Differential\nconsiderations include infectious or inflammatory etiologies.\n2. Normal appendix." }, { "input": "Streaky opacities in the lower lobe suggests minor atelectasis or scarring.\n\nThe liver, gallbladder, pancreas, spleen, adrenal glands, and kidneys appear\nwithin normal limits.\n\nThe stomach, small and large bowel, appear within normal limits. The appendix\nappears normal.\n\nThe uterus and adnexa appear within normal limits. The distal ureters and\nbladder appear normal. There is no ascites or mesenteric fluid.\n\nPartly visualized thoracolumbar fusion appears unchanged. No fracture is\nidentified.", "output": "Small superficial hematomas and edema in subcutaneous fat along each flank,\nbut otherwise no evidence of injury." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits.\nABDOMEN:\n\nHEPATOBILIARY: There is suggestion of hepatic steatosis as evidenced by\nregions of fatty sparing. There is no biliary dilatation. The gallbladder is\nwithin normal limits.\n\nPANCREAS: Unremarkable. There is no peripancreatic stranding.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis there is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No ascites or bowel obstruction. The appendix is\nunremarkable.\n\nPELVIS: There is no free fluid in the pelvis. The uterus and adnexa are\nunremarkable for age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT findings to explain abdominal pain.\n2. Hepatic steatosis." }, { "input": "LOWER CHEST: There is minimal atelectasis at the left lung base. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is moderate\ncolonic stool burden, however the colon and rectum are otherwise within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of intra-abdominal or pelvic mass.\n2. Moderate colonic stool burden." }, { "input": "LOWER CHEST: Please refer to dedicated chest CT performed concurrently.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains multiple\ngallstones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a subcentimeter hypodense lesion in the upper pole of the\nright kidney that is too small to characterized There is mild fullness of the\ncollecting system bilaterally and of the right ureter, which could be related\nto reflux. There is no perinephric abnormality.\n\nGASTROINTESTINAL: NG tube has its tip terminating in the gastric antrum. \nThere are diffuse fluid-filled loops of small and large bowel likely due to\nthe patient's known enterocolitis.\n\nPELVIS: The patient is status post cystectomy with ileal conduit in the right\nlower quadrant. A Foley catheter is noted within the ileostomy. There is\nsmall amount of pelvic free fluid.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Moderate subcutaneous edema is noted throughout the abdomen and\npelvis.", "output": "1. Status post cystectomy with ileal conduit in the right lower quadrant. \nFoley catheter noted in the ileostomy.\n\n2. Diffuse fluid-filled loops of small and large bowels are likely related to\nknown enterocolitis.\n3. Please refer to dedicated chest CT report dictated separately.\n4. Cholelithiasis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:44 ___, 10\nminutes after discovery of the findings." }, { "input": "LOWER CHEST: Mild basal dependent atelectasis noted. There is a punctate\ncalcified granuloma in the right lower lobe (2; 1). There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Normal enhancement. No intrahepatic or extrahepatic biliary\nductal dilation. Main portal vein is patent.\n\nPANCREAS: Normal.\n\nSPLEEN: Normal.\n\nADRENALS: Normal.\n\nURINARY: Enhancement is symmetric and excretion is prompt and equal. No signs\nof pyelonephritis, hydronephrosis or worrisome renal lesion.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. There is dilatation of appendix up to 15 mm\nwith surrounding fat stranding and trace free fluid in the pelvis. \nAppendicolith is are noted throughout the appendix, including a 5 mm\nappendicolith within the proximal segment (601; 17). There is no extraluminal\nair or drainable fluid collections. A small fat containing umbilical hernia\nis noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSpondylolysis noted bilaterally at L5 without associated anterolisthesis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute uncomplicated appendicitis.\n2. L5 pars defects." }, { "input": "LOWER CHEST: There is necrotizing pneumonia in the right lower lobe. Please\nrefer to separate report of CT chest performed on the same day for description\nof the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The transplant liver is normal in morphology unchanged from\nprior. There is homogeneous attenuation and enhancement throughout. There is\nno evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: Lesions within the pancreatic body likely representing side-branch\nIPMNs were better characterized on prior MRI. No new pancreatic lesions are\nvisualized. There is no peripancreatic stranding.\n\nSPLEEN: There is splenomegaly measuring up to 21 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNumerous hypodense lesions seen throughout both kidneys likely represent\nsimple cysts though many are too small for accurate characterization. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is a Foley catheter in place. Mild thickening of the urinary\nbladder may be related to cystitis and correlation with UA is recommended. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is enlargement of the portal system unchanged from prior.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Splenomegaly with enlargement of the portal system consistent with portal\nhypertension. Transplant liver appears normal with no focal liver lesions and\nno vascular occlusion.\n2. Pancreatic lesions were better seen on prior MRCP, likely representing\nside-branch IPMNs.\n3. Mild thickening of the urinary bladder may be related to cystitis and\nurinalysis is recommended.\n4. Please see separate chest CT report for thoracic findings, including the\npresence of right lower lobe necrotizing pneumonia." }, { "input": "LOWER CHEST:\n\nThe imaged lung bases demonstrate emphysema and a stable 5 mm pulmonary nodule\nin the left lung base (02:11). Coronary artery calcifications are present.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild prominence of the\nintrahepatic bile ducts. The common bile duct is dilated up to 14 mm in the\npancreatic head (601b:31) with narrowing at the sphincter of Oddi. This is\nincreased from ___. The gallbladder is surgically absent.\nPANCREAS: The pancreas demonstrates mild dilation of the pancreatic duct\nmeasuring 4 mm downstream with upstream dilation to the level of the\npancreatic tail. The pancreatic parenchyma enhances homogeneously. There is\nno peripancreatic stranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, suspicious renal lesions or hydronephrosis. A\nleft simple cyst is unchanged. There are no urothelial lesions in the kidneys\nor ureters. There is no perinephric abnormality.\nGASTROINTESTINAL: There is borderline gaseous distension of a loop of\nduodenum and proximal jejunum (2:30). The remainder of the small bowel is\nnormal in caliber. Colon and rectum are within normal limits. Appendix has\nnormal caliber without evidence of fat stranding.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is mild to moderate\ncalcium burden in the infrarenal abdominal aorta. The celiac artery and SMA a\nostia are widely patent.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Uterus is not visualized. Adnexa is within normal limits.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. Increased dilation of 14 mm common bile duct with more prominent mild\ndilation of the intrahepatic bile ducts and pancreatic duct compared to ___ raises concern for a potential obstructing process or sphincter of Oddi\nspasm. No obvious mass or radiopaque stone is identified. Clinical\ncorrelation is needed regarding significance of these findings and, if\nindicated, further evaluation with MRCP or ERCP could be considered. \nSometimes it is possible for biliary dilation to be as great as this as an\nincidental finding, which may wax and wane on different examinations to some\nextent.\n2. Borderline distension of loops of duodenum and proximal jejunum could\nrepresent a mild inflammatory process or ileus.\n\nNOTIFICATION:\n The findings were discussed by Dr. ___ with Dr. ___ in person on\n___ at 10:53 ___, during discovery of the findings." }, { "input": "LOWER CHEST: Stable left lower lobe perifissural nodule. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. Dilation of the common bile duct to a 17 mm tapering toward the ampulla\nis unchanged. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 4 cm left\ninferior pole renal cyst. There is no evidence of suspicious renal lesions\nwithin the limitations of an unenhanced scan. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not seen. No adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.", "output": "1. No acute findings in the abdomen or pelvis to explain the patient's\nsymptoms.\n2. Stable dilation of the common bile duct, likely related to post\ncholecystectomy state." }, { "input": "LOWER CHEST: Present unchanged, 4 mm, calcified nodule within the anterior\nleft lower lobe and unchanged sub 4 mm nodule within the lateral right lower\nlobe. Please refer to separate report of CT chest performed on the same day\nfor comprehensive description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The patient is status-post subtotal pancreatectomy. The remaining\npancreas has normal attenuation throughout, without evidence of focal lesions\nor pancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The patient is status-post splenectomy.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with cortical thinning,\nbut otherwise normal nephrogram. There is no evidence of focal renal lesions\nor hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is well distended and distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. The proximal celiac artery demonstrates 14 mm ectasia with\nmoderate calcification (series 5 image 60), unchanged from ___.\n\nBONES AND SOFT TISSUES: There are extensive multilevel degenerative changes\nthroughout the visualized spine with a compression deformity of the L4\nsuperior endplate that is new since the CT torso dated ___. There\nis a small, fat containing umbilical hernia.", "output": "1. Post subtotal pancreatectomy. No evidence of recurrence or metastatic\ndisease.\n2. Small hiatal hernia.\n3. Uncertain age of the compression deformity at the L4 superior endplate, but\nit is new since ___. Correlation with outside facility studies may be\nhelpful if available.\n4. Stable pulmonary nodules described above. Please refer to separate report\nof CT chest performed on the same day for comprehensive description of the\nthoracic findings." }, { "input": "LUNG BASES: The heart appears mildly enlarged. There is mild bibasilar\natelectasis left greater than right. There is mild bronchial wall thickening\nin the lower lungs, correlate for small airways inflammation. The distal\nesophagus appears circumferentially mildly thickened, correlate for reflux or\nesophagitis. No pleural or pericardial effusions seen. Faint aortic valvular\ncalcifications are present.\n\nABDOMEN: The unenhanced appearance of the liver is normal. The gallbladder is\nunremarkable. The pancreas is normal. The spleen is normal in size. Adrenal\nglands are normal bilaterally. The kidneys appear grossly unremarkable\nwithout stones or hydronephrosis. The abdominal aorta is mildly calcified\nthough normal in caliber. No retroperitoneal lymphadenopathy. The stomach\nand duodenum appear normal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is normal. The VP shunt tubing terminates in the right lower\nquadrant. The colon contains a moderate fecal load. Diverticulosis is noted.\nThere is focal ___ diverticular inflammation in the left lower quadrant along\nthe distal descending colon concerning for acute diverticulitis. There are\nmildly prominent reactive adjacent lymph nodes. There is no free air or\ndrainable collection. Trace fluid tracks along the left pericolic gutter. \nThe urinary bladder is mostly decompressed. The prostate is mildly prominent\nmeasuring 6 cm in transverse dimension. No pelvic sidewall or inguinal\nadenopathy.\n\nBONES: Post laminectomy changes are noted in the lumbar spine at L3 and L4\nlevels. Mild multilevel degenerative disc disease in lumbar spine.", "output": "1. Acute uncomplicated diverticulitis along the distal descending colon.\n2. Thickened distal esophagus, correlate for reflux/esophagitis.\n3. Mild bronchial wall thickening in the lower lungs, correlate for small\nairways inflammation.\n4. Mild cardiomegaly with aortic valvular calcification.\n5. VP shunt tubing terminates in the right lower abdomen." }, { "input": "LOWER CHEST: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nHEPATOBILIARY: The liver is normal in size and attenuation. No focal hepatic\nlesions are identified. The portal vein is patent. There is no intra or\nextrahepatic biliary duct dilatation. There is cholelithiasis without evidence\nof cholecystitis.\n\nSPLEEN: The spleen is normal in size and enhancement.\n\nPANCREAS: The pancreas shows normal enhancement. There is no pancreatic duct\ndilatation or peripancreatic fat stranding.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys display symmetric nephrograms with no evidence of\nhydronephrosis or mass lesion in either kidney. The ureters are symmetrical\nin their course to the bladder.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber. The large bowel is\nwithin normal limits. The appendix is normal in caliber and air-filled.\n\nLYMPH NODES: No lymphadenopathy.\n\nVASCULAR: Normal caliber aorta.\n\nPELVIS: The bladder is within normal limits. The rectum and sigmoid colon are\nwithin normal limits. There is minimal hemorrhagic fluid within the pelvis. \nThe uterus is within normal limits. The ovaries are normal in size. Of note,\na corpus luteal cyst is identified on the right.\n\nBONES AND SOFT TISSUES: No aggressive osseous lesions. No fracture\nidentified.", "output": "1. Normal appendix. Minimal hemorrhagic fluid in the pelvis may be related to\nrupture of a follicle. The bilateral ovaries are within normal limits for\nsize.\n2. No evidence of bowel obstruction.\n3. No evidence of hydronephrosis or nephrolithiasis." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic, with normal attenuation throughout without\npancreatic ductal dilatation. There is no peripancreatic stranding. There is\nhowever a cystic lesion at the body of the pancreas (601:23) measuring\napproximately 1.6 by 0.9 cm.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic bilaterally with normal nephrogram. There\nis a 3.1 cm simple cyst in the upper pole the left kidney and a 2.4 cm simple\ncyst in the lower pole of the left kidney. Multiple additional bilateral\nsubcentimeter hypodensities are too small to characterize by CT. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is otherwise\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder wall is mildly thickened, which may be due to\ndecompression. The distal ureters are unremarkable. There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The bilateral adnexae are within normal limits. Coarse\ncalcifications within the uterus likely represent calcified fibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is ectatic, measuring up to 2.4 cm. Extensive\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild to moderate degenerative changes are noted in the lower thoracic and\nlumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process to explain the patient's symptoms.\n2. Diverticulosis without diverticulitis.\n3. A 1.6 cm cystic lesion at the pancreatic body, likely an IPMN." }, { "input": "LOWER CHEST: There are small nonhemorrhagic bilateral pleural effusions with\nadjacent compressive atelectasis. Hazy densities in the adjacent left lung\nbase are likely also atelectatic. Heart size is normal without pericardial\neffusion. Prominent mitral valvular calcifications are partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder demonstrates gallstones though the gallbladder is\ndecompressed without wall thickening or inflammatory change.\n\nPANCREAS: The pancreas is mildly atrophied without evidence of focal lesions\nwithin the limitations of an unenhanced scan. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is mild-to-moderate asymmetric right renal atrophy. There is a\n12 mm left upper pole renal cyst. Otherwise no gross suspicious renal lesion\nis seen. There is no stone or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Percutaneous gastrostomy tube appears in satisfactory\nposition. Stomach is unremarkable. Duodenum and distal small bowel loops are\nnormal caliber without evidence of obstruction. A rectal tube is in place. \nThere are a few scattered colonic diverticula. The large bowel is otherwise\nunremarkable. There is mild colonic fecal loading. Small pneumoperitoneum is\nlikely secondary to recent gastrostomy tube placement. No fluid collections\nare seen.\n\nPELVIS: Bladder is collapsed around a Foley catheter. There is trace free\npresacral pelvic fluid, likely third-spacing. This fluid is not organized.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are not seen. No gross adnexal\nabnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small areas of stranding are noted in the left low abdominal\nwall, likely from injection site. Left-greater-than-right iliopsoas\nmusculature is atrophied, without fluid collection identified.", "output": "1. No acute findings in the abdomen or pelvis. No organized fluid collection\nidentified.\n2. Small bilateral pleural effusions.\n3. Trace non organized free presacral fluid is likely due to third spacing.\n4. Cholelithiasis.\n5. Interval percutaneous gastrostomy tube placement with associated small\npneumoperitoneum." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. There is dilation of the main pancreatic duct at the head of\nthe pancreas measuring up to 5 mm. No definite cause for obstruction is\nidentified. This may represent a head ductal fusion anomaly. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 1.2 x 1.9 cm left adrenal mass lesion is seen, previously\nmeasuring 1.1 x 1.5 cm. This is compatible with a metastatic lesion. The\nright adrenal gland is within normal limits.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere are bilateral renal hypodensities, measuring 1.4 cm, with average\nHounsfield unit measurement of 75 in the mid polar region of the left kidney,\nand a measuring 0.9 cm with an average Hounsfield unit measurement of 46 in\nthe interpolar region of the right kidney. These Hounsfield values are more\nthan expected for simple cysts, and given the clinical history, further\nevaluation with dedicated ultrasound is recommended. A focal wedge-shaped\narea of hypodensity is noted in the periphery of the right kidney, likely\nrepresenting focal scarring. There is mild atrophy of the renal cortex\nbilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: A 1.3 cm right periesophageal lymph node is seen. Otherwise,\nthere is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: The patient is status post aorto bi iliac stent graft, which is\npatent. There is extensive atherosclerotic change of the native aorta and\niliac vessels.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: 1.4 cm soft tissue nodule noted along the left flank, increased\nfrom previous where it measured 0.6 cm, and compatible with focal metastatic\ndeposit. A second soft tissue nodule is seen in the left perineum, measuring\n1.5 cm. This has increased in size, where it previously measured 1.2 cm, and\nis also suspicious for focal deposit.", "output": "1. Multiple metastatic deposits are seen, including a 1.2 x 1.9 cm left\nadrenal lesion, a 1.4 cm soft tissue lesion along the left flank, and a\nsuspicious 1.2 cm lesion in the left perineum.\n2. 1.3 cm right periesophageal lymph node, highly suspicious given the\nclinical history.\n3. Multiple renal hypodensities, denser than expected for simple cysts. Given\nthe history, recommend correlation with dedicated ultrasound.\n4. Renal wedge-shaped hypodensity noted along the periphery of the right\nkidney, likely related to focal scarring. No previous is available for\ncomparison, and clinical correlation is recommended to exclude the possibility\nfocal infarct or pyelonephritis (so these are less likely given the lack of\nsignificant surrounding inflammatory change or associated abnormality).\n5. Slightly prominent main pancreatic duct at the level of the pancreatic\nhead, without definite obstructive lesion identified.\n6. Chest images will be reported separately.\n\nRECOMMENDATION(S): Dedicated renal ultrasound for further evaluation renal\nhypodensities detailed above.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:29 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: An 11 x 14 mm left adrenal nodule is unchanged. The right adrenal\ngland is normal size and shape.\n\nURINARY: Foci of right renal cortical thinning are unchanged, likely sequela\nof prior infectious or ischemic insult. Simple appearing right and left renal\ncysts are unchanged. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a small umbilical\nRichter's hernia without any associated wall thickening, fat stranding, or\nevidence of obstruction. There is diverticulosis without evidence of\ndiverticulitis. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: A 9 mm retrocrural lymph node is unchanged. There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is an aorto bifem bypass which is unremarkable in appearance. \nExtensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An enhancing 1.5 x 1.6 cm left flank soft tissue nodule has\nagain increased size (02:53), previously 1.2 x 1.4 cm. An enhancing 1.6 x 1.9\ncm perineal soft tissue nodule has increased in size (2:113), previously 1.4 x\n1.6 cm in ___. A calcified subcutaneous lesion in the left buttocks\nis unchanged, likely an injection site granuloma.", "output": "1. Unchanged left adrenal nodule.\n2. Mild interval enlargement of left flank and perineal subcutaneous nodules.\n3. Small umbilical hernia." }, { "input": "LOWER CHEST: There is dense consolidation within the right lower lobe. Please\nrefer to separate report of CT chest performed on the same day for description\nof the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas appears mildly atrophic, with a prominent pancreatic\nduct that is stable since ___. The pancreas has normal\nattenuation throughout, without evidence of focal lesions. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal nodule has increased in size, currently measuring\napproximately 3.0 x 2.2 cm (series 2, image 54), concerning for metastatic\ndisease. The right adrenal gland is normal in size and shape.\n\nURINARY: There are multiple foci of cortical thinning bilaterally, likely\nrepresenting scarring from prior infection or ischemia. There is a stable 9\nmm hypodensity within the right kidney, likely a hemorrhagic cyst. There is a\nstable 14 mm hypodensity within the left kidney, also likely a hemorrhagic\ncyst. Otherwise, the kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nare multiple prominent inguinal lymph nodes bilaterally, which are stable and\ndo not meet the CT size criteria for lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. There is an aortobifemoral bypass graft which is patent and\nnormal in appearance.\n\nBONES: Degenerative changes are seen within the hips bilaterally. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The left lateral abdominal wall soft tissue mass continues to\nincrease in size, currently measuring 3.2 x 2.9 cm (series 2, image 59),\nconcerning for metastatic disease. The peroneal mass has also enlarged,\ncurrently measuring 3.0 x 3.3 cm (series 2, image 115). There is a small fat\ncontaining umbilical hernia.", "output": "1. Interval increase in size of the left adrenal mass, left flank mass, and\nleft peroneal mass likely representing metastatic disease.\n2. No new foci of metastatic disease.\n3. Patent aorto bi femoral bypass graft.\n4. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodensity in peripheral segment 4A too small to characterize\nbut likely represents a cyst or biliary hamartoma. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is circumferential wall thickening of a\nsegment of the sigmoid colon (3:110, 601:35) may represent muscular ___\nsecondary diverticulosis, but is concerning for malignancy. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Circumferential wall thickening in an area of the sigmoid colon concerning\nfor malignancy. No adenopathy or evidence of metastatic disease in the\nabdomen or pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S): Colonoscopy to evaluate for mass in the sigmoid colon." }, { "input": "LOWER CHEST:\n\nThere are unchanged bilateral pleural effusions.\n\nABDOMEN:\nThere is nasogastric tube with tip terminating in the distal stomach.\n\nThere are dilated loops of proximal to mid small bowel measuring up to 5.1 cm\nin diameter. There is a segmental area of relative small bowel narrowing the\nmid to lower abdomen in series 2, image 54. Small bowel caliber appears to\nreturn to normal proximal to the anastomotic sutures in the left para midline\nlower abdomen. There are dilated air and stool-filled loops of proximal colon.\nThere is no evidence of anastomotic leak. There is no evidence of pneumatosis\nor portal venous gas. There is no intraperitoneal free air.\n\nLiver has homogeneous echogenicity without evidence of mass. The gallbladder\nis unchanged in appearance. Spleen is not enlarged. Pancreas has homogeneous\nattenuation.\n\nThere is symmetric renal enhancement and excretion of intravenous contrast.\nThere are bilateral renal cysts. There is a left adrenal nodule consistent\nwith adenoma characterized on outside facility MRI.\n\nThere is a 2.0 x 5.3 cm pelvic fluid collection peripheral enhancement. There\nis a mild amount of ascites.\n\nNondependent air within the urinary bladder is likely secondary to indwelling\ncatheter. There are no enlarged inguinal, iliac chain, or retroperitoneal\nlymph nodes. There is extensive atherosclerotic calcification of the abdominal\naorta and iliac vessels.\n\nThere is no suspicious osseous lesion.", "output": "1. Dilated loops of small bowel with questionable small bowel caliber\nnarrowing proximal to the anastomosis in series 2, image 54 with normal\ncaliber small bowel loops immediately proximal to the anastomosis. Findings\nfavor a partial small bowel obstruction given the presence of non collapsed\ndistal small bowel loops and dilated air and stool-filled loops of colon.\n2. No evidence of anastomotic leak.\n3. Walled-off, peripherally enhancing fluid collection in the pelvis measuring\n2.0 x 5.3 cm. In the setting of leukocytosis, finding is concerning for\nabscess.\n4. Bilateral pleural effusions.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 4:57 ___, 20 minutes after discovery of the findings." }, { "input": "LOWER CHEST: A 3 mm triangular opacity in the left lower lobe is stable from\n___. Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.6 cm simple hepatic cyst in the left lobe is unchanged from prior. There is\nno evidence of concerning focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is within normal limits. No evidence of obstruction\nor hydronephrosis bilaterally. At the inferior pole of the left kidney, there\nis a wedge-shaped area of hypoattenuating parenchyma with associated scarring\nwhich is new from the prior study from ___, consistent with history of prior\npartial nephrectomy. No perinephric abnormality is demonstrated.\n\nGASTROINTESTINAL: Postsurgical changes after a Roux-en-Y gastric bypass are\nagain demonstrated. Oral contrast passes freely to the ascending colon. No\nevidence of bowel obstruction. No ascites. The appendix is not visualized. \nDiverticulosis is again demonstrated without evidence of diverticulitis. \nDense material along the peritoneum superior to the umbilicus appears\nunchanged from prior (series 2, image 34), and is presumed to be postsurgical.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Posterior fixation hardware spans L3-S1. There is grade 1\nretrolisthesis of L2 over L3 which is unchanged from ___. No evidence of\nperihardware complication. No aggressive osseous lesions are demonstrated.", "output": "1. No bowel obstruction or ascites. No hernia is demonstrated.\n2. Postsurgical changes after a Roux-en-Y gastric bypass and a partial left\nnephrectomy.\n3. Diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: Small bilateral pleural effusions are partially demonstrated,\nright greater than left. Please refer to separate report of CT chest\nperformed on the same day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric though atrophic bilaterally. Multiple\nbilateral cortical renal cysts are visualized measuring up to 2.3 cm in the\nlower pole left kidney and 1.3 cm in the lower pole of the right kidney. \nThere is no evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder wall is mildly thickened which is nonspecific and\nmay be secondary to bladder outlet obstruction. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe and extensive\natherosclerotic disease is noted.\n\nBONES: Multilevel degenerative changes visualized throughout the imaged\nportion of the thoracolumbar spine without acute fracture or worrisome osseous\nlesion identified. Well corticated and fragmented bony fragments adjacent to\nthe left ischium likely reflect prior injury.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.", "output": "1. No lymphadenopathy identified within the abdomen or pelvis.\n2. Small bilateral pleural effusions.\n3. Please see same day CT chest for characterization of intrathoracic\nfindings." }, { "input": "LOWER CHEST: Bibasilar atelectasis with trace effusions are demonstrated. \nThere is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small bowel is\nunremarkable. In the upper mid to right abdomen there is a segment of large\nbowel containing air and fecalized material consistent with the cecum (02:53).\nCompared to the referenced MRE, the cecum appears to be displaced more\nsuperiorly and centrally. There is no definite obstruction, free fluid, or\nsigns of inflammation. The remaining colon and rectum are unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An appropriately positioned IUD is demonstrated. \nOtherwise, the visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Compared to the referenced MRE from ___, the cecum appears displaced more\nsuperiorly in the right upper quadrant. Differential diagnosis considerations\ninclude flipped cecum or early volvulus, which cannot be excluded." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate bibasilar atelectasis. There\nis no evidence of pleural or pericardial effusion. Again seen is a small\ncalcified pleural plaque in the left lower lung. Again seen is subsegmental\nbronchiectasis in the visualized lingula. There are coronary artery\ncalcifications and mild cardiomegaly.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are a few subcentimeter hypodensities in the liver, too small to\ncharacterize. Again seen is mild intrahepatic biliary ductal dilatation. No\nextrahepatic biliary ductal dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Again seen\nis a 1.8 cm hypoattenuating lesion in the anterior spleen, indeterminate, but\nstatistically likely representing a hemangioma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAgain seen are bilateral hypodensities, many of which are too small to\ncharacterize. A previously seen right lower pole 1.2 cm lesion is compatible\nwith a simple cyst. No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Again seen are\nmultiple diverticula involving the ascending and sigmoid colon with stranding\nand multiple locules of gas surrounding the sigmoid colon in the central\npelvis. Interval decrease in degree of pneumoperitoneum. There is a 4.1 cm\ngas containing collection anteriorly which appears to communicate with the\nsigmoid colon (___), previously 2.4 cm. No fluid collection. The appendix\nis normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Unchanged dilatation of the\nvisualized distal descending thoracic aorta, measuring up to 3.6 cm, at the\nlevel of the aortic hiatus. (___). Extensive atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small right small bowel containing inguinal hernia. The\nabdominal and pelvic wall is within normal limits.", "output": "1. Compared to ___, interval increase in a 4.1 cm gas-containing\ncollection which appears to communicate with the sigmoid colon. Again seen is\nstranding and multiple locules of gas surrounding the sigmoid colon in the\ncentral pelvis, compatible with perforated acute diverticulitis. Interval\ndecrease in degree of pneumoperitoneum.\n2. Unchanged dilatation of the descending thoracic aorta, measuring up to 3.6\ncm at the level of the aortic hiatus." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate mild bibasilar atelectasis,\nslightly increased from prior. A small calcified pleural plaque is again\nnoted in the left lower lung. Bronchiectasis in the lingula is again noted.\n\nABDOMEN: The liver, spleen, pancreas, adrenal glands and kidneys are unchanged\nexcept for new pockets of portal venous gas in the peripheral left hepatic\nlobe. Cholecystectomy changes are again noted. Mild extrahepatic biliary\nprominence is stable, likely due to cholecystectomy.\n\nGASTROINTESTINAL: There is no intestinal obstruction. No change in small\namount of ascites. The perforated sigmoid diverticulitis is again noted with\ndecrease in size of a sigmoid abscess measuring 4.8 cm, previously 5.4 cm,\npost drain catheter placement. There is a new loculated pocket of fluid with\nincomplete wall in the right lower quadrant adjacent to the inferior\nepigastric vasculature and distal ileal loops, the latter demonstrating mild\nwall thickening, likely reactive. The amount of pneumoperitoneum is increased\nand somewhat incongruent for the drain and is likely related to ongoing\nperforated sigmoid diverticulitis.\n\nPELVIS: There is a trace amount of loculated non drainable pelvic fluid\n(series 5, image 75).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Dilatation of the descending aorta is unchanged.\n\nBONES: Unchanged", "output": "1. Redemonstration of perforated sigmoid diverticulitis with increased\npneumoperitoneum, incongruent for a drain catheter, and new portal venous gas.\nThe perisigmoid abscess is decreased.\n2. New pocket of loculated fluid in the pelvis and in the right lower\nquadrant with incomplete wall, although concerning for developing abscesses.\n3. No additional changes." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. Very subtle lucencies in left lobe of the liver could be tiny, residual\nportal venous gas. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Unchanged approximately 2 cm hypodense lesion of the spleen, better\ncharacterized on the prior CT. Otherwise, the spleen shows normal size and\nattenuation throughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral renal hypodensities are too small to characterize, and\nbetter characterized on the prior CT. The kidneys are of normal and symmetric\nsize. There is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The patient is status post\nsigmoid and small bowel resection. An abdominal surgical drain is in place. \nThe anastomoses are intact, without evidence of leak. No appreciable\npneumoperitoneum or focal fluid collections. Aside from the aforementioned\nprocedures, the small bowel loops, colon, and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Unchanged dilatation of the descending thoracic aorta. Mild\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small, fat containing right inguinal hernia. Otherwise, the\nabdominal and pelvic wall is within normal limits.", "output": "1. Status post sigmoid and small bowel resection, with no evidence of\nanastomotic leak or focal fluid collections. No appreciable pneumoperitoneum.\n2. Possible tiny, residual portal venous gas in the left lobe of the liver.\n3. Unchanged dilatation of the descending thoracic aorta.\n4. Small, fat containing right inguinal hernia.\n5. Please refer to the separate report of the chest CT performed on the same\nday for thoracic characterization." }, { "input": "LOWER CHEST: Unchanged pericardial calcifications. Heterogeneous\nconsolidations in the bilateral lower lungs are improved from the prior CT and\nare most consistent with the previously described multi lobar pneumonia. \nSmall left pleural effusion. Mild bibasilar atelectasis. Small\ncalcifications of the left chest wall could be compatible with prior asbestos\nexposure. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A hypodensity in the right hepatic lobe (05:21) is too small to\ncharacterize. Otherwise, the liver demonstrates homogenous attenuation\nthroughout. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Unchanged 2 cm hypodense lesion of the spleen (05:15). Otherwise, the\nspleen shows normal size and attenuation throughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral hypodensities of the kidneys are too small to characterize.\nThe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the stomach. The stomach is\nunremarkable. The patient is status post sigmoid colectomy and small bowel\nresection. Mild wall thickening and fat stranding around the sigmoid\nanastamosis are most likely post-surgical. No evidence of anastomotic leak. \nNo focal fluid collections or abscesses. Aside from the aforementioned\nprocedures, the small bowel loops, colon, and rectum are within normal limits.\n\nPELVIS: A Foley catheter is in place. The urinary bladder and distal ureters\nare unremarkable. There is no free fluid in the pelvis. Small calcifications\nwithin the pelvis are most likely phleboliths.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Unchanged dilatation of the descending thoracic aorta. Mild\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Redemonstrated, small fat containing right inguinal hernia. The\nabdominal and pelvic wall is within normal limits.", "output": "1. No evidence of an abscess or acute intra-abdominal process.\n2. Status post sigmoid colectomy and small bowel resection, with expected\npostsurgical changes.\n3. Improved heterogeneous consolidations in the bilateral lower lungs, most\nconsistent with multifocal pneumonia, as described on the prior chest CT.\n4. Small left pleural effusion.\n5. Unchanged, 2 cm hypodense lesion of the spleen.\n6. Unchanged dilation of the descending thoracic aorta.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:47 am, 3 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Centrilobular emphysema. No pleural effusions. Please review\ndedicated same day chest CT.\n\nABDOMEN:\n\nHEPATOBILIARY: Small ascites. No ductal dilation or discrete lesion. \nUnremarkable gallbladder.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY: Mild outward rotation of bilateral kidneys. Punctate calculi in the\nright inferior pole. No hydronephrosis. No discrete lesion.\n\nGASTROINTESTINAL: Large colonic stool burden with 86 mm rectal stool ball. No\nintestinal obstruction. No fluid collection.\n\nPELVIS: Unremarkable bladder, uterus, and adnexa.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Patent aorta and major branches. Moderate arteriosclerosis.\n\nBONES AND SOFT TISSUES: Chronic L5 changes with compression and central\nlucency, unchanged since ___. Mild anasarca.", "output": "1. No identifiable neoplastic process in the abdomen and pelvis.\n2. Small ascites and mild anasarca.\n3. Punctate right renal calculi. No hydronephrosis.\n4. Large colonic stool burden." }, { "input": "LOWER CHEST: Moderate right pleural effusion with some compressive\natelectasis. Subsegmental atelectasis is also noted in the left lower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: Postsurgical changes from hepatic trisegmentectomy with a 10.2\nx 7.0 cm subdiaphragmatic fluid collection at the resection site. There are\nsome scattered foci of gas and fat within the collection. Surgical clips are\nnoted. There is a small amount of fluid and stranding tracking down the right\nparacolic gutter.\n\n The remnant liver demonstrates homogenous attenuation without focal lesion\nidentified. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Tiny left renal cyst. The kidneys are of normal and symmetric size\nwith normal nephrogram. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic\ndiverticulosis is noted.\n\nPELVIS: There is a small amount of gas in the bladder, likely from recent\ncatheterization. There is trace free fluid in the pelvis, likely postsurgical\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild body wall edema.", "output": "1. Status post hepatic trisegmentectomy with a right upper quadrant\nsubdiaphragmatic fluid collection at the resection site as detailed above." }, { "input": "LOWER CHEST: There is interval resolution of the previously described right\npleural effusion. The lung bases are unremarkable. No suspicious pulmonary\nnodules are seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient status post trisegmentectomy of the liver. There\nis marked interval decrease in the size of the previously described\npostsurgical fluid collection. Currently the residual collection measures 6.6\nx 3.6 cm in the coronal plane. It measured 9.2 x 5.1 cm previously. The\npercutaneous pigtail catheter is identified within the posterior and superior\naspect of the collection and probably can be pole plaque slightly to be\ncentered more within the remaining fluid. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is mild heterogeneity of the spleen, not significantly changed\nfrom the prior study and most likely presents a sequela from a prior vascular\ninsult.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The seminal vesicles and prostate normal in size for the\nage of the patient.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The patient status post a subcostal and median supraumbilical\nlaparotomy.", "output": "1. Status post trisegmentectomy of the liver with significant interval\ndecrease in the known subdiaphragmatic perihepatic fluid collection. The\ncatheter appears to be in the superior posterior aspect of the collection and\nprobably can be pulled back so the pigtail is within the residual fluid. 2. \nInterval resolution of the right-sided pleural effusion." }, { "input": "There is most sec attenuation at the lung bases, more so dependently which is\nnonspecific and could be due to air trapping.\n\n10 mm nonobstructing stone within the lower pole of the right kidney (series\n2, image 45). No hydronephrosis. Subcentimeter hypodensities within the\nkidneys bilaterally are too small to characterize. Otherwise, the kidneys are\nunremarkable.\n\nThere is a right diaphragmatic eventration containing liver. Otherwise, the\nliver, gallbladder, pancreas, spleen and adrenal glands are unremarkable\nlimits. There is no evidence of bowel obstruction or ascites. No\nabdominopelvic lymphadenopathy.\n\nThe prostate is enlarged measuring 5.6 x 4.8 cm. No free pelvic fluid.\n\nModerate atherosclerosis. Small fat containing left inguinal hernia. Patient\nis status post posterior fusion of L3 through L5. No suspicious osseous\nlesions.", "output": "Nonobstructing right nephrolithiasis. No solid renal mass or hydronephrosis\ndemonstrated." }, { "input": "LOWER CHEST: There is linear scarring/subsegmental atelectasis in the lower\nlobes bilaterally. There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is mild diffuse decreased attenuation of the liver\nparenchyma in keeping with hepatic steatosis. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRight renal simple cysts have increased in size since ___. The largest\narising from the lower pole measures 6 cm, previously 4.5 cm. Additional\nbilateral subcortical hypodensities are too small to characterize. There is\nno hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small sliding hiatal hernia. Stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits.\n\nThere is a cystic lesion in the left upper mesentery measuring 5 x 3 x 7 cm,\npreviously 4 x 2 x 4 cm. This lesion abuts the anterior body of the pancreas\non the current examination but was previously completely separate from the\npancreas and therefore most likely arises within the small bowel mesentery. \nThere is no associated solid component or calcifications. There is no\nsignificant associated mass effect.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. There is no adnexal\nmass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 7 cm cystic lesion in the left upper small-bowel mesentery has increased in\nsize since ___. This lesion continues to demonstrate features similar to a\nbenign cyst, likely represents an enteric duplication cyst or lymphatic\nmalformation. No nodular or aggressive features seen.\n2. No solid focal pancreatic lesion.\n3. Small sliding hiatal hernia." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is enlarged and demonstrates heterogeneous\nenhancement but is overall unchanged compared to prior study. There is no\nevidence of focal lesions. Re-demonstrated is diffuse periportal edema. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: There is unchanged, mild circumferential bladder wall thickening,\npossibly secondary to a neurogenic bladder. There is a small volume of free\nfluid in the pelvis, likely physiologic.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are within normal limits\nfor age.\n\nLYMPH NODES: Multiple prominent mesenteric lymph nodes are not significantly\nchanged compared to prior study. There is no retroperitoneal lymphadenopathy.\nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: Re-demonstrated is multilevel central endplate compression (H-shaped\nvertebrae) in the thoracic and lumbar spine, consistent with patient's known\nsickle cell disease. There is unchanged sclerosis along the superior aspect\nof the bilateral femoral heads and in the proximal left femur, which most\nlikely represents chronic avascular necrosis. There is no evidence of femoral\nhead subchondral collapse.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intraabdominal or intrapelvic pathology.\n2. Unchanged enlargement and heterogeneous enhancement of the liver. Diffuse\nperiportal edema may be secondary to fluid resuscitation.\n3. Circumferential bladder wall thickening is unchanged dating back to at\nleast ___.\n4. Unchanged chronic avascular necrosis in the lumbar spine, bilateral hips\nand proximal left femur." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Small fat containing right\nBochdalek's hernia.\n\nABDOMEN: Study is limited for evaluation of the parenchyma and visceral organs\ndue to lack of IV contrast.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Limited evaluation of the pancreas due to lack of surrounding fat\nand contrast. No gross abnormality is identified. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nIn the upper pole of the left kidney there is a 2 millimeter nonobstructing\nstone in the lower pole of left kidney there is a 3 millimeter nonobstructing\nstone. There is no evidence of focal renal lesions or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. There is moderate colonic stool. The appendix is not visualized.\n\nPELVIS: The bladder is mostly decompressed. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Retroverted uterus. No large adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 1 cm subcutaneous left buttocks nodule, likely a\nsebaceous cyst.", "output": "1. Nonobstructive left renal calculi measuring up to 3 millimeters.\n2. Additional findings as above." }, { "input": "LOWER CHEST: There is a focus of rounded atelectasis in the lingula, similar\nto prior (2:8). Otherwise, the visualized lung fields are within normal\nlimits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The hepatic parenchyma demonstrates decreased attenuation\ncompatible with steatosis with areas of focal fatty sparing. There is no\nevidence of overt lesions within the limitations of an unenhanced scan. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is unremarkable.\n\nPANCREAS: The pancreas is normal in bulk and homogeneous in attenuation. \nThere is no main ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Incidental\nnote is made of a 13 mm splenule (02:42).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There has\nbeen interval resolution of the previously seen left-sided\nhydroureteronephrosis. There is no nephrolithiasis. There is a 4 mm stone\neither within the left UVJ or within the bladder lumen, difficult to determine\nas the patient was scanned in the supine position. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is no small bowel\nobstruction. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval resolution of previously seen left-sided hydroureteronephrosis.\n2. 4 mm stone is located either within the left UVJ or in the bladder lumen. \nIf clinically indicated, the patient could return for repeat scanning of the\npelvis in the prone or decubitus position to see if the stone falls\ndependently in the bladder.\n3. Hepatic steatosis.\n\nRECOMMENDATION(S): Radiological evidence of fatty liver does not exclude\ncirrhosis or significant liver fibrosis which could be further evaluated by\n___. This can be requested via the ___ (FibroScan) or the\nRadiology Department with either MR ___ or US ___, in\nconjunction with a GI/Hepatology consultation\" *\n\n* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver\ndisease: Practice guidance from the ___ Association for the Study of\nLiver Diseases. Hepatology ___ 67(1):328-357" }, { "input": "LOWER CHEST: Bilateral small pleural effusions are demonstrated. There is\noverlying compressive atelectasis without evidence of suspicious consolidative\nopacity.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The nephrogram on the right is delayed and striated, with wedge\nshaped cortical hypodensities, consistent with pyelonephritis (05:28). There\nis no contrast seen within the right collecting system or proximal ureter,\nwhich is mildly dilated. No right-sided perinephric abnormality or evidence\nof perinephric abscess is demonstrated. The tract from the previously removed\nPCN appears within normal limits. The left and proximal ureter is within\nnormal limits.\n\nThe left kidney demonstrates a normal nephrogram without evidence of\nhydronephrosis or perirenal abnormality. The left ureter is well opacified\nand is seen draining into the bladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. The duodenum is noted to cross\nthe midline, however no other features are present to indicate malrotation. \nNo evidence of bowel obstruction. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS:\nFiducial markers are seen within an area of stranding and soft tissue density\nat the distal right ureter (5:79), likely representative of treated disease,\nseen on prior MR. ___ is diffuse and mild fat stranding along the bilateral\nperirenal fascia. No focal collections are demonstrated.\nThe bladder demonstrates irregular wall thickening with thin urothelial\nenhancement consistent with cystitis.\n\nREPRODUCTIVE ORGANS: No discrete uterine lesion is identified, within the\nlimits of modality. The left adnexa has been surgically removed. The right\nadnexa appears grossly within normal limits and appears to lie near the area\nof fibrosis.\n\nLYMPH NODES: No lymphadenopathy by size criteria. Previously demonstrated\nbilateral external iliac lymph nodes are not apparent. Calcifications are\nseen within lymph nodes along the periaortic chain, consistent with treated\ndisease.\n\nVASCULAR: The splenic artery originates from the aorta. There is no abdominal\naortic aneurysm. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse mild subcutaneous tissue stranding, otherwise\nthe abdominal and pelvic wall is within normal limits.", "output": "1. Right pyelonephritis with delayed nephrogram with mild hydronephrosis and\nno contrast excretion at 3 minutes, indicating obstruction secondary to\nureteral inflammation and fibrosis at the right distal ureter near the treated\ntumor.\n2. Thin urothelial enhancement along a mildly thickened bladder indicative of\ncystitis, which may be infectious or due to radiation changes.\n3. Diverticulosis without evidence of diverticulitis.\n4. Bilateral small pleural effusions which are new from prior.\n\nNOTIFICATION: The initial findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:35 pm, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Evaluation of the lung bases is limited by respiratory motion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is mild fullness of the kidneys, bilaterally, possibly due to\noverdistention of the urinary bladder and aggressive hydration. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 5.9 x 3.1 x 9.0 cm hematoma centered within the\nmusculature of the right flank. There is a small amount of hematoma tracking\nalong the right paracolic gutter and at the inferior tip of the right hepatic\nlobe (series 2, image 81, 124), which suggests violation of the peritoneum. \nThere is no free intra-abdominal air. No evidence of injury to the underlying\nliver parenchyma. No definite underlying bowel injury. High density material\nwithin the hematoma likely represents extravasated contrast.", "output": "1. Right flank hematoma with probable active extravasation. Small volume\nhemoperitoneum in the right pericolic gutter and at the inferior tip of the\nright hepatic lobe, suggests penetration of the peritoneum. No definite bowel\ninjury or hepatic injury. No free intra-abdominal air." }, { "input": "LOWER CHEST: Mild left basilar atelectasis. Heart is normal in size. Mild\ncoronary artery calcification. No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypoattenuating with areas of focal\nfatty sparing, consistent with hepatic steatosis. There is no evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Two punctate stones are noted at the right UVJ, the larger measuring\n2 mm (601:47), with moderate right hydronephrosis and hydroureter (02:23,\n02:28, 601:45), as well as mild right perinephric stranding, consistent with\nobstructive nephrolithiasis. A punctate nonobstructing 3 mm stone in the\nlower pole of the left kidney is unchanged (2:27). There is no evidence of\nfocal renal lesions within the limitations of an unenhanced scan.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the colon is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nair-filled and normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: Multiple old, healed anterior bilateral rib fractures\nare again seen. Kyphoplasty changes involving the T11 vertebral body are\nunchanged in appearance since ___. Compared to CT lumbar spine\nfrom ___, there is a new compression deformity of L2 vertebral\nbody, with vertebral body height of L3. Compression fracture of the L1\nvertebral body with 6 mm of retropulsion of superior endplate into the spinal\ncanal, resulting in significant narrowing at this level, is grossly unchanged.\nMoth-eaten appearance of the visualized vertebral bodies and pelvic bones is\nconsistent with the known diagnosis of multiple myeloma, similar in appearance\nto multiple prior CTs dating back to ___.", "output": "1. Obstructing tiny right UVJ stones x2, the larger measures 2 mm, with\nmoderate right hydronephrosis and mild perinephric stranding.\n2. Unchanged 3 mm nonobstructing left renal stone.\n3. Compression deformity of the L2 vertebral body is new since CT from ___. Developing compression deformity of the L3 vertebral body. \nUnchanged compression deformity of the L1 vertebral body with stable 6 mm of\nretropulsion of the superior endplate into the spinal canal, resulting in\nsignificant narrowing at this level.\n4. Hepatic steatosis.\n\nNOTIFICATION: Updated wet read findings were discussed with Dr. ___ by\n___, M.D. on the telephone on ___ at 10:33 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 2 mm\nnonobstructing renal stone in the left upper pole (2; 52). Subcentimeter\nhypodense lesions in the bilateral kidneys are too small to characterize but\nlikely represent cysts. 1.6 cm cyst is noted in the right midpole, similar to\nprior. There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Please refer to the separate dictated report regarding thoracic spine\nand ribs. Extensive involvement of the axial skeleton by known myeloma with\nmultilevel compression fractures is again demonstrated. Compared to ___, there is redemonstration of severe compression fractures of L1 and L2\nwith nearly complete loss of height and redemonstration of compression\nfractures of L3 and L4 with less than 50% of height loss. There is also\nredemonstration of nonunited left inferior pubic ramus fracture, which appears\nmore corticated compared to prior. Increased sclerosis of the left superior\npubic ramus suggestive of healing of prior fracture. Interval placement of an\nintramedullary rod with gamma nail in the right proximal femur for internal\nfixation of a displaced right intertrochanteric fracture. Fracture lines are\nstill minimally visible. Interval sclerosis of the left sacral insufficiency\nfracture consistent with healing. Interval development of a subtle comminuted\nnondisplaced fracture of the left anterior iliac crest likely corresponding to\narea of pain.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Interval development of subtle nondisplaced likely comminuted fracture of\nthe left anterior iliac crest, likely corresponding to area of pain.\n2. Redemonstration of extensive osseous involvement of known myeloma with\nextensive lumbar vertebral compression fractures L1 through L4, similar to\nprior. Redemonstration of healing left sacral fracture and left superior and\ninferior pubic ramus fracture with possible nonunion of the left inferior\npubic ramus fracture.\n3. Nonobstructing 2 mm left upper pole renal stone. No hydronephrosis.\n4. Diverticulosis without evidence of diverticulitis.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___,\nM.D. on the telephone on ___ at 2:47 pm, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. Small volume predominantly left-sided is\nsimilar prior and presumably related to the CBD stent which appears\nappropriately positioned. The gallbladder is within normal limits. Small\namount of air within is also likely related to the CBD stent.\n\nPANCREAS: Ill-defined hypoenhancing pancreatic head mass measures\napproximately 1.5 x 1.2 cm, previously up to 2.1 cm (2:117). Upstream\npancreatic atrophy and pancreatic ductal dilation is not significantly changed\ncompared to prior. Hazy soft tissue surrounding the right hepatic artery and\nGDA is unchanged compared to prior. The right hepatic artery is again noted\nto arise directly from the celiac axis. Left hepatic artery supplying the\nlateral left lobe of the liver arises from the left gastric artery. The left\nhepatic artery supplying the medial left lobe of the liver arises from the\nGDA. Mass and surrounding hazy soft tissue appears to contact the SMV with\nless than 180 degrees of involvement.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Nodular thickening of the medial limb of the right adrenal gland is\nunchanged compared to most distant prior in ___. Left adrenal gland\nis unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. The subcentimeter hypodensities bilaterally are\nsmall to characterize, but likely represent simple cysts.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. No adnexal abnormalities are\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. A hepatic arterial anatomy as described above.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Slight interval decrease in size of poorly defined pancreatic head mass\nwith similar locoregional involvement. No evidence of distant metastatic\ndisease in the abdomen or pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Bibasilar atelectasis and small bilateral pleural effusions are\nseen. The heart is top-normal in size. Esophageal varices are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver shrunken and nodular in appearance, consistent with\ncirrhosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically\nabsent. Moderate ascites is noted in the abdomen. The main portal vein is\npatent, but demonstrates a partial filling defect (2:30), which likely\nrepresents a chronic thrombus that is now recannulized.\n\nPANCREAS: The pancreas is atrophic but otherwise unremarkable.\n\nSPLEEN: The spleen is enlarged to 15.7 cm but demonstrates a homogeneous\nattenuation. The splenic vein is patent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThe hypodensity too small to characterize but likely representing renal cyst\nis noted in the upper pole of the left kidney. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post partial gastrectomy and\nRoux-en-Y. Two feeding tubes pass through the esophagus and terminate in the\nremnant stomach. Oral contrast is seen in the remnant stomach, however\ncontrast does not pass into the Roux limb. A tube is seen entering the\nabdomen at the site of the previously visualized enterocutaneous fistula and\nterminating in the duodenum. Contrast is seen in the afferent limb to the\njejunojejunostomy. A probable end-to-side small bowel anastomosis is noted in\nthe mid abdomen. There is a colostomy that arises from the proximal\ntransverse colon. Left colon is sutured off but demonstrates retained fecal\nmaterial. The ascending colon demonstrates a slightly thickened wall which\ncould represent colitis or which could be secondary to liver disease.\n\nPELVIS: A Foley is noted in the bladder. The bladder wall is very thickened,\nconcerning for cystitis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Prominent lymph nodes are noted in the area of the porta\nhepatis, likely reactive secondary to cirrhosis. There is no retroperitoneal\nor mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Locules of air are seen in the fat anterior to the bladder in\nthe prevesicular space, of unclear etiology. There is extensive body wall\nedema.", "output": "1. Cirrhosis, ascites, splenomegaly, esophageal varices.\n\n2. Status post partial gastrectomy and Roux-en-Y with two feeding tubes\npassing through the esophagus into the remnant stomach and one tube entering\nthe abdomen at the site of the previously visualized enterocutaneous fistula\nin terminating in the duodenum. Contrast seen in the stomach, however\ncontrast does not pass into the Roux limb. Contrast is seen in the afferent\nlimb.\n\n3. Colostomy arising from the proximal transverse colon.\n\n4. Very thickened bladder wall, concerning for cystitis. Locules of air in\nthe prevesicular space, of unclear etiology.\n\n6. Main portal vein is patent, but demonstrates a partial filling defect\nwhich likely represents a recannulized chronic thrombus.\n\n5. Bilateral small pleural effusions.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. in person on ___ at 4:40 ___, 30 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Again there is right middle lobe pulmonary nodule measuring up to\n6 mm (02:48) and appears grossly unchanged from prior study. Bibasilar\ndependent atelectasis again noted. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is small hyperdensity in segment III of the liver that is too small to\ncharacterize but likely represents a hepatic cyst versus hamartoma. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Accessory splenule is again seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe descending and sigmoid colon is noted, without evidence of wall thickening\nand fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.4 x 4.5 x 5.8 cm and\ngrossly stable from prior study.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is moderate multilevel degenerative disease of the thoracic and\nlumbar spine. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: Patient is status post right inguinal hernia repair with\npostsurgical changes noted within the right inguinal canal (2:111).", "output": "1. No acute intra-abdominal or pelvic process.\n2. Grossly stable right middle lobe pulmonary nodule for which follow-up chest\nCT is recommended.\n3. Postsurgical changes within the right inguinal canal.\n4. Diverticulosis without diverticulitis.\n5. Stable prostatomegaly.\n\nRECOMMENDATION(S): The ___ Society guidelines for pulmonary nodule\nguidelines suggest for pulmonary nodules greater than 6 mm or less than 8 mm,\n___ month follow-up in low-risk patients, and ___ month follow-up in high\nrisk patients. Low risk patients have minimal or absent history of smoking or\nother known risk factors for primary lung neoplasm. High risk patients have a\nhistory of smoking or other known risk factors for primary lung neoplasm." }, { "input": "LOWER CHEST: There is moderate right lower lobe atelectasis. The otherwise,\nthe visualized lung fields are within normal limits. The heart is enlarged. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is delayed nephrogram with heterogeneous enhancement of the\nkidney, which may be from either intrinsic parenchymal disease or vascular\nocclusion. There is extensive calcification in the renal arteries bilaterally\nwith heterogeneous enhancement of distal renal arteries, though evaluation for\nocclusion is limited on this study. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Nasogastric tube is seen within the esophagus coursing down\ninto the stomach. The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nthickening of the colonic wall up to 6 mm, involving the transverse to the\nrectum, which may be due to ischemic or pseudomembranous colitis. Rectal tube\nis in place. The appendix is normal.\n\nPELVIS: The urinary bladder is underdistended with small focus of air, which\nmay be from recent instrumentation. Distal ureters are unremarkable. There\nis small amount of free fluid in the pelvis. Drainage catheter terminates at\nthe level of aortic bifurcation.\n\nREPRODUCTIVE ORGANS: Again seen is a fibroid uterus. Ovaries are not\nidentified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Extensive colonic wall edema involving the transverse colon to the rectum,\nwhich may be due to ischemic or pseudomembranous colitis.\n2. Delayed nephrogram with heterogeneous enhancement of bilateral kidneys,\npossibly due to vascular occlusion or intrinsic parenchymal disease.\n3. Extensive vascular calcifications.\n4. Small focus of air in the bladder. Please correlate with history of recent\ninstrumentation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 2:00 ___, 10 minutes after discovery of the\nfindings." }, { "input": "CT abdomen with contrast: Liver enhances homogeneously without focal lesion\nor biliary dilatation. Portal vein is patent. Gallbladder is collapsed and\nunremarkable.\n\nSpleen, pancreas and adrenal glands are unremarkable. Kidneys are mildly\natrophied bilaterally, however present symmetric nephrograms without focal\nlesion or hydronephrosis. Previously identified heterogeneous nephrogram is\nnot seen on today's examination.\n\nUpper enteric tube terminates in the gastric body. Stomach is otherwise\ngrossly unremarkable. Small bowel loops are normal caliber without evidence\nof obstruction. There are persistent areas of colonic wall thickening\nthroughout the large bowel, most notable in the sigmoid colon, though this has\nsignificantly improved compared to the prior examination. There is otherwise\nno pericolonic fat stranding or organizing fluid collection.\n\nSevere atherosclerotic calcifications are again noted throughout the abdominal\naorta and its branch vasculature. Scattered mesenteric and retroperitoneal\nlymph nodes are not pathologically enlarged by CT size criteria. There is\ntrace ascites. There is no abdominal free air or ventral abdominal hernia. \nStaples are noted from ventral midline incision.\n\nCT pelvis with contrast: Bladder is unremarkable. Rectal tube is in place. \nCalcified fibroids are seen within otherwise unremarkable uterus. Add necks\nare unremarkable. There is trace free pelvic fluid. There is no free pelvic\nair. There is no inguinal or pelvic sidewall lymphadenopathy by CT size\ncriteria.\n\nBones and soft tissues: There is mild diffuse superficial fat stranding of\nthe soft tissues suggestive of anasarca. There is no suspicious focal bone\nlesion.", "output": "1. Interval improvement of previously seen colonic wall thickening mainly with\nresidual areas in the sigmoid colon.\n2. Previously identified delayed, heterogeneous nephrogram is no longer\nvisualized.\n3. Diffuse anasarca with superficial fat stranding and trace ascites.\n4. Uterine fibroids.\n5. Severe atherosclerotic disease.\n6. For thoracic findings, please refer to the separately dictated report under\nclip ___." }, { "input": "CTA thorax:\n\nThere is a non-occlusive filling defect within one of the subsegmental\nbranches of the right upper lobe pulmonary artery (series 3, image 42)\ncompatible with a previous subsegmental pulmonary embolism. The pulmonary\narteries are otherwise well opacified to the subsegmental level without acute\nfilling defects within the main, right, left, lobar, segmental, or\nsubsegmental pulmonary arteries. The aorta and its major branch vessels are\npatent, with no evidence of stenosis, occlusion, dissection, or aneurysmal\nformation. The main and right pulmonary arteries are normal in caliber, and\nthere is no evidence of right heart strain.\n\nThe thyroid gland is unremarkable. There is no supraclavicular, axillary,\nmediastinal, or hilar lymphadenopathy. The heart and pericardium are\nunremarkable. There is no pericardial effusion. The airways are patent to the\nsubsegmental level. There is moderate atelectasis at the lingula and left\nlower lobe and mild atelectasis in the right middle and lower lobes. There is\na trace left pleural effusion. There is no pneumothorax.\n\nABDOMEN:\n\nThe liver is normal in appearance and without focal abnormality. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder, pancreas, spleen, and bilateral adrenal\nglands are normal. The kidneys enhance symmetrically and are without\nsuspicious solid mass.\n\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare normal in caliber and without evidence of wall thickening. The appendix is\nvisualized and normal. There is no retroperitoneal lymphadenopathy by CT size\ncriteria. There is no free abdominal fluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. There is no\npelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified. The uterus is markedly enlarged with several\nenhancing fibroids, similar in appearance to prior study.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.", "output": "1. No acute pulmonary embolism or aortic pathology. Residual findings of a\nprior subsegmental PE in the right upper lobe with the recannulization of the\nartery.\n\n2. Moderate atelectasis in the lingula and left lower lobe. Mild right lower\nlobe atelectasis.\n\n3. Trace left pleural effusion.\n\n4. No evidence of acute pathology within the abdomen or pelvis. Enlarged\nfibroid uterus.\n\nNOTIFICATION: Findings discussed with ___ by ___ telephone at 1:44am\non ___, with updated findings discussed with ___ at 9:30am on\n___." }, { "input": "Limited study due to patient motion. The scan was interrupted and the\nstructures above T12 including the superior aspect of the liver, spleen and\nleft kidney among others were not imaged. Within this limitation:\n\nABDOMEN:\n\nHEPATOBILIARY: The imaged liver demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The imaged spleen shows normal size and attenuation throughout,\nwithout evidence of focal lesions.\n\nADRENALS: The right adrenal gland and visualized portion of the left adrenal\ngland are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The imaged distal stomach is unremarkable. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThere is moderate stool burden in the descending and rectosigmoid colon. \nOtherwise, the colon is within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Limited study without imaging of structures of the upper abdomen. Within this\nlimitation, no evidence of acute process in the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nmild to moderate left-sided hydroureteronephrosis and surrounding perinephric\nstranding in likely a small amount of fluid. This can be traced to the level\nof a 3 mm stone at the left UVJ.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: Minimal degenerative changes is seen in the lower thoracic and lumbar\nspine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "An obstructing 3 mm left UVJ stone results in mild/moderate left\nhydroureteronephrosis. There small perinephric fluid and stranding." }, { "input": "LOWER CHEST: There is mild atelectasis lung bases, bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter renal hypodensities are too small to characterize but\nlikely represent simple renal cysts. There is no hydronephrosis.\n\nGASTROINTESTINAL: There is a small hiatal hernia and mild edema of the\nvisualized esophageal wall, likely due to reflux. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nColonic wall thickening and hyperemia involving the descending and sigmoid\ncolon is moderate. There is cecal diverticulosis without diverticulitis. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis. A dystrophic calcification along\nthe anterior aspect of the uterus likely represents a torsed fibroid.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Descending and sigmoid colitis, likely infectious or inflammatory.\n2. Cecal diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: Consolidation at the left lung base may represent atelectasis,\npneumonia or aspiration. Multiple calcified granulomas are noted. There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.0 cm right hepatic lobe hypodensity is not significantly changed, is\nconsistent with a hepatic cyst or biliary hamartoma. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is not\nvisualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. A subcentimeter hypodense lesion in\nthe lower pole of the right kidney on series 2, ___ 39 is too small to\ncharacterize but is stable compared to ___ and does represents a cyst. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. There is a short focal segment of small bowel which\ndemonstrates possible wall thickening, however evaluation is slightly limited\ndue to incomplete distention, and may be secondary to peristalsis (601b:25,\n2:53). The colon and rectum are within normal limits. The appendix is normal\n(601b:28).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There are degenerative changes in lumbar spine. There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Possible wall thickening of a short segment of bowel in the left lower\nquadrant may be secondary to peristalsis, however could be further evaluated\nwith small bowel follow-through or repeat CT with oral contrast if clinically\nindicated.\n2. A consolidation at the left lung base may represent atelectasis, pneumonia\nor aspiration.\n\nNOTIFICATION: The updated findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 9:00 AM, 30 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: The partially imaged lower lungs are clear. No evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: An 1-cm hypodensity in the right hepatic lobe is overall\nunchanged from the prior CT and MR ___ 2, image 25). Postsurgical changes\nin segment 5 related to prior resection of a hepatic adenoma is unchanged. \nThe remaining hepatic parenchyma has homogeneous attenuation throughout. No\nnew hepatic lesions are identified. No evidence of intrahepatic or\nextrahepatic biliary ductal dilation. The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypodensity in the left lower renal pole cortex is too small to accurately\ncharacterize on CT, statistically likely a cyst (series 601b, image 28). No\nhydronephrosis. No perinephric abnormality.\n\nGASTROINTESTINAL: Ingested oral contrast reaches the proximal transverse\ncolon. The stomach is distended with ingested oral contrast. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThere is diffuse edema involving the descending colon and sigmoid colon with\nmild hyperemia (series 601 B, image 25, 24). No evidence of bowel obstruction\nor free air. No evidence of pneumatosis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis, nonspecific also seen on a prior MR\nin ___.\n\nREPRODUCTIVE ORGANS: The patient has had prior hysterectomy. Several ovarian\nhypodense cystic structures are noted bilaterally, which is consistent with\nnormal follicular activity. In the left ovary, the largest measures up to 3.3\ncm (Series 601b, image 30).\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted. \nThe SMV, IMV, main portal vein, and splenic veins appear patent on this\nnondedicated exam. The SMA also appear patent.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Mild\nmultilevel degenerative changes of the visualized spine are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Descending and sigmoid colitis. No pneumatosis or free air. No focal\nfluid collection.\n3. Non-specific small amount of free fluid in the pelvis, also seen in ___\nMR.\n4. Unchanged 1-cm right hepatic lobe hypodensity, likely a benign cyst." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions, right greater than\nleft with overlying compressive atelectasis. No pericardial effusion. The\nheart is enlarged.Pacemkaer wires are incompletely visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: There is mild fatty atrophy of the pancreas without evidence of\nfocal lesion or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys are symmetrically shrunken and atrophic in\nappearance. Multiple bilateral renal and ureteral calculi are demonstrated as\nfollows:\n\n-0.5 cm nonobstructing left interpolar renal calculus.\n-Several right UPJ stones measure up to 1.2 cm in maximum dimension (2:51,\n601:41).\n-Additional right renal calculi measure up to 0.9 cm in the right interpolar\nkidney (02:47, 44).\nThere is fullness of the bilateral renal collecting systems, right greater\nthan left. The mid and distal ureters do not appear dilated. There is no\nevidence of focal renal lesions within the limitations of an unenhanced scan. \nBilateral perinephric soft tissue stranding is symmetric. No organized\nperinephric collection is identified.\n\nGASTROINTESTINAL: The stomach is largely distended with enteric tube likely\nterminating in the proximal stomach/GE junction. Intraluminal contrast\nmaterial is also seen within the lower esophagus. The majority of the small\nbowel loops, descending colon, and transverse colon is seen within the massive\nleft inguinal hernia. There is no evidence of bowel obstruction or. Small\nbowel loops demonstrate normal caliber and wall thickness.\n\nPELVIS: Multiple large calcifications seen along the posterior wall of the\nbladder measuring up to 9 mm on the right and 10 mm on the left likely\ncorrespond to bladder calculi (2:70, 81). The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with multiple coarse\ncalcifications and the seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. A right femoral access site is demonstrated (2:103-119).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a massive left inguinal hernia containing multiple\nsmall and large bowel loops as well as a small volume of free fluid. There is\na large hernia neck measuring approximately 10 x 8 mm. This large hernia\nexerts mass-effect on the testicles and penis. There is extensive scrotal\nwall edema and bilateral hydroceles.", "output": "1. Massive left inguinal hernia containing small and large bowel loops as well\nas small free-fluid extending into the scrotum. There is associated scrotal\nwall edema and bilateral hydroceles. No evidence of bowel incarceration.\n2. Atrophic appearance of the kidneys with bilateral renal pelvic fullness. \nBilateral nephrolithiasis and right-sided UPJ stones measure up to 1.2 cm.\n3. Large bladder calculi measure up to 1.0 cm.\n4. Cholelithiasis.\n5. Prostatomegaly.\n6. Small bilateral pleural effusions, right greater than left.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:47 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There is mild scarring in the right lower lobe. The visualized\nesophagus is patulous with fluid within. There is no pleural effusion or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding. There is suggestion of pancreatic divisum.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 5 mm accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nIn the upper pole of the right kidney, there is a 3.3 x 3.0 cm hypodensity,\nlikely a simple cyst. In the anterior column lower pole of right kidney,\nthere is marked cortical thinning with dilation of the calices, likely due to\nchronic atrophy. 8 mm hyperdensity in the anterior dilated calix within the\natrophic portion of the kidney may represent a stone. Subcentimeter\nhypodensity in the upper pole of the right kidney is too small too\ncharacterize by CT (02:18). There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is demonstrates mucosal prominence. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Mild narrowing of the superior mesenteric artery at its origin is\ndemonstrated (series 602b, image 41). The renal vasculature appears to be\npatent, though evaluation is somewhat limited due 2 single phase exam.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L4 over L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Nonspecific prominence of of gastric mucosa may reflect gastritis.\n2. Atherosclerosis including mild SMA origin narrowing. No overt evidence of\nbowel ischemia.\n3. Renal atrophy of the anterior column of the right lower pole, possibly due\nto prior infection or ischemia." }, { "input": "Streak artifact from spinal fusion hardware limits evaluation of the lower\nchest and upper abdomen.\n\nLOWER CHEST: There is minimal dependent atelectasis in the imaged lung bases. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. A\nmoderate-sized perinephric hematoma is seen along the mid to lower aspect of\nthe left kidney, measuring up to 8.8 x 1.7 cm in the sagittal plane (602b:56).\nA small amount of hemorrhage tracks inferiorly, anterior to the left psoas\nmuscle.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is seen in appropriate position within the uterus.\nA 1.7 cm simple right adnexal cyst is seen (601b:36), likely physiologic in a\npremenopausal woman. The left adnexa is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is incompletely imaged lower thoracic spinal fusion hardware, without\nevidence of complication.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Streak artifact from spinal fusion hardware limits evaluation of the lower\nchest and upper abdomen.\n2. Moderate-sized perinephric hematoma along the mid to lower aspect of the\nleft kidney, measuring up to 8.8 x 1.7 cm in the sagittal plane. A small\namount of hemorrhage tracks inferiorly, anterior to the left psoas muscle.\n3. IUD in appropriate position within the uterus." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis. The blood pool is hypoattenuating\nwhen compared to the interventricular septum suggesting anemia. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Predominantly segment 4 and 8 in addition to a small amount of\nsegments V and VI demonstrate heterogenous attenuation consistent with TACE\nprocedure. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits with no evidence of\nhyperattenuation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: In the interpolar region of left kidney is a well-circumscribed\nhypodensity that measures up to 2.1 cm which is likely a simple renal cyst. \nThe kidneys are of normal and symmetric size. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nunremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Mild atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The patient is status post TACE procedure with expected heterogenous\nappearance of the liver.\n2. No evidence of hyperattenuation external to the liver." }, { "input": "This study is limited secondary to poor bolus timing.\n\nCHEST: The visualized lung bases are clear. The heart is normal in size and\nthere is no evidence of pericardial effusion.\n\nABDOMEN:\n\nWithin the limitations of this study, the liver enhances homogeneously and is\nwithout focal lesions. The portal venous system is not well opacified. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. Adjacent to\nthe left hepatic lobe of the liver in the region of the gastric fundus is an\narea of hyperdensity measuring approximately 59 Hounsfield units, which likely\nrepresents hemoperitoneum and is similar in size to ___ (3b:95).\n\nThere is a small amount of hemoperitoneum posterior to the spleen, which has\nmildly increased from ___ (3b:78). The pancreas and adrenal glands are\nunremarkable..\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance. The gastric band is without evidence of erosion.\nThe visualized stomach, small, and large bowel are unremarkable.\n\nThere are no enlarged mesenteric or retroperitoneal lymph nodes. There is no\nfree air.\n\nOSSEOUS STRUCTURES: There are no concerning lytic or sclerotic bony lesions.\n\nCTA: There is no evidence of active extravasation. Views of the upper\nabdominal aorta are unremarkable.", "output": "1. No evidence of gastric band erosion.\n2. Mild increase in hematoma posterior to the spleen.\n3. Stable hemoperitoneum adjacent to the left lobe of the liver and gastric\nfundus.\n4. No etiology for bleed on this CT scan through the upper abdomen.\n5. Please see CTA from same day for details of lower abdominal and pelvic\nstructures.\n\nNOTIFICATION: Findings were discussed with ___ by Dr. ___\n___ the telephone on ___ 16:15, 20 min after they were made." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.7 cm simple cyst arising from the interpolar region of the left\nkidney. There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a\nsegment of sigmoid colon which demonstrates wall thickening and surrounding\nfat stranding, consistent with acute diverticulitis. There is an adjacent rim\nenhancing fluid spanning approximately 1.9 X 1.7 cm, consistent with\nphlegmon/early abscess. There are several adjacent small foci of air, as well\nas air tracking up the right retroperitoneum with several small foci of free\nair under the diaphragm (601:33). The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.", "output": "Acute perforated sigmoid diverticulitis with adjacent 1.9 cm rim enhancing\nfluid collection consistent with phlegmon/early abscess, and small amount of\nfree air. No drainable fluid collection." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is top-normal in size. No evidence of splenic lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. 2.3 cm, interpolar left kidney hypodensity\nconsistent with simple cyst. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Again seen are\nmultiple diverticula throughout the sigmoid colon. There is bowel wall\nthickening and fat stranding surrounding multiple diverticula (series 2; image\n66/series 601; image 33) suggestive of acute diverticulitis. Previously seen\npunctate foci of free air and 1.9 cm collection are not appreciated on today's\nexam. No evidence of drainable collection in the area of diverticulitis. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Persistent sigmoid diverticulitis with interval resolution of 1.9 cm adjacent\ncollection and ectopic gas from perforation." }, { "input": "LOWER CHEST: There is minimal dependent atelectasis in bilateral lower lobes.\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a 5 mm hypoattenuated rounded focus in the right lobe of the liver at\nthe hepatic dome (series 2:7) which is too small to characterize but likely\nrepresents a simple cyst or biliary hamartoma.. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Anastomotic sutures are noted\nabutting the distal small bowel (series 2:57). There is sigmoid colonic\ndiverticulosis without evidence of diverticulitis. There is a round rounded\nperipherally hyperattenuating focus measuring 0.7 cm abutting sigmoid colon\n(series 2:61) likely representing a partially calcified diverticulum. \nAppendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is retroflexed but otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a congenital anomaly of the T11 vertebral body with relative\nhypoplasia of the right aspect of the vertebral body (series 601:31)\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormality in the abdomen or pelvis. No evidence of mass or\nlymphadenopathy.\n2. Appendix is normal.\n3. Mild sigmoid colonic diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY:\nThe liver demonstrates homogenous attenuation throughout. There is no\nevidence of steatosis: 130 ___ on contrast scan (normal >100HU)There is no\nevidence of focal lesions.\nThe gallbladder is surgically absent, new since ___\nThere has been decrease 2 of the dilatation of the common extrahepatic duct\nthe proximal duct measuring now 9.9 mm compared to 15.6 mm in ___. \nSimilarly the intrahepatic bile duct dilatation has a markedly decreased with\nonly minimal prominence of the central intrahepatic ducts There is no small\npneumobilia on the left the likely secondary to sphincterotomy.\nPANCREAS:\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN:\nThe spleen shows normal size and attenuation throughout, without evidence of\nfocal lesions.\nADRENALS:\nThe right and left adrenal glands are normal in size and shape.\nURINARY:\nThe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of stones, focal renal lesions or hydronephrosis.\nThere are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\nGASTROINTESTINAL:\nThe stomach is not distended. There is no abnormality in the duodenum.\nSmall bowel loops demonstrate normal caliber, wall thickness. The transverse\ncolon and the visualized part of the ascending and descending colon show\ndiverticulosis with no signs of diverticulitis RETROPERITONEUM & MESENTERY:\nThere is no evidence of retroperitoneal, mesenteric and omental lymph node\nenlargement. No solid or cystic mass.\nVASCULAR:\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nSKELETAL:\nMild degenerative changes in the lumbar spine noted.", "output": "1. Status post cholecystectomy with the appropriate in size the hepatic and\nbile duct prominence, 9.9 mm. No abnormal mass seen" }, { "input": "LOWER CHEST: Lung bases are clear.\n\nHEPATOBILIARY: Calcified hepatic granuloma. Portal vein and hepatic veins are\npatent. Gallbladder appears unremarkable.\n\nPANCREAS: Appears unremarkable.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable adrenals.\n\nURINARY:No hydronephrosis. No suspicious masses.\n\nGASTROINTESTINAL: Stomach appears unremarkable. Small bowel loops are of\nnormal caliber. Colonic diverticulosis without diverticulitis.\n\nPERITONEUM: No free air. No free fluid. No peritoneal stranding.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Normal caliber abdominal aorta with mild atherosclerotic disease. \nIntra-abdominal branches are patent.\n\nPELVIS: Prostate and seminal vesicles are unremarkable. Contrast opacifies an\nunremarkable urinary bladder.\n\nBONES:No acute osseous abnormality.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. No large gastric or colonic masses identified by CT. If continued high\nclinical concern, consider endoscopic evaluation.\n2. Colonic diverticulosis.\n3. Otherwise, unremarkable examination of the abdomen." }, { "input": "LOWER CHEST: Small bilateral pleural effusions, left greater than right, have\ndecreased in size since prior. No pericardial effusion is seen. Mild\natelectasis of the right lower lobe is improved. Moderate atelectasis of the\nleft lower lobe is similar.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS:\nThe pancreas head and tail demonstrate normal attenuation, improved from\nprior. The pancreas body has been largely replaced by rim enhancing fluid\ncollections.\n\nThe largest collection, in the region of the pancreatic body, measures\napproximately 7.8 x 3.1 x 4.9 cm (6:28, 8:20), similar to prior, previously\nmeasuring 7.5 x 3.4 x 4.8 cm. A left posterolateral approach drain terminates\nin this main collection.\n\nNumerous smaller rim enhancing fluid collections measuring up to 3 cm seen\nsuperiorly, inferiorly and adjacent to the pancreas tail have demonstrated\ninterval evolution and are more organized in appearance.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Interval resolution of previously seen inferior\npole hypoperfusion.\n\nADRENALS: The right adrenal gland is normal. A 1.5 x 1.2 cm nodule in the\nleft adrenal gland is indeterminate, but unchanged in size.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral subcentimeter hypoattenuating lesions are too small to characterize,\nbut are unchanged. There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube tip terminates in the proximal jejunum. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits.\n\nModerate volume abdominopelvic ascites is overall decreased, particularly in\nthe pelvis. No pneumoperitoneum.\n\nPELVIS: Air is noted within the urinary bladder, likely related to recent\ncatheterization.\n\nREPRODUCTIVE ORGANS: A 2.4 cm round, heterogeneously hypodense lesion is again\nseen in the body of the uterus, which may represent a lipoleiomyoma. No\nsuspicious abnormality is seen in the bilateral adnexa.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. The splenic vein is non visualized and likely completely\noccluded. There is moderate attenuation of the proximal SMV (06:30) secondary\nto mass effect from adjacent fluid collections, worse from prior.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Large 7.8 cm rim enhancing fluid collection in the region of the pancreas\nbody is similar in size, with left posterolateral approach drain terminating\nwithin this collection. Numerous adjacent fluid collections measuring up to 3\ncm are more organized.\n2. Moderate attenuation of the proximal SMV secondary to adjacent fluid\ncollections is increased. The splenic vein is not visualized and likely\ncompletely occluded.\n3. Numerous additional chronic findings, as above." }, { "input": "LOWER CHEST: Pulmonary emboli again seen in the right lower lobe. A small\ndependent right pleural effusion with adjacent mild to moderate left basilar\natelectasis is similar. No pericardial or right pleural effusion is seen. \nThe right lung base is clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas head demonstrates normal attenuation. Re-demonstration\nof necrosis of the majority of the remainder of the pancreas.\n\nPatient is status post placement of double cystogastrostomy tubes, whose ends\nterminate in the gastric antrum and a large rim enhancing fluid collection in\nthe region of the body of the pancreas. This collection is smaller, now\nmeasuring 6.8 x 3.2 x 2.7 cm, previously 12.8 x 6 x 4 x 7.9 cm. A left\nposterolateral approach pigtail drain is in unchanged position, terminating in\nthe lateral aspect of the aforementioned large collection.\n\nA smaller collection tracking along the superior mesenteric artery is mildly\nsmaller. Fluid adjacent to the colon near the splenic flexure is decreased.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal. A 1.4 cm left adrenal nodule is\nunchanged.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral subcentimeter hypoattenuating lesions are too small to characterize.\nThere is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the proximal small bowel. \nSmall enlarged bowel loops are normal in caliber. Small volume ascites is\nsimilar.\n\nPELVIS: The urinary bladder is unremarkable. There is trace free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: A 2.5 cm fat-containing lesion in the posterior uterine\nwall is unchanged, most likely representing a lipoleiomyoma. No adnexal\nabnormality is seen.\n\nLYMPH NODES: Redemonstration of multiple prominent mesenteric lymph nodes,\nwhich are likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nRe-demonstration of complete thrombosis of the splenic vein, with prominent\nperigastric collaterals again noted. Severe attenuation of the main portal\nand superior mesenteric veins near their confluence is similar.\n\nBONES: No suspicious osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post placement of double cystogastrostomy tubes with interval\ndecrease in size of large rim enhancing fluid collection in the region of the\npancreatic body and adjacent smaller fluid collections.\n2. Unchanged severe attenuation of the main portal and splenic veins near the\nconfluence and complete thrombosis of the splenic vein.\n3. Additional findings, as above." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Ill-defined (series 9, image 35) progressively enhancing mass\nin the left hepatic lobe measures roughly 2.9 x 2.0 cm and is unchanged. \nAssociated left hepatic peripheral mild intrahepatic biliary ductal dilatation\nis unchanged. No additional suspicious hepatic lesions identified.\n\nThe gallbladder is surgically absent.\n\nPANCREAS: Diffuse pancreatic calcifications are suggestive of chronic\npancreatitis. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is an 18 mm simple renal cyst arising from the anterior aspect\nof the left kidney. Additional subcentimeter hypodensities scattered\nthroughout the kidneys, bilaterally are too small to characterize but likely\nrepresent simple renal cysts.\n\nGASTROINTESTINAL: Paraesophageal lymph nodes measure up to 7 mm (series 4,\nimage 19) are unchanged. The stomach is unremarkable. There is a small\nduodenal diverticulum. Loops of small bowel are otherwise unremarkable. The\ncolon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: Hypodense porta hepatis lymph nodes measuring up to 1.9 x 1.3 cm\nare mildly decreased (previously 2.3 x 1.9 cm) (series 4, image 42) and appear\nless necrotic.\n\nMildly enlarged retroperitoneal lymph nodes are unchanged (series 4, 61, 77,\n63).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Ill-defined known cholangiocarcinoma, is grossly unchanged. Porta hepatis\nlymphadenopathy is mildly decreased." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThere is mild diffuse decreased attenuation of the liver parenchyma in keeping\nwith hepatic steatosis. Fiducial markers are noted in the left lateral\nsection. There is mild atrophy of the left hepatic lobe similar to the prior\nstudy. No discrete mass is identified although there is heterogeneity within\nthe left lobe. Note is again made of chronically occluded left portal vein. \nThere is no intrahepatic biliary duct dilatation. Common hepatic duct and CBD\nare normal in caliber. There is mild mucosal enhancement of the right, left\nand common hepatic ducts (series 10, images 102-105) similar to the prior\nstudy which may be secondary to radiation.\nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Calcifications are noted in\nthe pancreatic which may be a sequela of remote pancreatitis. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n2 cm left renal cyst is unchanged. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nLYMPH NODES: Note is again made of few enlarged upper retroperitoneal and\nmesenteric lymph nodes:\nNecrotic appearing celiac node (series 10, image 101) measures 11 mm,\npreviously 13 mm\nPortacaval node (series 10, image 103) measures 8 mm, previously 8 mm\nPorta hepatic node (series 10, image 110) measures 9 mm, previously 8 mm\n\nNote is again made of a 5 mm lower paraesophageal lymph node (series 10, image\n82), previously 6 mm.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Stable appearance of the left hepatic lobe. The primary tumor is\nill-defined and not discretely visualized. There is no new intrahepatic\nbiliary duct dilatation. Mild enhancement of the right, left and common\nhepatic duct is unchanged and may be related to radiation therapy.\n2. Enlarged upper mesenteric and retroperitoneal lymph nodes are stable in\nsize" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Mild decreased attenuation of the liver in keeping with mild\nhepatic steatosis. Fiducial markers are in the left lateral lobe. There is\nagain seen mild atrophy of the left hepatic lobe, similar to prior studies. \nThere is heterogeneous enhancement in the left lobe. No discrete mass is\nseen. Again seen is chronic occlusion of the left portal vein. The main\nportal and right portal vein are patent. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding. Calcifications within the pancreas suggests remote pancreatitis.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis. Hypodensities within both kidneys are unchanged. The\nlargest is in the interpolar segment of the left kidney measures 2 cm. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Very focal wall thickening of\nthe third portion of the duodenum with surrounding fat stranding. Otherwise\nthe small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Several prominent upper retroperitoneal mesenteric lymph nodes\nare noted including: A necrotic lymph node measuring 1.2 cm in the porta\nhepatis is unchanged. A portacaval lymph node measuring 0.7 cm, previously\nmeasured 0.9 cm. A porta hepatic lymph node measuring 0.9 cm is unchanged. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable appearance of the left hepatic lobe with continued heterogeneity of\nthe left hepatic lobe without a discrete mass. There is no intrahepatic\nbiliary ductal dilatation.\n2. Stable enlarged upper retroperitoneal and mesenteric lymph nodes.\n3. Very focal wall thickening of the third portion of the duodenum surrounding\nfat stranding is noted. Differential considerations includes duodenitis. \nCorrelate clinically. If there is further concern an upper endoscopy may be\nconsidered.\n4. Mild hepatic steatosis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 18:01 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver attenuation is mildly decreased in keeping with mild\nhepatic steatosis. Fiducial markers are again seen in the left lateral lobe. \nChronic occlusion of the left portal vein is again seen. There is no discrete\nmass. Main portal and right portal vein are patent. There is no evidence\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding. Unchanged calcification within the pancreas suggesting normal\npancreatitis.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are hypodensities seen in bilateral kidneys that appear unchanged from\nprior and likely represent cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are several prominent upper retroperitoneal mesenteric\nlymph nodes that appear decreased in size from prior. The previously seen 12\nmm porta hepatis lymph node now measures 8.4 mm (8; 102). Another porta\nhepatic lymph node currently measures 5.9 mm and previously measured 7.4 mm\n(8; 104). Another porta hepatic lymph node currently measures 7.9 mm and\npreviously measured 8.7 mm (8; 109).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable appearance of left hepatic lobe with continued heterogeneity.\n2. Interval decrease in size in porta hepatic lymph nodes.\n3. Mild hepatic steatosis." }, { "input": "LOWER CHEST: Centrilobular emphysematous changes. Small amount of pleural\neffusions bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Moderate bilateral hydronephrosis. Limited assessment of bilateral\nureters. Markedly distended urinary bladder.\n\nGASTROINTESTINAL: Stomach is distended to the level of the antrum. G-tube\nwithin the stomach appears in good position. There is circumferential wall\nthickening of the gastric antrum extending into the pylorus suspicious for\nneoplasm. Contrast passes through the duodenum with no holdup. Duodenum\nappears unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Colonic resection-anastomosis\ntransverse colon. The appendix is not visualized.\n\nPELVIS: The bladder distended. Distal ureter not seen. Moderate amount of\nfree fluid and free air within the abdomen. Mild peritoneal enhancement,\nlikely reactive related to the recent surgical intervention.\n\nREPRODUCTIVE ORGANS: Mild prostatic enlargement measuring 5 cm with central\nprostatic calcifications\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine. Evidence of a\nchronic healed fracture through the left iliac crest and potentially sacrum. \nNo acute fractures identified. No suspicious osseous lesions.\n\nSOFT TISSUES: Minimal subcutaneous soft tissue edema. No anterior abdominal\nwall hernias. Subcu emphysema in the upper abdomen related to the recent\nprocedure.", "output": "1. Circumferential thickening of the gastric antrum concerning for neoplasm. \nNo suspicious local or regional metastatic disease within the abdomen.\n2. G-tube in place.\n3. Postsurgical changes with moderate amount of ascites, free intraperitoneal\nair, subcutaneous emphysema. Mild peritoneal enhancement, can be secondary to\ninflammatory changes.\n4. Moderate hydronephrosis with distended bladder, can be related to\nincomplete bladder evacuation, BPH. Recommend voiding and correlation with\nrenal functions.\n The findings were discussed with Dr ___. by ___, M.D. on the\ntelephone on ___ at 7:07 pm, 60 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous hypoattenuation throughout\ncompatible with fatty liver disease. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nPartially occlusive thrombus is visualized in the right portal vein and better\nassessed on previous same-day abdominal ultrasound. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSeveral bilateral subcentimeter renal hypodensities are visualized, too small\nto characterize, likely compatible with renal cysts. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\ndiffusely thickened throughout a may be secondary to portal colopathy versus\ninfection versus inflammation. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is a superior endplate deformity of L1 suggestive of an old\nfracture. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diffuse colonic mucosal thickening compatible with colitis which may be\nsecondary to portal colopathy versus an infectious or inflammatory process.\n2. Non occlusive thrombus in the right portal vein.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffusely low attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. A chronic L2 compression deformity is unchanged from the\nprior examination.", "output": "1. No evidence for acute intra-abdominal process. Normal appendix.\n2. Hepatic steatosis without focal suspicious lesion." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. Visualized lung fields\nare otherwise within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Hepatic steatosis, as before. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is underdistended, limiting evaluation. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder is underdistended, but grossly unremarkable. The\ndistal ureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAgain seen is a L2 compression deformity (602 B/48), unchanged from the\nearliest available study ___\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormality in the abdomen or pelvis. The appendix is normal, as\nclinically questioned.\n2. Unchanged diffuse hepatic steatosis." }, { "input": "LOWER CHEST: Mild left greater than right bibasilar atelectasis. Otherwise,\nvisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypoattenuating, consistent with hepatic\nsteatosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. High-density\nmaterial seen within the large bowel is consistent with retained oral contrast\nlikely from a prior study. Otherwise, the colon and rectum are within normal\nlimits. No bowel obstruction. No free intraperitoneal air. No ascites. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Compression deformity of the L2 vertebral body (602b:47) unchanged\nsince at least ___. No additional fractures or concerning osseous\nlesions identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic process to explain patient's\nsymptoms. Specifically, evidence of appendicitis or pancreatitis.\n2. Hepatic steatosis.\n3. Unchanged L2 compression deformity. No new fractures identified." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in the bilateral lower\nlobes.. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a small periampullary\nduodenal diverticulum. Otherwise, small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. An accessory right renal artery is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nCompression deformity L2 vertebral body is stable as compared to CT abdomen\nand pelvis ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormality in the abdomen or pelvis to explain patient's reported\nright lower quadrant pain. Appendix is normal. No evidence of obstruction.\n2. Stable compression deformity of the L2 vertebral body, unchanged from CT\nabdomen and pelvis ___." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis is present. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically resected.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Incidental note is made of a\nsmall duodenal diverticulum (02:32). Otherwise, the small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is visualized and is\nnormal (2:67-72).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Re-demonstrated is an accessory right renal artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged compression deformity of L2.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process to explain patient's pain. Normal appendix" }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis with trace bilateral\npleural effusions without pericardial effusion. No large focal consolidation\nis appreciated in the visualized lung fields.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver demonstrates diffusely decreased attenuation consistent\nwith fatty liver disease. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. Again seen is mild\nmisty appearance of the mesentery with slightly prominent mesenteric lymph\nnodes (series 2; image 91), unchanged compared to prior.\n\nPELVIS: Urinary bladder is largely decompressed. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere unchanged multilevel degenerative changes throughout the visualized\nthoracolumbar spine with mild anterior wedging of the L2 vertebral body,\nunchanged compared to prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal pathologic process. Normal appendix. No\nsuggestion of sequela of trauma.\n2. Unchanged mild misty appearance of the mesentery consistent with mild\nmesenteric panniculitis.\n3. Diffusely decreased attenuation of the liver consistent with fatty liver\ndisease." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout,\nconsistent with hepatic steatosis. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged wedge deformity of L2.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process to explain the patient's symptoms. Normal\nappendix.\n2. Hepatic steatosis." }, { "input": "LUNG BASES: Port-A-Cath tip is seen at the cavoatrial junction. The imaged\nportions of the lungs notable for emphysema and mild scarring in the lower\nlobes.\n\nABDOMEN: The liver appears hypoattenuating relative to the spleen suggesting\nsteatosis. Main portal vein is patent. No biliary ductal dilation. \nGallbladder is surgically absent. The pancreas appears normal. The spleen is\nnormal in size. The adrenal glands are normal bilaterally. The kidneys\nenhance symmetrically. No hydronephrosis or worrisome renal lesion. The\nabdominal aorta is normal in course and caliber without significant\natherosclerotic calcifications. No adenopathy, free air or free fluid. \nStomach and duodenum appear normal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is clearly visualized and is normal. The colon contains a mild fecal\nload. No signs of colitis or diverticulitis. The urinary bladder appears\nnormal. The prostate is normal in size. No pelvic free fluid. No pelvic\nsidewall or inguinal adenopathy.\n\nBONES: No worrisome lytic or blastic osseous lesion is seen. Chronic superior\nendplate compression deformity is again seen at L2. A chronic ununited\ntransverse process fracture is noted at L4 unchanged.", "output": "Normal appendix. No findings to account for right lower quadrant pain. Mild\nhepatic steatosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged, heterogeneous, and possibly\ninvading the base of the bladder, which is concerning for possible neoplasm.\n\nLYMPH NODES: Extensive lymphadenopathy is identified throughout the abdomen\nand pelvis. Retroperitoneal lymphadenopathy, is seen measuring up to 2 cm.\nLeft pelvic large lymph nodes, measure up to 4.8 cm. Innumerable, enlarged\nmesenteric, and inguinal lymph nodes are seen.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous soft tissue gas is seen in the right inguinal\nregion, which could reflect a prior intervention. Abdominal pelvic wall is\notherwise within normal limits.", "output": "1. Extensive the lymphadenopathy throughout the abdomen and pelvis, as\ndescribed above.\n\n2. Enlarged and heterogeneous prostate which may be invading the base of the\nbladder. Recommend correlation with PSA and/or possible prostate biopsy, to\nevaluate for prostate malignancy.\n\n3. Subcutaneous soft tissue gas is seen in the right inguinal region.\nRecommend correlation with any prior intervention." }, { "input": "LOWER CHEST: Numerous stable bilateral small pulmonary nodules are again noted\nin the lung bases (7:3, 5, 6, 14). Subpleural fibrotic change Partially\nvisualized Coronary arterial and mitral annular calcifications are also noted.\nCoarsened interstitial markings and mild bibasilar atelectasis are unchanged\ncompared to the prior study.\n\nABDOMEN:\n\nHEPATOBILIARY: There is no evidence of focal lesions within the limitations\nof an unenhanced scan. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder filled with multiple calcified\ngallstones, with no evidence of wall thickening or pericholecystic fluid\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 1.5 cm rounded nodule in the left adrenal gland is low-density\n(0.5 ___, compatible with a benign adenoma. The right adrenal gland is\nunremarkable.\n\nURINARY: The right kidney is atrophic. The left kidney is unremarkable. \nThere is no hydronephrosis, stones, or renal mass bilaterally. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable, with the\nexception of a small foci of air within the bladder dome (3:78), presumably\nfrom recent prior Foley catheterization. There is no free fluid in the\npelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: Subcutaneous fat stranding is noted over the bilateral groins,\ngreater on the right. Skin thickening and mild subcutaneous fat stranding are\nnoted at over the left lower quadrant abdominal wall, with associated small\nfocus of subcutaneous emphysema (03:52), presumably related to prior\nsubcutaneous injection site.", "output": "1. No evidence of retroperitoneal hematoma or other acute abdominopelvic\npathology within the limits of this unenhanced scan.\n2. Multiple bibasilar pulmonary nodules and chronic interstitial disease is\nunchanged. Agree with previous recommendations for pulmonary nodule follow-up\nimaging as described on the prior chest CT from ___.\n3. Cholelithiasis, with no evidence of cholecystitis.\n4. Diverticulosis, with no evidence of diverticulitis.\n5. 1.5 cm benign left adrenal adenoma and atrophic right kidney are unchanged." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN: The liver, spleen, pancreas, adrenal glands and kidneys are\nunremarkable. Cholelithiasis is noted.\n\nGASTROINTESTINAL: No bowel obstruction or ascites. The appendix is within\nnormal limits..\n\nPELVIS: There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Cholelithiasis. No acute appendicitis. Otherwise, the etiology of pain is\nnot elucidated." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Bibasilar\natelectasis is noted. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post central pancreatectomy and\npancreaticojejunostomy. There is extensive peripancreatic fluid, consistent\nwith acute pancreatitis. There is no definite signs of pancreatic necrosis or\npseudocyst formation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\nsplenic flexure appears to have a slightly thickened wall, which may represent\nreactive inflammation secondary to pancreatitis. Sigmoid diverticulosis is\nseen without acute diverticulitis. The colon and rectum are otherwise within\nnormal limits. The appendix is not clearly identified but none are no\nsecondary signs acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nFacet disease is noted in the lower L-spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Findings consistent with acute pancreatitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver appears diffusely hypoattenuated, compatible with\nsteatosis. There is no evidence of focal lesions within the limitations of an\nunenhanced scan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. A few small gallstones are noted. Otherwise, the gallbladder is\nwithin normal limits.\n\nPANCREAS: Tiny punctate calcification noted within the pancreatic body. \nOtherwise, the pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Again seen is a left adrenal mass, measuring 2.7 cm in greatest\ndimension without significant change from prior study in ___ and\napproximately 3 ___, consistent with an adrenal adenoma. The right adrenal\ngland appears normal in size and shape.\n\nURINARY: The left kidney has a malrotated appearance. The right kidney\nappears normal in size and appearance. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis or hydroureter. There is no nephrolithiasis or\nureterolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nunremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Moderate diffuse\natherosclerotic disease. Some calcified plaque is noted in the abdominal\naorta at the celiac, SMA and right renal artery origins.\n\nBONES AND SOFT TISSUES: Multilevel degenerative changes are noted in the\nspine. There is no evidence of worrisome osseous lesions or acute fracture. \nThe abdominal wall is within normal limits.", "output": "1. Stable left adrenal adenoma.\n2. Hepatic steatosis" }, { "input": "LOWER CHEST: There is atelectasis of the lung bases bilaterally. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is asymmetrically enlarged compared to the right\nkidney. There is moderate right-sided hydronephrosis, stable from prior exam.\nThere is new mild left-sided hydronephrosis and left hydroureter which extends\ninto the pelvis. Right ureteral stent extending from the collecting system of\nthe right kidney into the bladder is in stable appropriate position compared\nto prior exam. There is no evidence of focal renal lesions within the\nlimitations of an unenhanced scan. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix not visualized.\n\nPELVIS: There is grossly stable appearance of confluent soft tissue in the\nretrovesical space extending along the right pelvic sidewall to the anterior\npelvis. There is soft tissue posterior to the bladder measures approximately\n5.0 x 2.8 cm. There is possibly increased soft tissue at the left posterior\nbladder wall the expected location of the left UVJ (2:65) as well. Abnormal\nsoft tissue seen extending to the region of the greater sciatic notch. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Some of fat planes between the prostate and the left\nseminal vesicle are obscured due to adjacent soft tissue.\n\nLYMPH NODES: There is extensive retroperitoneal lymphadenopathy which is a\nbetter evaluated on recent contrast-enhanced CT abdomen pelvis. This appears\ngrossly stable compared to that prior exam. A large right-sided retrocrural\nnode measures up to 2.1 cm, stable. There is extensive right pelvic sidewall\nlymphadenopathy which appears grossly stable compared to prior exam.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New mild left-sided hydronephrosis and left hydroureter which extends to\nthe level of the pelvis. Possible increased soft tissue at the left posterior\nbladder wall at the expected location of left UVJ may account for this\nobstruction.\n2. Re-demonstration of grossly stable confluent soft tissue within the\nrectovesical space with extensive associated retroperitoneal and pelvic\nlymphadenopathy consistent with known bladder cancer.\n3. Persistent moderate hydronephrosis. Stable appropriate positioning of\nright ureteral stent." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypoattenuating lesion near the hepatic dome (2:80) is too small\nto characterize. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A small accessory spleen is noted inferiorly\n(02:30).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is clockwise swirling of\nthe SMV, mesentery and small bowel loops about SMA, which courses inferiorly\nin the right abdomen. This is associated with aberrant positioning of the\nascending colon and cecum, with the cecum being located in the mid upper\nabdomen (601:27), likely representing cecal bascule. There is no evidence of\ngastrointestinal obstruction. There is no abnormal small or large bowel wall\nthickening. The appendix is not definitely visualized. No ascites or\npneumoperitoneum. No evidence of bowel ischemia.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Clockwise swirling of the SMV, mesentery and small bowel loops about the\nSMA. This is associated with aberrant positioning of the cecum in the mid\nupper abdomen, likely representing cecal bascule. Findings suggest bowel\nmalrotation. No ascites or pneumoperitoneum. No evidence of gastrointestinal\nobstruction or bowel ischemia.\n2. No hernia of the abdominopelvic wall. No findings to correlate with\npatient's symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is retrocecal, fluid-filled and\ndilated measuring 1.3 cm in diameter (601A:32). There is significant adjacent\nfatty stranding and small volume adjacent free fluid. There is no\nextraluminal air or adjacent fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Findings compatible with acute appendicitis likely complicated by\nmicroperforation. No drainable collection or free air." }, { "input": "LOWER CHEST: There is left lower lobe hazy opacity, concerning for pneumonia. \nThere is right middle lobe and bilateral lower lobe atelectasis. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Again seen is mild intrahepatic\nbiliary dilatation. The CBD is mildly enlarged, measuring 0.9 cm, not\nsignificantly changed compared to ___ and likely secondary to\ncholecystectomy.\n\nPANCREAS: Again seen is prominence of the main pancreatic duct without\ndilatation. Pancreas divisum, as before. The pancreas has normal attenuation\nthroughout, without evidence of focal lesions There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is wedge-shaped hypodensity in the inferior pole of the left\nkidney, likely representing cortical scar. The kidneys are of normal and\nsymmetric size with normal nephrogram. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is dilated with an enteric tube. There are\nmultiple dilated loops of small bowel with decompressed loops in the right\nlower quadrant. No distinct transition point is identified. Findings are\nconcerning with a small-bowel obstruction. There is trace free fluid in the\nabdomen. Surgical suture is seen in the right lower quadrant from prior bowel\nsurgery. Diverticulosis without evidence of diverticulitis. Colon is\nvisualized to level of transverse colon. The ascending colon and cecum are\nnot clearly delineated. No definite adjacent surgical clips are noted\nhowever. The appendix is not visualized, however there are no secondary signs\nof appendicitis. Cyst previously seen in the right lower quadrant is no\nlonger visualized.\n\nPELVIS: A Foley catheter partially decompresses the bladder. The distal\nureters are unremarkable. There is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The aorta is tortuous. \nExtensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are extensive multilevel degenerative changes of the visualized\nthoracolumbar spine.\n\nSOFT TISSUES: Postoperative changes seen along the anterior abdominal wall\nwith herniorrhaphy superiorly.", "output": "1. Proximal small bowel loops are dilated with decompressed loops in right\nlower quadrant. Though no transition point is discretely identified, findings\nare concerning for acute small bowel obstruction. There is trace free fluid\nin the abdomen and pelvis.\n2. Left lower lobe hazy opacity at the left lung base, concerning for\npneumonia." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Hypodense area adjacent to the falciform ligament, likely\nfocal fatty infiltration. The liver otherwise demonstrates homogenous\nattenuation throughout. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\ncontains gallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Right upper pole renal cyst. There are other smaller renal\nhypodensities bilaterally, too small to accurately characterize but also\nlikely cysts. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of intra-abdominal or intrapelvic malignancy.\n2. Cholelithiasis without evidence of cholecystitis." }, { "input": "LOWER CHEST: Right lung base demonstrates a new large right pleural effusion.\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is distended with\nnumerous gallstones however without gallbladder wall thickening, similar to\nprior examination.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are subcentimeter bilateral renal cysts measuring up to 9 mm on the\nright. There is no evidence of suspicious focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable noting punctate\ncalcification in the anterior uterine fundus likely related to fibroid.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is bilateral spondylolysis at L5-S1 with grade 1 anterolisthesis. There\nare multilevel degenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. Distended gallbladder with numerous gallstones similar in appearance to\nprior examination without gallbladder wall thickening or pericholecystic\nfluid.\n3. Please see chest CT report for detail evaluation of chest findings,\nincluding new right pleural effusion." }, { "input": "Small bilateral pleural effusions, right greater than left, with associated\nsubsegmental atelectatic changes present\n\nThe visualized liver and spleen are unremarkable.\n\nThe gallbladder contains several small gallstones. No evidence of\ncholecystitis.\n\nThe right adrenal gland is unremarkable. Small 1 cm adenoma in the body of\nthe left adrenal gland.\n\nThe pancreas is unremarkable.\n\nThe native kidneys are atrophic. Small cortical hypodensities are seen, too\nsmall to characterize, but likely cortical cysts.\n\nAdequate corticomedullary differentiation of the right lower quadrant renal\ntransplant. There is pelviectasis, with a double-J catheter in situ.\n\nThe transplant renal vein and renal artery are widely patent. Please see 3D\nvolume rendered reconstructions, series 298 and 300 for more details. There\nare mild surrounding postoperative changes, with small amount of free air.\n\nThere is significant narrowing of the right external iliac vein, central\n(superior) from where the renal vein connects, secondary to two fluid\ncollections on both sides of the vein, measuring 3.7 cm x 3.0 cm and 4.5 cm x\n2.1 cm, demonstrating hematocrit level and hyperdense pre-contrast, and\nthought to represent two extrinsic hematomas. This is best seen on series\n303, multiplanar reformations perpendicular to the right common and external\niliac vein.\n\n4.4 cm x 4.5 cm subcutaneous fluid collection underlying the surgical skin\nstaples in the right lower quadrant, with a small hematoma at the anterior\naspect, likely postoperative.\n\nSmall amount of air is seen within the bladder, likely with due to recent\ninstrumentation.\n\nModerate atherosclerotic calcifications of the abdominal aorta. Right\nexternal iliac stent seen.\n\nNo size significant lymph nodes.\n\nIncidental small duodenal diverticulum. Mild nonspecific thickening of the\nrectal and sigmoid wall, likely due to collapse. No evidence of obstruction.\n\nNo suspicious bone lesion.", "output": "1. Adequate perfusion of the right lower quadrant renal transplant, with the\nrenal vein and renal artery widely patent.\n\n2. Narrowing of the right external iliac vein, central from where the renal\nvein connects, secondary to probably extrinsic hematomas.\n\n3. Postoperative changes as described above.\n\nNOTIFICATION: The case was discussed with Dr. ___ at 13:43, on ___." }, { "input": "LOWER CHEST: There are trace bilateral dependent pleural effusions and mild\nbibasilar atelectasis, right greater than left.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. The gallbladder contains\ngallstones, as on prior.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The native kidneys are atrophied. A right iliac fossa renal\ntransplant is noted, with excreted contrast material seen in the renal pelvis\nand bladder. A nephroureteral stent is in unchanged position. Mild\npelviectasis of the renal transplant is unchanged.\n\nTwo hematomas measuring 4.5 and 3.8 cm inferior to the renal transplant, on\neither side of the right external iliac vein are similar (2:77).\n\nGASTROINTESTINAL: There is a small hiatus hernia. Small and large bowel loops\nare normal in caliber. No pneumoperitoneum.\n\nPELVIS: A Foley balloon and air are seen in the urinary bladder. Bilateral\npenile prosthesis is again noted.\n\nRETROPERITONEUM: There is no new retroperitoneal hematoma.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nVASCULAR: Right external iliac artery stents are seen. Narrowing of the right\nexternal iliac vein is better appreciated on prior CTA study.\n\nBONES: There are no aggressive appearing osseous lesions.\n\nSOFT TISSUES: A 6.8 cm subcutaneous fluid collection in the right lower\nquadrant anterior abdominal wall (2:68) is bigger, previously 5.5 cm.\n\nLOWER EXTREMITIES: There is a strip of intermediate density material measuring\napproximately 9.9 x 2.8 x 11.0 cm (TV by AP by CC), in the medial right lower\nextremity, superficial to the right adductor longus muscle (2:109, 303:114),\nlikely representing a hematoma. This extends from the right inguinal region\nto the mid right thigh. No intramuscular hematoma is seen.\n\nThere is asymmetric enlargement and subcutaneous edema of the right lower\nextremity. A moderate right knee joint effusion is noted.", "output": "1. Unchanged hematomas adjacent to the right iliac fossa renal transplant. No\nnew retroperitoneal hematoma.\n2. 6.8 cm right lower quadrant subcutaneous hematoma is bigger, previously 5.5\ncm.\n3. Markedly asymmetric edema and swelling of the right lower extremity may be\nrelated to venous congestion in the setting of narrowing of the right external\niliac vein, better appreciated on prior CTA study." }, { "input": "LOWER CHEST: Small left pleural effusion, slightly worse when compared to\nprior, however interval decrease in amount of small right pleural effusion,\nnow trace in amount. Ground-glass opacities within the lung bases bilaterally\nas well as the visualized portions of the right middle lobe and lingula, that\nare new from prior.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver demonstrates nodular contours compatible with known liver\ncirrhosis. Allowing for a single phase CT, there is no concerning hepatic\nmass lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a tiny 5 mm hypodensity at the lower pole of the right kidney that is\ntoo small to appropriately characterize, however most likely a renal cyst. No\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates within the stomach. There is a\nsmall hiatal hernia. There has been interval improvement in previously seen\nmild dilatation of the small bowel loops which is now decompressed throughout.\nThere is however gaseous and fluid-filled distention of the colon\npredominantly involving the ascending and transverse colon without a\ntransition point that has slightly increased when compared to prior. There is\nmild thickening of the ascending colonic wall, unchanged from prior, likely\nreactive to surrounding ascites. Sigmoid diverticulosis noted without signs\nof acute diverticulitis.\n\nPELVIS: Urinary bladder is decompressed around a Foley's catheter. Moderate\namount of ascites which has increased when compared to prior CT dated ___.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Unchanged scattered retroperitoneal and mesenteric lymph nodes\nthat are not pathologically enlarged by size criteria. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic healed fractures of left ribs.\n\nSOFT TISSUES: Small fat containing umbilical hernia.", "output": "1. No small bowel obstruction. Previously seen mild dilatation of the\nproximal small bowel loops has improved.\n2. Slight worsening of gaseous and fluid filled colonic loops mainly of the\nascending and transverse colon without focal transition point.\n\n3. Moderate ascites has increased since prior.\n\n4. New bilateral ground-glass opacities within the lung bases as well as\nvisualized portions of the right middle lobe and lingula. Infectious etiology\nis not excluded." }, { "input": "LOWER CHEST: Please review same day dedicated chest CT report.\n\nABDOMEN:\n\nHEPATOBILIARY: No suspicious lesion or ductal dilation.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY: No hydronephrosis or hydroureter.No suspicious lesion.\n\nGASTROINTESTINAL: No intestinal obstruction. Nonvisualized appendix. Sigmoid\ndiverticulosis.\n\nPELVIS: Unremarkable rectum, prostate, seminal vesicles, and bladder. Direct\nright inguinal hernia containing fat.\n\nLYMPH NODES: Unchanged 9 mm left common iliac lymph node.\n\nVASCULAR: Patent aorta and major branches. Mild arteriosclerosis. Separate\norigins of common hepatic and splenic arteries, normal variant. Again noted,\ntortuous and irregular left common femoral and proximal superficial femoral\narteries with adjacent scarring.\n\nBONES AND SOFT TISSUES: Status post Girdlestone procedure of the left hip\nwith femoral head resection and placement of a prosthesis. Interval increase\nin the space between the femoral head prosthesis and the femoral shaft\nmeasuring 9 mm (previously 2 mm. Overriding of the femur unchanged. \nIpsilateral hip joint effusion an posteromedial heterotopic ossification,\nunchanged. Unchanged lucency around the left femoral intra medullary nail\nwith cortical thickening.\n\nUnchanged sclerotic metastases right tenth rib, right L5, and bilateral iliac\nbones.\n\nUnchanged Lytic metastases right L3, right L4, left L5 transverse process, \nright posterior superior iliac spine, left ischium,and right symphysis pubis.\n\nNo soft tissue mass.", "output": "1. Unchanged multi focal lytic and sclerotic osseous metastases.\n2. No new lesions." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is normal.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable apart from a small hiatal\nhernia. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. Sigmoid colonic diverticulosis, without evidence of\ndiverticulitis. Otherwise, the colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: There is high-density material within the urinary bladder, which is\notherwise normal in morphology. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes of the visualized spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. A small\nfat containing umbilical hernia is present.", "output": "1. Sigmoid colonic diverticulosis. No evidence of diverticulitis.\n2. High-density material within the urinary bladder, may related to recent\ncontrast enhanced study. Correlation with recent imaging is recommended." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is an unchanged subcentimeter hypodense lesion in the superior\naspect of the spleen, that is too small to characterize.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Similar appearance of moderate symmetric wall thickening\ninvolving the distal esophagus. Gastrostomy tube has been removed. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There has been no significant interval change of a 2.3 x 2.1 cm\ninfrarenal saccular aneurysm. Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes throughout the lumbar spine.\n\nSOFT TISSUES: Note is made of increased subcutaneous soft tissue stranding\nposterior to the sacrum (5:109) with trace gas tracking within it, suggestive\nof a decubitus ulcer.", "output": "1. Similar appearance of moderate thickening of the distal esophagus at the GE\njunction, compatible with posttreatment inflammatory changes, limiting\nevaluation for residual tumor. No focal mass detected.\n2. No evidence of metastatic disease in the abdomen or pelvis.\n3. Stable 2.3 x 2.1 cm abdominal aorta saccular aneurysm.\n4. Increased subcutaneous soft tissue stranding posterior to the sacrum with\ntrace gas tracking within it is concerning for a decubitus ulcer.Please\ncorrelate clinically." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nModerate intrahepatic biliary ductal dilatation is unchanged from prior\nexamination. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: A 3 mm hypodensity near the dome of the spleen likely represents a\nsimple splenic cyst Otherwise, the spleen shows normal size and attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: There is mild thickening in the left adrenal gland without discrete\nnodule. The right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is moderate wall thickening of the distal esophagus. \nThe stomach is unremarkable. Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 1.9 cm cystic lesion in the right ovary,\nunchanged. The uterus is not visualized. The left adnexa is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is mild aneurysmal dilatation of the infrarenal aorta\nmeasuring up to 2.3 x 1.9 cm. Moderate atherosclerotic disease is noted.\n\nBONES: There is severe degenerative change at the left hip joint. No evidence\nof osseous malignancy.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Moderate esophageal wall thickening of the distal esophagus may represent\npost treatment changes, but cant exclude malignancy. For further assessment\nof the esophagus please see CT chest from the same date.\n2. No evidence of malignancy within the abdomen or pelvis.\n3. Unchanged 2.3 x 1.9 cm saccular aneurysm of the infrarenal aorta.\n4. 1.9 cm cystic lesion in the right ovary, unchanged from ___ . \nAttention on follow up is recommended." }, { "input": "LOWER CHEST: There is new consolidation and centrilobular ground-glass\nopacities at the left lung base. There is no pleural or pericardial\neffusion..\n\nABDOMEN: The upper abdominal organs are unchanged. There is a small amount\nof ascites, however increased compared to the previous study. No significant\nchange in small amount of loculated fluid in the pelvis.\n\nGASTROINTESTINAL: The stomach is now collapsed. No NG tube is visualized. \nWithin the pelvis, there is re-demonstration of a short-segment closed loop\nobstruction involving the distal ileum. The proximal and distal transition\npoints are again seen in the anterior pelvis, in close proximity to the\nventral midline incision. There is no pneumatosis or free air within the\nabdomen and pelvis, but the bowel loop within the closed loop obstruction\ndemonstrates decreased mural enhancement. More proximally, there is interval\nincreased distension of the proximal small bowel, now measuring up to 3.2 cm\nin diameter. Distal to the closed loop obstruction, small bowel loops\ncontinue to be collapsed.\n\nPELVIS: The uterus is unremarkable on CT for age. The ovaries are not\nvisualized.\n\nLYMPH NODES: Metallic clips are in seen in the aortocaval region, secondary to\nrecent lymph node dissection. No enlarged abdominal or pelvic lymph nodes.\n\nVASCULAR: Unchanged.\n\nBONES: Unchanged.\n\nSOFT TISSUES: Midline incision scar is noted", "output": "1. Re-demonstration of closed loop obstruction involving the distal ileum. \nThe distal and proximal transition points are noted anteriorly in the pelvis,\nin close proximity to the ventral midline incision. There is no pneumatosis\nor free air, but the involved loop of small bowel demonstrate decreased mural\nenhancement concerning for bowel ischemia. Additionally, there is interval\ndiffuse increased dilatation of the small bowel proximal to the closed loop\nobstruction.\n2. Mild increase in ascites and redemonstration of loculated pockets of pelvic\nfluid as described.\n3. New consolidation and centrilobular ground-glass opacities in the left\nlower lobe, concerning for pneumonia.\n\nNOTIFICATION: The findings were discussed with the gynecology team by ___\n___, M.D. at the Gyn Onc tumor boards on ___ at 10:00 am, 15 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. High-density material in the gallbladder\nis related to stones and sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is atrophic. The right kidney is normal. There is\nno evidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted. There is a new stent in the origin of the\nceliac artery. The stent in the right renal artery remains in stable\nposition. Two right common iliac and single stent are unchanged. Soft tissue\naround the right common femoral artery and stent, likely related to fibrosis\nor scarring, is unchanged. A right femoral bypass is noted. Intraluminal\npatency cannot be assessed on this non-contrast study.\n\nThere is a large indirect hernia containing multiple small bowel loops. The\nsac measures approximately 5.3 x 11.3 cm. There is no evidence of obstruction\nor incarceration.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Soft\ntissue stranding in the anterior abdominal wall is likely related to injection\ngranulomas.", "output": "1. No lymphadenopathy, splenomegaly, abnormal mural thickening or aneurysmal\ndilatation of the GI tract to suggest the presence of intra-abdominal\nlymphoma.\n2. Large indirect hernia containing multiple small bowel loops. The sac\nmeasures approximately 5.3 x 11.3 cm. There is no evidence of obstruction or\nincarceration." }, { "input": "LOWER CHEST: Bibasilar consolidations with small air bronchograms with some\nassociated atelectasis and small, right greater than left pleural effusions\nare new. A moderate pericardial effusion is increased in size since ___. Partially imaged calcified coronary atherosclerosis is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. An\nintermediate attenuation lesion in the peripheral aspect of segment V/segment\nVIII is stable from most recent exam and measures 2.2 cm (series 2, image 21).\nThis is however larger than previous study from ___. A hypoattenuating\nlesion in segment II is too small to completely characterize, but unchanged,\nprobably a cyst or biliary hamartoma. A punctate calcification adjacent to\nthe left portal vein could reflect left hepatic artery calcification or a\nsmall left hepatic duct stone (series 2, image 22). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is distended\nwith an irregular, calcified gallstone noted. Gallbladder wall thickness is\ndifficult to assess on noncontrast exam, likely top normal. Abdominal fat\nstranding does not appear centered around the gallbladder.\n\nPANCREAS: There is mild peripancreatic fat stranding centered at the\npancreatic head and neck, fat stranding more prominently extending\ninferiorlyand laterally toward the right involving the mesentery and\nretroperitoneum, predominantly the right anterior perirenal space toward the\nright pericolic gutter. No pancreatic or peripancreatic fluid collection. \nThe pancreatic parenchyma itself is not particularly prominent. Parenchymal\ncalcifications are noted, significantly increased since ___. No\nevidence of pancreatic ductal dilation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. An interpolar simple\nleft renal cyst measures up to 2.9 cm. A right upper pole simple cyst\nmeasures up to 1.6 cm. Additional hypoattenuating lesions are too small to\ncompletely characterize, probably additional simple cysts. Punctate\ncalcifications in the renal hila are probably vascular in etiology. No\nhydronephrosis. There is no hydronephrosis. There is no nephrolithiasis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is significantly distended and fluid-filled. \nApparent wall thickening of the pylorus and distal second portion and third\nportion of the duodenum could reflect underdistention or secondary\ninflammation. Small bowel loops otherwise demonstrate normal caliber and wall\nthickness throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small, fat containing umbilical hernia.", "output": "1. Probable acute on chronic pancreatitis with small volume perihepatic and\npelvic ascites, but no well-formed peripancreatic fluid collections.\n2. The gallbladder is distended with cholelithiasis. If clinical concern for\nacute cholecystitis superimposed on pancreatitis, could consider ultrasound\nand/or HIDA scan.\n3. A punctate calcification adjacent to the left portal vein may be calcified\natherosclerosis of the left hepatic artery or a small left hepatic duct stone.\nNo evidence of left intrahepatic biliary ductal dilation, possibly favoring\natherosclerosis given overall severe calcified atherosclerosis elsewhere.\n4. Bibasilar consolidations with small air bronchograms raising the\npossibility of pneumonia, possibly related to aspiration.\n5. An intermediate attenuation lesion in the peripheral aspect of hepatic\nsegment V/segment VIII is minimally changed from most recent exam but is\nlarger than ___. Given intermediate attenuation, this could be further\nassessed with nonemergent ultrasound.\n6. Bibasilar consolidations with small air bronchograms raising the\npossibility of pneumonia, possibly related aspiration.\n\nRECOMMENDATION(S):\n1. The gallbladder is distended with cholelithiasis. If clinical concern for\nacute cholecystitis superimposed on pancreatitis, could consider ultrasound\nand/or HIDA scan.\n2. An intermediate attenuation lesion in the peripheral aspect of hepatic\nsegment V/segment VIII is minimally changed from most recent study but\nincreased from ___ in size. Given intermediate attenuation, this could be\nfurther assessed with nonemergent ultrasound." }, { "input": "Motion artifact diminishes the quality of the study.\n\nLOWER CHEST: Mild bibasilar atelectasis, left greater than right with pleural\nthickening. Moderate serous density pericardial effusion, unchanged compared\nto ___, no constrictive morphology of the cardiac chambers. \nTritruncal coronary arterial calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The hypodensity, previously characterized on ultrasound a cyst,\nwithin segment V/VIII is slowly grown in size (series 2, image 19). There\nremain curvilinear calcification paralleling the left portal vein, favored to\nrepresent atheromatous calcification of the left hepatic artery, rather than\nsmall duct stones, and there is no dilation of the biliary radicals. There\nremains a large gallstone within the dependent portion of the gallbladder,\nwithout findings of acute cholecystitis.\n\nPANCREAS: There is enlargement of the pancreatic body and head, with\nobliteration of the peripancreatic fat clefts, in keeping with interstitial\nedema with extensive peripancreatic fat stranding and non walled-off pockets\nof fluid extending along the mesenteric root along the fascial planes. There\nremain background changes of chronic pancreatitis, with progressed coarse\ncalcifications and atrophic changes. The lack of intravenous contrast, limits\nassessment for necrosis.\n\nSPLEEN: No definite splenic artery aneurysm, or findings of infarct allowing\nfor limited assessment. A 3 mm hyperdense lesion is again seen, likely\nrepresenting a calcified granuloma (2, image 18).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There remain punctate and curvilinear calcifications within the\nkidneys, likely representing nonobstructive calculi, and vascular\ncalcifications, unchanged. A simple left interpolar renal cyst measuring up\nto 2.2 cm, previously 2.9 cm, is again seen. A 1.6 cm partially exophytic\nsimple renal cyst is again seen in the upper pole of the right kidney,\nunchanged from prior. There is no perinephric abnormality.\n\n\nGASTROINTESTINAL: Uncomplicated colonic diverticula. No extraluminal air.\n\nPELVIS: There is a small amount of serous density fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostatomegaly of with prostate measuring 5.4 cm in\ntransverse dimension. Seminal vesicles are unremarkable.\n\nLYMPH NODES: No enlarged lymph nodes.\n\nVASCULAR: There is extensive atheromatous calcification of the abdominal aorta\nand its tributaries without aneurysmal dilatation.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative disease of the thoracolumbar spine.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.", "output": "1. CT findings of acute interstitial pancreatitis with non walled-off\nperipancreatic fluid on chronic background changes of pancreatitis, for\nclinical correlation. Assessment for necrosis is limited given the lack of IV\ncontrast.\n2. Cholelithiasis without evidence of acute cholecystitis.\n3. Small pleural effusions, bibasal atelectasis, with moderate pericardial\neffusion persists.\n4. With exception of a benign-appearing cyst in the right lobe of the liver,\nthe remainder of the findings are not significantly changed." }, { "input": "LOWER CHEST: There is bibasilar atelectasis and trace pleural effusions. \nThere is a moderate pericardial effusion, increased from the prior study. \nPatient is status post aortic valve replacement.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a 3.2 cm simple cyst or biliary hamartoma in hepatic segment 6. \nThere are additional subcentimeter hypodensities that are too small too\ncharacterize but likely represent simple cysts or biliary hamartomas. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains a 1.7 cm calcified gallstone without wall thickening or\nevidence of inflammation.\n\nPANCREAS: There is redemonstration of extensive calcification of the\npancreatic parenchyma, likely sequelae of chronic pancreatitis. There is no\nperipancreatic stranding.\n\nSPLEEN: The previously characterized splenic laceration is not apparent on\nthis study. There is extensive splenic artery calcification.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a punctate\ncalculus in the upper pole of the right kidney. Simple cysts are\nre-demonstrated bilaterally. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended with fluid. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. There is colonic\ndiverticulosis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is redemonstration of a left femoral lesser trochanter avulsion\nfracture with anterior displacement, with stable appearance of the proximal\nanterior left thigh hematoma (2:86).\n\nThere are severe multilevel degenerative changes of the lumbar spine with\nlarge osteophytes and a combination disc bulging and ligamentum flavum\nhypertrophy causing severe spinal canal stenosis at L2-L3, L3-L4, and L4-L5.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. There is chronic dissection of the distal infrarenal\nabdominal aorta extending into the bilateral common iliac arteries.", "output": "1. Redemonstration of a left femoral lesser trochanter avulsion fracture with\nanterior displacement, with grossly stable appearance of the proximal anterior\nleft thigh hematoma (2:86).\n2. No evidence of a retroperitoneal hematoma.\n3. Moderate pericardial effusion, increased from the prior study from ___." }, { "input": "LOWER CHEST: Large pericardial effusion appears similar to prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. 3.2\ncm simple cyst in hepatic segment 6 is unchanged. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or evidence of inflammation.\n\nPANCREAS: The pancreas is heavily calcified likely sequela of chronic\npancreatitis. No suspicious pancreatic lesions or main pancreatic duct\ndilatation. No peripancreatic stranding.\n\nSPLEEN: Splenic calcifications may represent prior granulomatous infection or\nvascular calcifications. Spleen is not enlarged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are mildly atrophic, bilaterally. A 1.3 cm renal cyst\nnoted arising from the upper pole of the right kidney and 1.8 cm simple cyst\narising from the left kidney. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: Urinary bladder is collapsed. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is mildly enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Chronic dissection the infrarenal abdominal aorta (series 3, image\n43) is unchanged. Heavy atherosclerotic disease is noted.\n\nBONES: Left femoral lesser trochanteric avulsion fracture, is re-demonstrated\nwith 6.2 cm of anterior displacement. Surrounding hematoma appears perhaps\nmildly increased. A small component the hematoma likely tracks along the\niliopsoas tendon into the lower pelvis (series 3, image 66).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Left femoral lesser trochanteric avulsion fracture with 6.2 cm of anterior\ndisplacement. The surrounding hematoma is not definitely changed,, although\nit is noted that the full extent of it is not imaged with this technique. No\ndefinite underlying lesion.\n2. Large pericardial effusion, is unchanged." }, { "input": "LOWER CHEST: The lung bases are clear aside from bibasilar atelectasis. \nEvaluation the heart demonstrates a small pericardial effusion. The heart is\nenlarged. Extensive coronary calcifications and stents are present.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A 2\ncm hypodense lesion in segment 6 has increased in size but was also seen on\nthe prior examination, and likely represents a small cyst. Other\nhypodensities seen on the prior study are not well demonstrated on this\nunenhanced examination. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder contains gallstones without wall\nthickening or evidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Spleen measures up to 13 cm in AP dimension, which is borderline\nenlarged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A 3 cm cyst is seen in\nthe upper pole of the left kidney. A 1.8 cm exophytic cyst is seen in the\nupper pole the right kidney. These have increased in size since the prior. \nOther previously seen subcentimeter hypodensities are not well demonstrated on\nthe current study. A tiny, nonobstructive calculus is seen in a right upper\npole calyx. There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Loops of small bowel\ndemonstrate normal caliber. Fecalized material is seen within several loops\nof distal small bowel, without associated wall thickening, fluid, or\nstranding. Colonic stool burden is moderate to large. Solid stool is noted\nwithin the rectum, with associated rectal wall thickening and perirectal fat\nstranding. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged and contains punctate, central\ncalcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes are seen throughout the lower thoracic\nand lumbar spine. No definite acute fracture is.\n\nSOFT TISSUES: A fat containing umbilical hernia is present.", "output": "1. Moderate to large stool burden.\n2. Stool within the rectum with mild rectal wall thickening and perirectal\nstranding may be compatible with stercoral colitis in the appropriate clinical\ncontext.\n3. Small pericardial effusion." }, { "input": "LOWER CHEST:\n\nThe lung bases are essentially clear. Previous small pleural effusions have\nresolved.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is post cholecystectomy. Pneumobilia in the right\nand left lobes of the liver is compatible with recent ERCP. Dense material\nwithin the common bile duct likely reflects refluxed oral contrast (5:29).\nThere is no intrahepatic bile duct dilatation. No focal liver lesion is\nidentified.\n\nPANCREAS: The pancreas enhances normally throughout with normal caliber main\npancreatic duct. There is persistent inflammatory soft tissue density\ninfiltrating posterior and inferior to the pancreas and extending into the\nmesentery. Known semi-organized peripancreatic fluid collections have\ndecreased in size; for example, the most inferior retroperitoneal collection\nanterior to the aorta and IVC is now 1.3 cm maximally, previously 2.6 cm\n(05:43), and a pocket near the pancreatic tail is now 2.2 x 1.2 cm, previously\n3.8 x 1.5 cm (05:33). A thin fluid pocket within the mesentery is also\nsmaller, difficult to measure due to its elongated, curved configuration but\nmeasures less than 1 cm in AP dimension (05:40). There are no new\ncollections.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: The adrenal glands are normal bilaterally.\n\nKIDNEYS: The kidneys enhance and excrete contrast symmetrically without\nhydronephrosis.\n\nGASTROINTESTINAL: The small bowel loops and colon are within normal limits.\nOral contrast progresses without obstruction into distal small bowel. The\nappendix is normal.\n\nLYMPH NODES: No pathologically enlarged retroperitoneal or mesenteric lymph\nnodes are seen.\n\nVASCULAR: The portal veins are patent. A focally dilated 5 mm\narterially-enhancing focus to the right of but not communicating with the\nsuperior mesenteric vein (05:35) was not clearly present on prior exam, and\nmay reflect a tiny pseudoaneurysm of a mesenteric branch. The abdominal\naorta is normal caliber throughout.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. The uterus and adnexa\nare within normal limits for age. Tortuous veins are noted in the left\nhemipelvis, associated with a dilated left gonadal vein (5:69).\n\nBONES AND SOFT TISSUES:\n\nThere are no focal osseous lesions concerning for malignancy or infection. The\nabdominal and pelvic body wall is within normal limits.", "output": "1. Overall decreased size of semi-organized peripancreatic fluid since the\nprior exam. No new or drainable collections. No pancreatic necrosis.\n2. New 5 mm arterially-enhancing focus within the lower mesentery may reflect\na tiny arterial pseudoaneurysm of a distal mesenteric branch. Attention to\nthis region recommended on followup.\n3. Interval resolution of small bilateral pleural effusions.\n4. Dilated left gonadal vein and left pelvic veins can be seen in pelvic\ncongestion syndrome if supported by correlating clinical symptoms." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis.\n\nABDOMEN: There is pneumobilia with interval mild increase in degree of\nintrahepatic biliary ductal dilation in this patient status post prior\ncholecystectomy. A small amount of hyperdense material is seen in the distal\ncommon bile duct likely representing refluxed contrast (2, 31) in this patient\nwith prior sphincterotomy. No focal liver lesions are seen. The main portal\nvein is patent. The spleen is normal. Adrenal glands are both normal. The\nkidneys enhance symmetrically and excrete contrast promptly without focal\nlesion of concern or hydronephrosis. The abdominal aorta is normal in course\nand caliber with widely patent major branches.\n\nThe pancreatic volume appears normal and there is no evidence of pancreatic\nnecrosis. The pancreatic duct is mildly dilated measuring up to 4 mm\ncontaining a locule of gas. No discrete pancreatic mass is seen. However, as\nseen previously, there is abnormal soft tissue density extending inferiorly\nfrom the pancreas along the root of mesentery and along the anterior pararenal\nfascia, left greater than right. Fluid containing sinus tracts are again\nidentified extending inferiorly from the pancreas. These tracts appears\nsimilarly positioned though slightly more extensive. For example, a sinus\ntract is seen extending from the region of the pancreatic uncinate process to\nthe mid transverse colon along the transverse mesocolon. However, there are\nfindings concerning for impending fistula formation with the blind of a sinus\ntract now inseparable from these mid transverse colon on series 602b, image\n37. No drainable fluid collection is identified.\n\nThe stomach and duodenum are mildly distended and filled with contrast. There\nis an abrupt caliber change at the level of the third portion of the duodenum\nbest seen on series 2, image 38 which could reflect mass-effect on the\nduodenum from the pancreatic inflammatory process. Alternatively, stricture of\nthe duodenum must be considered. In addition, there is an abrupt caliber\nchange of the SMV at the level of the pancreas which may indicate an\ninflammatory stricture.\n\nNo free air is seen. The abdominal arterial vasculature is normal in caliber\nwithout evidence of the of abdominal aortic aneurysm or significant\natherosclerotic calcifications. The splenic vein is patent. There is no\nretroperitoneal or intra-abdominal lymphadenopathy.\n\nThe bilateral adrenal glands and kidneys are normal. There are no renal\nmasses. There is no hydronephrosis or pyelonephritis. The kidneys excrete\ncontrast symmetrically.\n\nPELVIS: The sigmoid colon is normal. The appendix is normal. The bladder,\nuterus, and adnexal are unremarkable. Again noted are prominent veins in the\nleft pelvis, suggesting pelvic congestion syndrome. There is no free fluid in\nthe pelvis. Coarse calcifications along the urethra are unchanged, and of\nuncertain significance. There is no pelvic or inguinal lymphadenopathy.\n\nOSSEOUS STRUCTURES AND SOFT TISSUESS: There are no concerning lytic or\nsclerotic osseous lesions. No fracture is identified. The soft tissues are\nunremarkable. No hernia is identified.", "output": "1. Complicated pancreatitis with peripancreatic inflammatory mass centered in\nthe mesenteric root containing fluid-filled sinus tracts (likely pseudocysts) \nas seen previously. Concern for impending fistulization with the transverse\ncolon given findings detailed above.\n2. Probable stricture along the third portion of the duodenum due to adjacent\npancreatic inflammation. Slightly increased biliary ductal dilation may\nreflect increased duodenal pressures.\n3. Mass effect on the distal SMV likely due to adjacent inflammation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 4:48 ___, 10 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The colon and rectum are\nwithin normal limits. Compared to the prior exam, the appendix is diffusely\ndilated, measuring up to 11 mm and containing homogeneously isodense material.\nTrace amount of fat stranding is seen around the enlarged appendix (2:67). \nThere is no drainable fluid collection or evidence of perforation. Mild\ndilation of the terminal ileum is likely related to the acute appendicitis.\nOtherwise, the remaining small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Scattered mesenteric lymph nodes in the right lower quadrant are\nmildly enlarged, likely reactive. There is no retroperitoneal\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small right inguinal hernia containing fat is noted.", "output": "Findings concerning for mild or early uncomplicated acute appendicitis. No\ndrainable fluid collection or perforation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 7:47 pm, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process." }, { "input": "This unenhanced scan of the abdomen was performed following a biopsy of the\nliver to exclude post- biopsy hemorrhage.\n\nThere is no evidence of hyperdense parenchymal changes to suggest parenchymal\nhemorrhage. Furthermore, there is no fluid around the liver or free-fluid\notherwise in the upper abdomen to suggest presence of pneumoperitoneum.\n\nAgain noted is a large lesion conglomerate in the right lobe of the liver. \nThis is best assessed on the recent CT of the abdomen performed with IV\ncontrast on ___. Liver parenchyma is not cirrhotic. The\nuninvolved portions of the liver normal in attenuation\n\nPatient is status post cholecystectomy. There is mild prominence of the CBD\nwith normal tapering towards the ampulla. No intrahepatic bile duct\ndilatation.\n\nNormal spleen and adrenal glands.\n\nAtrophic pancreas, demonstrating interdigitation of fat. No focal pancreatic\nlesions. No main duct dilatation.\n\nThere has been prior gastric bypass surgery. A portion of the stomach is seen\nherniating through the diaphragmatic hiatus. Surgical suture line intact. \nThere is an additional surgical suture line within the small bowel in the left\nhemiabdomen, intact. Visualized large bowel demonstrates scattered\nuncomplicated diverticula.\n\nNo free intra-abdominal air.\n\nRenal parenchyma grossly normal. No nephrolithiasis or hydronephrosis.\n\nThere is no upper abdominal lymphadenopathy.\n\nThere is multilevel degenerative facet arthropathy and mild multilevel\ndegenerative disc disease throughout the visualized spine.\n\nThere is mild stranding of the subcutaneous fat. Abdominal wall otherwise\nunremarkable.\n\nThere is a trace right pleural effusion, demonstrating no significant change\nfrom the study performed ___. No basal pneumothorax.", "output": "No evidence of parenchymal hemorrhage or hemoperitoneum following liver\nbiopsy.\n\nNo basal pneumothorax.\n\nNOTIFICATION: The study was reviewed by Dr. ___ at time of\nscan. Patient was admitted for pain management and hypertension. Findings\nwere communicated to the admitting hospitalist by Dr. ___." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are bilateral simple renal cysts measuring up to 1.1 x 1.2 cm. \nOther subcentimeter hypodensities in the bilateral kidneys statistically\nlikely represent simple cysts but are too small to characterize, and unchanged\nfrom prior. There is no hydronephrosis.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nSmall bowel is normal in caliber without focal wall thickening. Large bowel\nis normal in caliber without focal wall thickening. Appendix is not\nvisualized. There is no intra-abdominal free fluid or free air.\n\nPELVIS: There is bladder wall thickening, similar in appear insert prior. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications are noted in the prostate.\n\nLYMPH NODES: Again seen, is retroperitoneal and pelvic sidewall adenopathy. \nThe largest left para-aortic lymph node measures 14 x 21 mm, unchanged (series\n2, image 85). A right periaortic lymph node at this level measures 5 x 6 mm,\npreviously 7 x 9 mm (series 2, image 84). Pelvic sidewall lymph nodes have\nenlarged examples include a left external iliac chain lymph node measures 10 x\n17 mm, previously 6 x 13 mm and a right iliac chain lymph node measures 17 x\n17 mm (previously 9 x 10 mm) (series 2, image 103, 107).\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There are diffuse sclerotic bony lesions scattered throughout the axial\nskeleton. A lesion of the right posterior iliac bone demonstrates increased\nlysis and cortical breakthrough (series 2, image 96), as demonstrated on prior\nlumbar spine MRI. A mild compression deformity of L4, is unchanged since this\nMRI.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diffuse osseous metastatic disease. Mild compression deformity of L4 is\nunchanged compared to prior lumbar spine MRI.\n2. Mixed response of lymphadenopathy. Retroperitoneal lymphadenopathy is\nstable or smaller, whereas pelvic sidewall lymph nodes have increased in size." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.8 cm simple cyst arising from the interpolar region of the left kidney is\nnot significantly changed. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There is a stable left renal cyst. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of metastatic disease in the abdomen or pelvis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is an area of focal fatty sparing in hepatic segment IV. No evidence of\nnew worrisome hepatic lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 7 mm left adrenal nodule, incompletely characterized,\nunchanged. The right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a hypodense lesion within the lower pole of the left kidney measuring\n1.9 cm, consistent with prior study and likely simple cyst. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. There is increased stool burden in the\nrectal vault. The appendix is normal.\n\nPELVIS: There is evidence of air within the urinary bladder, likely related to\nrecent instrumentation. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Evidence of air within the urinary bladder. Please correlate with any\nrecent history of instrumentation, otherwise consider urinalysis to rule out\ncystitis.\n3. Stable 7 mm left adrenal nodule, incompletely characterize, though\nstatistically likely to represent adenoma.\n4. For full description of intrathoracic findings, please refer to dedicated\nreport of CT chest performed on the same day.\n\nRECOMMENDATION(S): With the finding of air within the urinary bladder, please\ncorrelate with any recent history of instrumentation, otherwise consider\nurinalysis to rule out cystitis." }, { "input": "LOWER CHEST: Please refer to the separately dictated CT chest from the same\ndate for a full description of the intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a focal area of decreased attenuation adjacent to the\nfalciform ligament in hepatic segment IVB compatible with focal fat deposition\nand unchanged in comparison to the prior (5:59). The liver is otherwise\nunremarkable without evidence concerning focal lesion. There is no\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nunremarkable.\n\nPANCREAS: The pancreas demonstrates homogeneous attenuation throughout without\nevidence of concerning focal lesion, pancreatic ductal dilatation or\nperipancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation. No evidence of\nconcerning focal lesion.\n\nADRENALS: There is a 7 mm left adrenal nodule, similar in appearance in\ncomparison to the prior study dated ___. The left adrenal gland is\nunremarkable.\n\nURINARY: The kidneys are of normal and symmetric size. There is an unchanged\n2.2 cm cyst arising from the lower pole of the left kidney. No evidence of\nconcerning focal lesion. There is fullness of the bilateral ureters\nproximally without evidence of hydronephrosis. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is not well assessed on CT but appears grossly\nunremarkable. Oral contrast is seen in within the small bowel and proximal\ncolon. There is no evidence of bowel obstruction. The appendix is\nunremarkable. No ascites.\n\nPELVIS: The urinary bladder is minimally distended with fullness of the right\ndistal ureter. No free fluid in the pelvis. The visualized reproductive\norgans are unremarkable.\n\nLYMPH NODES: No evidence of lymphadenopathy within the abdomen and pelvis.\n\nVASCULAR: No abdominal aortic aneurysm. Mild calcified atherosclerotic plaque\nis seen.\n\nBONES: Mild multilevel degenerative changes are noted about the thoracolumbar\nspine and in the pelvis. No evidence of worrisome osseous lesion.\n\nSOFT TISSUES: The soft tissues of the abdominal and pelvic walls are within\nnormal limits.", "output": "1. No definite evidence of metastatic disease within the abdomen or pelvis.\n2. There is fullness of the proximal ureters bilaterally and in the right\ndistal ureter, which may be secondary to the mildly distended bladder. No\nevidence of abnormalities within the bladder or stones.\n3. Unchanged appearance of a 7 mm left adrenal nodule.\n4. Please refer to the separately dictated CT chest and nuclear medicine bone\nscan for full description of the intrathoracic and osseous findings." }, { "input": "Chest: Please refer to CT chest dated same ___ clip # ___\nfor complete intra thoracic findings.\n\nAbdomen: The liver enhances homogeneously. No focal lesion is identified.\nThere is no intrahepatic biliary dilatation. The portal veins are patent. The\ngallbladder is without radiopaque cholelithiasis. The pancreas, spleen, and\nbilateral adrenal glands are unremarkable. The kidneys present symmetric\nnephrograms and excretion of contrast. The right kidney is without focal\nlesions. Within the lower pole of the left kidney, there is a 1.5 cm cortical\nhypodensity most compatible with a simple cyst. A left extra renal pelvis is\nincidentally noted.\n\nThe stomach, duodenum, and loops of small bowel are unremarkable. The appendix\nis visualized, normal in appearance. The colon is normal in caliber. There is\nno retroperitoneal or mesenteric adenopathy.\n\nThe abdominal aorta demonstrates no aneurysmal dilatation. The celiac trunk,\nSMA, renal arteries, and ___ are patent and normal in caliber.\n\nPelvis: The bladder is moderately well distended and unremarkable. The pelvis\nand bilateral adnexa are normal in appearance. There is no pelvic free fluid.\nThere is no inguinal or pelvic sidewall adenopathy.\n\nOsseous structures: No suspicious lytic or blastic lesion is identified.", "output": "1. No intraabdominal or intrapelvic metastasis.\n2. Please refer to CT chest dated same ___ clip # ___ for\ncomplete intra thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Hyperdense left renal cyst. Subcentimeter interpolar left renal\nlesion appears hyperdense, too small to characterize. No nephrolithiasis or\nhydronephrosis.\n\nGASTROINTESTINAL: Unremarkable small large intestine.\n\nRETROPERITONEUM: No adenopathy.\n\nVASCULAR: Patent major vasculature.\n\nPELVIS: Normal rectum, uterus, adnexa, and bladder. No free fluid. No\nadenopathy.\n\nBONES AND SOFT TISSUES: No suspicious sizes lesion.", "output": "No evidence of metastases." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a tiny accessory spleen at the hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple small cysts in the left kidney, the largest measuring 1.8 cm cyst in\nthe interpolar region, are similar to prior. There is no evidence of focal\nsolid renal lesions or hydronephrosis. Extrarenal pelvis is present\nbilaterally. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Atelectasis noted in the lung bases. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is decompressed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\nwithin normal limits. There is minimal soft tissue thickening noted along the\ndistal rectum without evidence of a drainable fluid collection. The appendix\nis not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Hypodensities noted within the uterus, compatible with\npatient's current menstrual cycle.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Minimal soft tissue thickening is noted along the distal rectum without\nevidence of a drainable fluid collection." }, { "input": "LOWER CHEST: Aside from mild bibasilar atelectasis, visualized lung fields are\nwithin normal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is a large lobulated mass replacing most of the\nparenchyma measuring 10.3 x 14.3 cm, previously 13.1 x 11.0 cm on ___ MRI. The differences in size may be related to differences in imaging\nplane and technique. The mass occupies most of the left hepatic lobe with\nextension into the right. Previously mentioned capsular retraction is again\nnoted specially on the left lobe of the liver. The marked dilation of the\nintrahepatic bile ducts are more pronounced on today's exam when compared to\nprior (02:23), especially in the left lobe of the liver. The overall\nenhancement pattern of the hepatic mass is heterogeneous. A focus of calcific\ndensity in the middle of the mass is likely postprocedural from Y 90 treatment\nin ___.\nNear complete occlusion of the middle and left hepatic veins are again seen. \nThere is persistent occlusion of the left portal vein. The anterior and\nposterior right portal veins remain patent.\nPreviously described satellite lesion in segment VII is not well demonstrated\non today's exam. The common bile duct is not dilated. Fiducial is noted\nadjacent to the stomach. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Pancreatic cystic lesion is\nbetter seen on the MRI from ___. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities in bilateral kidneys are nonspecific, though\nlikely simple cysts. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (601:20).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, with multiple calcified fibroid\nuterus. No adnexal abnormality is seen.\n\nLYMPH NODES: Pre-existing multiple portacaval lymph nodes are more pronounced\non today's exam, though present since ___ (02:40). There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Left\ngluteus minimus lipomas are again noted.", "output": "1. No significant interval change in overall size and of the large\ncholangiocarcinoma which measures approximately 10.3 x 14.3 cm.\n2. Intrahepatic biliary ductal dilation likely reflects central malignant\nobstruction. Consider percutaneous biliary drainage.\n3. Persistent occlusion of middle and left hepatic veins as well as the left\nportal vein due to the tumor." }, { "input": "LOWER CHEST: Liver simple linear scarring in the left lower, otherwise\nvisualized lung fields are within normal limits. There is borderline\ncardiomegaly and coronary artery calcifications noted. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. There is severe\nfecal loading without evidence of bowel obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is levoconvex scoliosis and degenerative changes of the lumbar spine. \nSevere diffuse demineralization of the bones is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of pelvic lymphadenopathy. No acute intra-abdominal process.\n2. Large stool burden throughout the colon." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in the right middle lobe. \nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 4 mm nonobstructive calculus in the upper pole the right kidney\n(2:27 and 601:31). A 2 mm hypodensity in the interpolar region of left kidney\n(04:36) is too small to characterize. There is a mild soft tissue stranding\nalong the entire course of the left ureter. No hydroureter or hydronephrosis.\nNo ureteral calculi.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized but there is\nno secondary sign of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are unremarkable. There is a\ncentrally hypoattenuated focus measuring 1.4 x 1.7 cm in the right adnexa\n(4:72) which likely represents a physiologic corpus luteal cyst.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild periureteral soft tissue stranding along the entire course of the left\nureter. Given the diffuse nature of the stranding, these findings likely\nrepresent ureteritis from urinary tract infection.\n2. No evidence of hydronephrosis or obstructive nephrolithiasis.\n3. 4 mm nonobstructive calculus in the upper pole of the right kidney." }, { "input": "LOWER CHEST: There is a right basilar airspace opacity. The left lung is\nclear. There is no pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple liver hypodensities, many of which are too\nsmall to characterize. The largest measures 10 mm in segment II and is\ncompatible with a simple cyst. Gallbladder is decompressed. There is no\nintra or extrahepatic biliary duct dilation. There is no intra-abdominal\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically. There is no\nhydronephrosis. There are multiple renal hypodensities some of which are\nintermediate in density measuring up to 2.5 cm in the left midpole, which\nlikely represent simple or hemorrhagic/proteinaceous cysts, unchanged from\n___. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A nasoenteric tube enters the stomach. Stomach is mildly\ndilated and fluid-filled. Small bowel loops are fluid-filled and dilated up\nto 3.9 cm with a transition to decompressed loops of bowel just distal to the\nlower abdominal anastomosis (series 2, image 59; series 601b, image 19). \nThere is no intra-abdominal free fluid or free air. There is no pneumatosis. \nThe colon is decompressed. The appendix is not visualized but there are no\nsecondary signs of appendicitis in the right lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Low-density lesion along the posterior aspect of the\nuterus presents a fibroid as demonstrated on prior pelvic ultrasound.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes including grade 1 anterolisthesis of\nL2 on L3, not significantly changed from prior. Multiple sclerotic bony\nlesions statistically likely represent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. High-grade small bowel obstruction with transition just distal to the lower\nabdominal anastomosis. No evidence of free air or pneumatosis.\n2. Right lower lobe opacity, concerning for pneumonia.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 1:35 ___, 1 minutes after discovery of\nthe findings." }, { "input": "Included views of the lung bases are clear. There is no pericardial pleural\neffusion. The heart size is normal.\n\nThe hepatic density is within normal limits. No concerning hepatic mass is\ndetected. There is no intra or extrahepatic bile duct dilation. The\ngallbladder is normal.\n\nThe pancreas demonstrates normal density and bulk.\n\nThe spleen size is normal.\n\nThe adrenal glands and kidneys are normal.\n\nA small amount of food lies within the stomach, which is mildly distended, and\nappears normal (series 4 image 20). Intra-abdominal intrapelvic loops of\nsmall and large bowel are normal in caliber, without wall thickening.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy, and no ascites.\n\nThe abdominal aorta, celiac trunk, SMA, and renal arteries are patent and\nnormal in caliber.\n\nThe rectum and intrapelvic loops of small and large bowel are normal.\n\nThe bladder is normal.\n\nThe uterus is normal in size. No concerning adnexal masses are detected.\n\nThere is no intrapelvic lymphadenopathy or free fluid.\n\nThere are no osseous lesions concerning for malignancy or infection. Mild\ndegenerative changes are seen at the L1/2 disc space, with there is a vacuum\nphenomenon and disc space narrowing, with minimal endplate sclerosis (series 7\nimage 52).\n\nNo soft tissue mass is detected. There is a small fat containing\nsubcentimeter ventral hernia along the lower midline (series 4 image 63,\nseries 7 image 53), originating from a subcentimeter fascial defect\napproximately 6.7 cm inferior to the umbilicus (series 7 image 46).", "output": "Tiny fat containing ventral hernia approximately 6.7 cm inferior to the\numbilicus." }, { "input": "LOWER CHEST: There is a 6 mm pulmonary nodule in the right lung base and a 7\nmm subpleural nodule along the left lung base. No evidence of pleural effusion\nor pericardial effusion. Atherosclerotic calcifications are seen in the\ncoronary arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Accessory spleen is incidentally seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of symmetric size. There is no evidence of focal\nrenal lesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality. However, there may be mild thickening of the urothelial walls of\nthe proximal and mid ureters, and pyelonephritis cannot be definitively\nexcluded in a noncontrast enhanced exam. There is thickened and bulky\nappearance of the interpolar region of the left kidney, which is not\ncompletely characterized on this exam.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diffuse colonic diverticulosis\nis noted without evidence of acute diverticulitis. Otherwise, the remaining\nvisualized colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed. Metallic streak artifact limits\nassessment of the posterior bladder. There is no free fluid in the pelvis.\nSurgical clips are seen along the pelvic sidewalls.\n\nREPRODUCTIVE ORGANS: The prostate is removed.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status post right hip replacement. Metallic artifact from\nthe hip replacement causes limited assessment of adjacent structures,\nparticularly in the base of the bladder and distal ureters. There is a small\namount of fluid in the left hip, likely bursa. There is a slight contour\nabnormality of the S4 vertebrae, likely sequela of prior injury. There are a\ncouple of sclerotic foci in the lower thoracic spine, which may be bone\nislands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is thickened and bulky appearance of the interpolar region of the\nleft kidney, which is not completely characterized on this exam. Recommend\nfurther characterization with renal ultrasound.\n2. Bilateral pulmonary nodules, the largest measuring 7 mm in the left lung\nbase. Recommend dedicated CT Chest for further evaluation.\n3. Colonic diverticulosis is noted without evidence of acute diverticulitis.\n4. A few small sclerotic foci are seen in the lower thoracic spine, which may\nbe bone islands. Correlation with PSA is recommended.\n\nRECOMMENDATION(S): Recommend dedicated CT Chest for further evaluation of\npulmonary nodules.\nClinical correlation with PSA for scattered sclerotic osseous foci is\nrecommended.\n\nNOTIFICATION: The updated final read and recommendations were emailed by\n___ at 9:39 AM on ___." }, { "input": "LOWER CHEST: Partially imaged bibasilar opacities are better seen on same-day\nchest CT.\n\nABDOMEN: The liver is normal in attenuation without focal lesions. There is\ntrace perihepatic ascites. There is no intra or extrahepatic biliary duct\ndilation. The spleen, adrenal glands, and pancreas are unremarkable. There\nis no hydronephrosis. There is a simple cyst in the upper pole of the left\nkidney measuring 3.9 cm. No obstructing renal stones are seen.\n\nThe distal esophagus is normal without a hiatal hernia. Small bowel is normal\nin caliber without focal wall thickening. There is extensive diverticulosis\nof these sigmoid colon. There is focal colonic wall thickening at the hepatic\nflexure with surrounding fat stranding centered at this level (series 601b,\nimage 30). This is in the region of diverticula seen on prior CT scan from\n___. The gallbladder is distended with surrounding stranding which is\nlikely secondary to a primary colonic process. Normal appendix.\n\nThe abdominal aorta is ectatic measuring up to 3.8 cm in its infrarenal\nportion. There is moderate atherosclerotic calcification. There are no\nenlarged mesenteric, retroperitoneal, pelvic sidewall, or inguinal lymph\nnodes. There is no intra-abdominal free air.\n\nPELVIS: The bladder is distended and contrast filled. There is no pelvic\nfree fluid.\n\nOSSEOUS STRUCTURES/SOFT TISSUES: There are no suspicious bony lesions. There\nis no soft tissue abnormality.", "output": "1. Right-sided diverticulitis at the hepatic flexure with secondary\ninflammatory change surrounding the gallbladder. No drainable fluid\ncollection or extraluminal air.\n2. Focal infrarenal abdominal aortic aneurysm measuring 3.8 cm." }, { "input": "LOWER CHEST: New, nonhemorrhagic, right pleural effusion with adjacent right\nlower lobe atelectasis. Focal opacity in the left lower lobe likely reflects\nan additional focus of atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nFocal hyperenhancement adjacent to the gallbladder suggests mild hyperemia. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nThere are no visible gallstones. The gallbladder remains distended with a\nshaggy wall and increased pericholecystic fat stranding suggestive of acute\ncholecystitis. There is a new lentiform fluid collection in the subcapsular\nspace and a new, small fluid collection in the subhepatic space with a mildly\nhyperenhancing border.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. 3.9 cm cyst in the upper pole of the\nleft kidney is reidentified. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The walls of the second and\nthird portions of the duodenum are hypoattenuating and thickened, consistent\nwith new, mural edema likely secondary to the adjacent inflammatory process in\nthe gallbladder and hepatic flexure. Remaining small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Interval decrease\nin wall thickening of the hepatic flexure and adjacent fat stranding suggest\nimproving right-sided colitis. There is extensive diverticulosis in the\nsigmoid and descending colon. The remaining colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles appear unremarkable\nwithin the limitations of CT technique.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is moderate atherosclerotic disease of the abdominal aorta\nwith focal ectasia of the infrarenal segment measuring up to 3.8 cm in\ndiameter, consistent with known abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes throughout the spine, most pronounced at L1-L2.\n\nSOFT TISSUES: There is new, minimal subcutaneous edema in the lateral\nabdominal wall.", "output": "1. Acute cholecystitis with new subcapsular and subhepatic fluid collections. \nRecommend further evaluation with targeted ultrasound and consideration of\npercutaneous cholecystostomy.\n2. Interval improvement in right-sided colitis.\n3. Interval development of enteritis involving the second and third portions\nof the duodenum, likely secondary to adjacent inflammatory process in the\ngallbladder and hepatic flexure.\n4. New, small, nonhemorrhagic right pleural effusion with adjacent right lower\nlobe atelectasis.\n5. Infrarenal abdominal aortic aneurysm measures up to 3.8 cm in diameter.\n\nRECOMMENDATION(S): Targeted ultrasound for further evaluation of the\ngallbladder. Consider percutaneous cholecystostomy.\n\nNOTIFICATION: The findings and recommendations were discussed by Dr. ___\n___ with Dr. ___ on the telephoneon ___ at 12:40 ___, 10 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: There is a moderate right pleural effusion with adjacent\natelectasis, unchanged compared to the prior exam.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is a percutaneous cholecystostomy\ntube in good position. A subcapsular fluid collection adjacent to hepatic\nsegment 8 measures 6.2 by 1.8 cm in maximum transaxial ___ compared to\na prior of 7.1 x 1.3 cm and has decreased in size. Another loculated\nsubhepatic fluid collection (Series 2, image 38) measures 6.4 by 2.9 cm\ncompared to a prior measurement of 8.1 x 4.3 cm and has also decreased in\nsize.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 4.1 cm simple cyst in the upper pole of the left kidney. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe entire colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. 8 mm ovoid calcification in the\nleft hemipelvis (series 2, image 85) is likely benign and represents sequela\nof an infarcted diverticulum or and appendix epiploica.\n\nVASCULAR: There is fusiform dilatation of the infrarenal abdominal aorta\nmeasuring up to 3.5 Cm. Moderate atherosclerotic calcified plaque is present.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Percutaneous cholecystostomy tube is in good position within a decompressed\ngallbladder.\n2. Perihepatic fluid collections have decreased in size compared to prior\nexamination, as detailed above. No new collections.\n3. Extensive diverticulosis without acute diverticulitis.\n4. Fusiform dilatation of the infrarenal abdominal aorta measuring up to 3.5\ncm" }, { "input": "LOWER CHEST: There is mild dependent atelectasis. Moderate to severe coronary\ncalcifications are noted. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is trace intrahepatic biliary\nductal dilatation, not unexpected status-post cholecystectomy. No significant\nextrahepatic biliary ductal dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 4.6 x 4.1 cm simple cyst arises from the upper pole of the left kidney. \nAdditional bilateral hypoattenuating lesions are too small to completely\ncharacterize, but likely reflect additional simple cysts. No hydronephrosis\nor perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening. Adjacent to\nthe sigmoid colon and abutting the anterior abdominal wall, there is a 2.5 x\n0.9 cm fatty structure with a dense rim and adjacent fat stranding (series 2,\nimage 58). More posteriorly within the left lower quadrant mesentery, there\nis a peripherally calcified structure, almost certainly the sequela of prior\nepiploic appendagitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is top normal in size.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is an infrarenal abdominal aortic aneurysm measuring 3.5 x 3.4\ncm. Mild atherosclerotic disease is noted. Incidental note is made of an\naccessory or replaced left hepatic artery arising from the left gastric\nartery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild lumbar spine degenerative changes including posterior disc\nbulges or protrusions which result in mild spinal canal narrowing, most\nprominent at L3-L4 and L4-L5.\n\nSOFT TISSUES: There are fibrotic changes in the midline anterior abdominal\nwall suggesting prior laparotomy.", "output": "1. Epiploic appendagitis in the anterior left lower quadrant.\n2. 3.5 cm infrarenal abdominal aortic aneurysm.\n3. Diverticulosis." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No focal consolidations. No pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneously hypodense, likely representing\nsteatosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is extremely enlarged and lobulated in\nappearance, compatible with multiple fibroids, some of which appear rim\ncalcified. No adnexal masses are visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild diastasis of the rectus abdominus. 3.3 x 2.7 cm\nwell-circumscribed cystic lesion within the subcutaneous tissues overlying the\nleft gluteal cleft, likely a sebaceous cyst (series 2, image 26).", "output": "1. No acute abnormalities within the abdomen or pelvis. No evidence of\ndiverticulitis.\n2. The uterus is extremely enlarged and lobulated, compatible with multiple\nfibroids, some of which appear rim calcified.\n3. Other incidental findings include hepatic steatosis and a likely 3.3 cm\nsebaceous cyst within the left gluteal cleft." }, { "input": "LOWER CHEST: There is subsegmental bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild extrahepatic biliary\ndilation measuring up to 10 mm in the pancreatic head, likely secondary to\npost cholecystectomy state. The gallbladder is surgically absent.\n\nPANCREAS: Pancreas is atrophic without evidence of focal lesions or pancreatic\nductal dilation. There is no peripancreatic stranding. Surgical clips are\nnoted near the tail the pancreas.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable aside for simple cysts are noted in the\nleft kidney the largest of which arises from the lower pole measures up to 3.3\ncm.\n\nGASTROINTESTINAL: No bowel obstruction. Status post appendectomy. Oral\ncontrast is seen to the level of the sigmoid colon. Changes of possible bowel\nresections are noted.\n\nPELVIS: There is no free fluid in the pelvis. Diminutive bladder calculi are\nnoted measuring up to 2 mm in the dependent aspect.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. A\ncalcified periportal lymph node versus a dropped gallstone is noted. There is\nno pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSpinal fusion hardware extends from level of T12 through L3. There are\ndegenerative changes of the visualized portion of the thoracolumbar spine. \nThere is grade 1 retrolisthesis of L3 on L4 and L5 on S1.\n\nSOFT TISSUES: Abdominal wall hernia containing part of the small bowel loop is\nseen in the mid anterior abdomen.", "output": "Diminutive bladder calculi. Otherwise, no CT findings to explain abdominal\npain." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are numerous targetoid hypoenhancing lesions throughout\nthe liver, likely representing metastatic disease. The largest representative\nlesion within segment VII measures 2.4 x 2.0 cm (series 5, image 47). There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: There is a triangular-shaped fat containing lesion within the head\nof the pancreas measuring approximately 1.9 x 1.5 cm (series 5, image 69),\nlikely a intrapancreatic lipoma. Otherwise, pancreas has normal attenuation\nthroughout, without pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There are 2 subcentimeter hypodensities within the spleen (series 5,\nimage 48, 54), which are indeterminate, but in the setting of a known\nmalignancy are concerning for metastatic disease.\n\nADRENALS: There is a solid 2.2 x 1.7 cm left adrenal nodule, which is also\nindeterminate, but concerning for metastatic disease. The right adrenal gland\nis normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Incidental\nnote is made of an extrarenal pelvis on the right. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is normal in appearance. The ovaries are\nnormal in appearance bilaterally. No adnexal masses are visualized.\n\nLYMPH NODES: There is a lymph node adjacent to the left adrenal gland, which\nonly measures 5 mm in short axis, but is suspicious in morphology (series 5,\nimage 53). There is no other retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are numerous lytic lesions throughout the lumbar spine (series\n9, image 34, 37, series 5, image 36). There appears to be a pathologic\nfracture through the inferior endplate of L3 with less than 25% loss of height\nand no retropulsion. There is also a destructive lesion of the left pubic\nsymphysis (series 5, image 112).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Numerous targetoid hypoenhancing lesions within the liver, measuring up to\n2.4 cm within segment VII, consistent with metastatic disease.\n2. Left adrenal nodule measuring up to 2.2 cm, which is indeterminate, but\npotentially concerning for metastatic disease. There is an adjacent\nsubcentimeter lymph node, which is nonenlarged, but morphologically abnormal\nand suspicious.\n3. 2 additional subcentimeter hypodensities within the spleen, which are\nindeterminate, but also concerning for metastatic disease.\n4. Numerous lytic lesions throughout the lumbar spine and pubic symphysis,\nwith a pathologic fracture through the inferior endplate of L3.\n5. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: The lung bases are clear with the exception of bibasilar\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There are multiple hypoattenuating nodules in the left adrenal\ngland, which are indeterminate. This may reflect nodular hyperplasia. The\nright adrenal gland is also thickened.\n\nURINARY: The left kidney has a slightly delayed nephrogram in appears mildly\nedematous with perinephric stranding. There is a large stone in the left\ninferior pole collecting system measures up to 16 mm (601:31). There is\nmoderate left hydroureteronephrosis, and a 3 mm obstructing stone in the\ndistal left ureter (2:63). There are multiple bilateral renal cysts,\nmeasuring up to 8.6 cm at the left superior pole. The right kidney is\nnormally enhancing with no hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient is\npost anterior perineal resection. There is a left lower quadrant colostomy\nwith an extremely large parastomal hernia containing nonobstructed loops of\ncolon. Near the superior portion of the hernia sac, there is moderate\nstranding and 2 prominent mesenteric lymph nodes (02:43). The appendix is not\nseen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is normal in size (series 602 image 36). No\nadnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is severe atherosclerotic disease involving the abdominal\naorta. The infrarenal aorta is severely narrowed by noncalcified\natherosclerotic plaque. There is likely a focal dissection (02:42). The left\ncommon iliac is completely occluded with reconstitution of the left common\nfemoral vein. The right common iliac is severely narrowed, with a patent but\nmoderately stenotic external iliac.\n\nBONES: There is a compression fracture of T12, of indeterminate chronicity. \nThis has mild retropulsion causing mild canal stenosis. No aggressive osseous\nlesions are seen.\n\nSOFT TISSUES: See above for description of the parastomal hernia.", "output": "1. Moderate left hydronephrosis with an obstructing 3 mm calculus in the\ndistal left ureter.. A calculus in the left lower pole measuring up to 16 mm\nlikely obstructs the left lower pole calyx.\n2. Large parastomal hernia containing nonobstructed loops of colon. There is\nnarrowing the colonic loops as they enter/exit the parastomal hernia, but\nthere is no upstream dilatation.\n3. Mild fat stranding and prominent mesenteric lymph nodes in the upper\nportion of the parastomal hernia sac is nonspecific, but could be related to\ninflammation and/or necrosis of the mesenteric fat.\n4. Severe atherosclerotic disease, with severe stenosis of the infrarenal\naorta and occlusion of the left common iliac artery which is almost certainly\nchronic, as collaterals fill the left common femoral artery. The right common\niliac artery is severely narrowed, with moderate stenosis of the external and\ncommon femoral arteries.\n5. Compression fracture of the T12 vertebral body is of indeterminate\nchronicity, as there are no priors to compare to. Recommend correlation with\nneurologic exam and clinically indicated, MRI can be performed to further\ncharacterize this fracture and spinal canal involvement." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural effusion. Trace pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: An area of relative hypodensity is demonstrated in segment 4B\n(series 5, image 27), correlating with the hyperechoic region on previous\nultrasound and most likely representing focal fatty infiltration. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits. A small amount of perihepatic ascites is noted. A\nsubcentimeter hypodensity in the right hepatic lobe is likely a hepatic cyst.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. A 1.6 cm\nhypodensity in the spleen is likely a cyst or hemangioma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is minimal soft tissue\nprominence at the esophagogastric junction. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Peritoneal\nthickening with hyper enhancement along the posterior pelvis as well as a\nmoderate amount of free fluid is seen in the pelvis.\n\nREPRODUCTIVE ORGANS: Prominent left adnexal tissue measuring approximately 5.2\nx 3.0 x 2.8 cm may represent ovarian primary versus peritoneal thickening.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: The level degenerative changes with mild spurring and intervertebral\ndisc space loss noted.There is increased sclerosis of the T11-T12 and L5-S1\nendplates.\n\nSOFT TISSUES: Omental infiltration and nodularity along the lower abdomen is\nnoted.", "output": "1. Peritoneal thickening and enhancement in the lower pelvis associated with\nfree fluid, perihepatic ascites and omental caking concerning for peritoneal\ncarcinomatosis.\n2. Soft tissue prominence in the left adnexa may represent ovarian primary\nversus peritoneal thickening.\n\n3. Minimal prominence of the esophagogastric junction is also demonstrated,\nnonspecific.\n\nNOTIFICATION: #1 and 2 of impression and recommendation above was entered by\nDr. ___ on ___ at 12:10 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Please see separately dictated CT chest report.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 2.4 cm lesion segment 7 right hepatic lobe, which\nhas decreased compared with 3.6 cm on ___, is not as well seen on ___. There is an indeterminate 1.0 cm lesion segment 4A left\nhepatic lobe, possibly present on ___ exam. . The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly measuring 16.7 cm, similar compared with ___.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Mild bilateral\nperinephric stranding is stable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nwall thickness, and enhancement throughout. There are multiple contrast\nfilled proximal, mid small bowel loops, with decompressed ileal, including\nterminal ileum, globes. Transition point is in the low central pelvis image\n101 114. There is trace adjacent mesenteric fluid. The colon and rectum are\nwithin normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder has been surgically excised. There is presence of\nileal conduit located in the right lower pelvis. Metal artifact partially\ncompromises evaluation of the pelvis. There are numerous surgical clips in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nMildly prominent bilateral inguinal lymph nodes, with preserved fatty hila,\nfavoring reactive etiology.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild thoracolumbar degenerative disease. Right total hip arthroplasty. \nStable acute fractures of the right twelfth rib, right L1 transverse process. \nThere is degenerative arthritis in bilateral sacroiliac joints, left hip\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Left lower lobe consolidative airspace opacities are concerning for pneumonia.\nThere is partial small bowel obstruction, transition point in the pelvis. \nTrace mesenteric fluid.\nIndeterminate 2 hepatic lesions, 1 decreased since ___, second lesion\npossibly present in ___.\nMildly prominent bilateral inguinal lymph nodes, with fatty hila, favoring a\nreactive etiology.\nStable acute fractures right twelfth rib, right L1 transverse process.\n\nNOTIFICATION: Findings were conveyed to Dr. ___ on ___ at\n___, by Dr. ___ 30 minutes after discovery." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.", "output": "1. No cause is identified to explain the patient's weight loss." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusions seen.\n\nABDOMEN: The liver enhances normally without concerning focal lesion. \nGallbladder is normal. Main portal vein is patent. No biliary ductal\ndilation. Spleen is normal. Adrenals are normal. The pancreas is normal. \nThe kidneys enhance symmetrically. No hydronephrosis or worrisome renal\nlesion. The abdominal aorta is normal in course and caliber. No adenopathy\nor free air. The stomach and duodenum appear normal.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix is abnormal with dilation along the mid segment measuring up to\n11 mm, series 2 image 45 through 51. There is very minimal ___ pannus seal\nfat stranding. Findings are concerning for early acute appendicitis. The\ncolon is unremarkable. Trace free fluid is noted. Urinary bladder is only\npartially distended though appears normal. No pelvic sidewall or inguinal\nadenopathy.\n\nBONES: Unremarkable.", "output": "Early acute appendicitis, uncomplicated." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is asymmetric enlargement of the right kidney with obscuration\nof the sinus fat compared to the contralateral side. There is no evidence of\nfocal renal lesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is distended. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Asymmetric enlargement of the right kidney with obscuration of the sinus\nfat, a nonspecific finding, but pyelonephritis is not excluded. Recommend\ncorrelation with clinical exam and laboratory values.\n2. No evidence of hydronephrosis or urolithiasis.\n3. Distended bladder.\n4. Normal appendix." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver demonstrates very low density, consistent with fatty\ndeposition. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: Fat stranding and tiny fluid collection are seen adjacent to the\ntail of the pancreas, consistent with acute pancreatitis. No large areas of\nnonenhancement or ductal dilatation are seen in the pancreas to suggest\nnecrosis. The adjacent vessels are unremarkable on this exam. Small\nhypoenhancing foci in the tail of the pancreas may represent IPMNs or foci of\nfluid. There is associated thickening of the anterior perirenal fascia.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Fat stranding and tiny fluid collection adjacent to the tail of pancreas,\nconsistent with acute pancreatitis. No areas of nonenhancement or ductal\ndilatation are seen in the pancreas.\n\n2. No imaging evidence of diverticulitis.\n\n3. Diffusely low attenuation liver is consistent with hepatic steatosis. \nSteatohepatitis and more significant diffuse liver disease cannot be excluded\nbased on imaging." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 2.7 cm\nexophytic iso-attenuating lesion in the right upper renal pole, which is\nincompletely characterized on this exam. A smaller indeterminate 1.6 cm\nlesion is noted in the right lower renal pole. There is a punctate\nnonobstructive stone in the left kidney. There is no hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL:Patient is status post gastric bypass. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: In the lower abdominal ventral wall, there is a large discrete\nmildly complex fluid collection measuring 20.8 x 6.7 x 8.6 cm (TV x AP x SI)\nsuperficial to the surgical plane as indicated by surgical clips, which may\nrepresent seroma with hemorrhagic or proteinaceous debris (2: 74 and 602: 45).\nPatient has bilateral breast implants.", "output": "1. 20.8 x 6.7 x 8.6 cm fluid collection in the subcutaneous tissues of the\nlower anterior abdominal wall superficial to the surgical mesh is likely a\nseroma or postsurgical collection. There is no evidence of a ventral\nabdominal wall hernia.\n2. Indeterminate exophytic right renal rounded lesions measuring up to 2.7 cm\nin size need additional evaluation by renal MRI.\n\nRECOMMENDATION(S): A dedicated renal MRI can for better evaluation of the\nindeterminate exophytic right renal lesions." }, { "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): isoattenuating\nSize (maximal axial dimension in cm): 3.1 cm.\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent\nBiliary tree abrupt cutoff with or without upstream dilatation: absent\n\nArterial evaluation\n\nSMA involvement: present\nSolid soft-tissue contact: ?180\u00b0\nIncreased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: present\nSolid soft-tissue contact: ?180\u00b0\nIncreased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: absent\n\nVariant anatomy: accessory left hepatic artery arises from left gastric.\n\nVenous evaluation\n\nMPV involvement: absent\n\nSMV involvement: present\nDegree of solid soft-tissue contact: ?180\u00b0\nDegree of increased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein: absent\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: celiac node measures 0.6 x 1.3 cm (03:53)\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm. There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion. Calcification is heavy in aortic valve,\nmitral valve annulus, and coronary arteries.\n\nABDOMEN:\n\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. Gallbladder contains gallstones without wall\nthickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Enlarged spleen measures 16.6 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A 0.9 cm hypodense lesion in the upper pole left kidney is too small\nto be characterized. There is no hydronephrosis. Bilateral nephrogram is are\nsymmetric.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colonic diverticulosis is noted. Appendix is not\nvisualized.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: A bladder diverticulum is noted in left anterior bladder wall. There\nis no evidence of pelvic or inguinal lymphadenopathy. There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\nCalcification is noted at the vas deferens.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nsmall sclerotic lesion in right ischial tuberosity is probably a bone island.\nOld fractures are noted in multiple left ribs.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. A 3.1 cm pancreatic mass comes in contact with SMV, SMA, and celiac axis.\n2. Colonic diverticulosis.\n3. Cholelithiasis.\n4. Splenomegaly." }, { "input": "LOWER CHEST:\n\nThere is no evidence pulmonary nodule or mass in the visualized lung bases.\nThere is no pleural or pericardial effusion.\n\nAbdomen/pelvis:\n\nEvaluation of abdominal and pelvic organs is limited due to lack of\nintravenous contrast. The liver is grossly unremarkable. There is no\nintrahepatic or extrahepatic biliary ductal dilatation. There are postsurgical\nchanges consistent with cholecystectomy.\n\nThe spleen is not enlarged. Pancreas is grossly unremarkable without evidence\nof pancreatic ductal dilatation.\n\nThere is unchanged nodularity of the left adrenal gland. Unchanged 7 mm right\nupper pole cortically based lesion measuring fat density is consistent with\nangiomyolipoma. Kidneys are symmetric in size. There is no evidence of\nhydronephrosis. Urinary bladder is mildly distended without gross abnormality.\n\nThere are postsurgical changes consistent with gastric bypass surgery with\nunchanged partial herniation of the gastric pouch through the hiatal hernia.\nThere is a prominent loop of small bowel in the midline mid to lower abdomen\nmeasuring up to 4.4 cm in diameter consistent with anastomosis site. There is\nno bowel wall thickening. There is no evidence of obstruction. There is no\nintraperitoneal free air or free fluid.\n\nThere is atherosclerotic calcification of the mid to distal abdominal aorta.\nThere are no enlarged inguinal, iliac, retroperitoneal, or mesenteric lymph\nnodes.\n\nThere is no suspicious osseous lesion. There are degenerative changes of the\nlower thoracic and lower lumbar spine. There is a small fat containing hernia\nof the midline abdominal wall of the approximate level of the umbilicus.\nUnchanged 1.3 cm soft tissue density in the left posterior para midline\nsubcutaneous fat likely represents sebaceous cyst.", "output": "1. Postsurgical changes consistent with gastric bypass including unchanged\nmild herniation of gastric pouch through hiatal hernia.\n2. Small fat containing midline abdominal hernia at the approximate level of\nthe umbilicus.\n3. Unchanged left adrenal nodule." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There is a suggestion of a\ninvoluting hemorrhagic cyst in the left ovary (601:28)\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Small amount of high-density material in the cul-de-sac which could be\ncompatible with a ruptured hemorrhagic cyst which is suspected in the left\novary. No other findings to explain symptoms." }, { "input": "LOWER CHEST: There are airspace in the right lung base, which may represent\natelectasis or aspiration. Calcified granuloma is noted in the right base. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is distended without\nevidence cholelithiasis. There is mild periportal edema. There is a small\namount of simple free fluid in the right upper quadrant, likely reactive.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a duplicated collecting system in the right kidney, the 2\nureters unite at the level of the mid to distal ureter. There is moderate\nright obstructive hydroureteronephrosis due to a 3-4 mm renal stone in the\ndistal ureter, near the right UVJ junction (series 2: Image 74 and series 601:\nImage 39). Heterogenous enhancement in the upper pole moiety of the right\nkidney may reflect pyelonephritis (series 601: Image 43). There is a mildly\ndelayed nephrogram in the right kidney compared to the contralateral side. \nRelatively large amount of perinephric stranding and fluid is suggestive of\nforniceal rupture.\n\nMultiple subcentimeter hypodensities are seen scattered throughout the\nbilateral kidneys, the largest measuring up to 9 mm in the left lower renal\npole, most of which are too small to fully characterize but likely\nrepresenting small simple cysts. The left kidney is normal without evidence\nof focal renal lesions or hydronephrosis in the left kidney. There is no\nperinephric fluid collection bilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid is noted in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbosacral spine with\nretrolisthesis of the L2-L3, L3-L4, L4-L5, and L5-S1 vertebral levels.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is mild to moderate right obstructive hydroureteronephrosis due to a\n3-4 mm renal stone distal ureter, near the right UVJ junction. Patient has a\nduplex collecting system in the right kidney however the unite distally and\nboth moieties are obstructed. Heterogenous hypoenhancement in the upper pole\nmoiety of the right kidney may reflect pyelonephritis.\n2. Perinephric fat stranding and perinephric fluid suggestive of forniceal\nrupture.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:30 am, 1 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nABDOMEN: There is prior lipiodol deposition in the segments ___. The liver\ndemonstrates nodular contours, compatible with known cirrhosis. Patient is\nstatus post TACE for the segment 6 lesion with expected posttreatment changes.\n\nThe unenhanced gallbladder, pancreas, spleen, kidneys, adrenal glands are\nunremarkable.\nThere is no evidence of bowel obstruction in the upper abdomen.\n\nThere are stable prominent periportal (series 2: Image 25) and peripancreatic\nlymph nodes, possibly reactive.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "Expected post-treatment changes are seen in hepatic segment VI." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post cholecystectomy and en bloc\nresection of the gallbladder fossa. A 1.2 cm well defined hypodensity is seen\nin segment 7 of the liver, stable compared to previous and likely representing\na small cyst or biliary hematoma. The remaining liver parenchyma demonstrates\nno focal lesions within the limitations of an unenhanced scan. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. Moderate amount\nof free fluid is seen surrounding the liver. A right-sided percutaneous drain\nis seen with its tip below the liver.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. An enteric tube is seen with\nits tip curled at the gastric fundus. Dilated fluid filled loops of small\nbowel are seen in the left upper quadrant. A very gradual transition is seen\nin the mid abdomen (2:72 - 75). The more distal small bowel is partially\ncollapsed but stool is seen within the colon. Moderate diverticulosis is\nnoted in the sigmoid and descending colon. The appendix is normal.\n\nPELVIS: The bladder is collapsed and contains a Foley catheter. Minimal free\nfluid is seen within the pelvis, likely physiologic.\n\nREPRODUCTIVE ORGANS: Calcified fibroids are seen within the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a old compression fracture of the T11 vertebral body.\n\nSOFT TISSUES: An abdominal wall incision is noted with cutaneous staples.", "output": "1. Status post open cholecystectomy and en bloc resection of the gallbladder\nfossa. There is moderate free fluid surrounding the liver.\n2. Dilated loops of proximal small bowel in the left upper quadrant. There is\na very gradual transition and fluid is seen within more distal bowel loops. \nFindings are in keeping with ileus rather than obstruction.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:33 ___, 20 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Multiple loops of small bowel are fluid-filled and mildly\ndilated up to 3.2 cm in diameter, within normal caliber distal ileum and large\nbowel. There is no evidence of pneumatosis, focal hypoperfusion, or\npneumoperitoneum. The appendix is fluid-filled and measures 9 mm in diameter\n(2:70), but without evidence of adjacent fat stranding.\n\nRETROPERITONEUM: Multiple prominent mesenteric and retroperitoneal lymph nodes\nare not pathologically enlarged by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. Trace free fluid is noted\nwithin the pelvis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.", "output": "1. Multiple loops of mildly dilated fluid-filled small bowel with normal\ncaliber distal ileum and large bowel, without discrete transition point. \nFindings likely represent a functional ileus in the setting of\ngastroenteritis.\n2. Fluid-filled and mildly dilated appendix measuring 9 mm diameter. \nHowever, no appreciable adjacent inflammatory changes are identified to\ndefinitively suggest acute appendicitis.\n3. Minimal, simple pelvic free fluid.\n4. Hepatic steatosis.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ Dr. ___ at 03:45 on ___." }, { "input": "LOWER CHEST: Minimal atelectasis is present in the bilateral lung bases. \nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter bilateral renal hypodensities are too small to characterize,\nstatistically most likely represent cysts. There is no evidence of\nnephrolithiasis or perinephric abnormality bilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are\nfluid-filled throughout, with no evidence of mechanical obstruction. The\nmucosa of the small bowel is somewhat hyper enhancing diffusely. The colon\nand rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Non-dilated small bowel loops are fluid-filled with mild mucosal hyperemia\nwhich could be related to mild enteritis.\n2. Otherwise, no acute pathology in the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild prominence of the CBD\nmeasuring up to 9 mm, at the upper limits for the patient's age. No\nobstructive lesions identified. There are a few small stones in the\ngallbladder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal. There is a 1.4 cm left adrenal\nnodule, indeterminate on a contrast enhanced CT.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple left renal cysts, the largest being a mildly complex cyst at the\nupper pole of the left kidney measuring up to 7 cm, containing a thin internal\nseptation. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Chronic appearing mild T11 and L4 compression deformities due to\nprominent Schmorl's nodes. Bilateral dynamic hip screws.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal pathology. Appendix not visualized.\n2. Slightly complex 7 cm left renal cyst, containing a thin internal\nseptation. Follow-up renal ultrasound in ___ months is recommended.\n3. 1.4 cm left adrenal nodule, determine on this contrast enhanced CT. See\nbelow for recommendations.\n\nRECOMMENDATION(S): Follow-up renal ultrasound in ___ months is recommended\nto document stability of the left renal cyst.\n\nIncidentally discovered adrenal lesion without prior studies for comparison\nmeasuring 1-2 cm. If there is no history of malignancy, this is probably\nbenign. Follow up dedicated adrenal CT in 12 months could be considered. If\nthere is a history of malignancy, a dedicated adrenal CT is recommended.\n\nRecommendations based on ___ ACR guidelines:\n___" }, { "input": "LOWER CHEST: Ill-defined linear branching opacities in right lower lobe are\nminimally changed from outside hospital CT torso ___ and could\nrepresent scarring versus atelectasis versus changes related to chronic\naspiration. There is a calcification of the aortic valve and dense\ncalcification of coronary arteries. There is no pericardial or pleural\neffusion\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. There is a\nhypoattenuated rounded focus in the inferior aspect the spleen measuring 1.3\ncm (series 2:30), minimally changed from ___ in likely represents\nsimple cyst.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small axial hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. The colon and rectum are within normal limits. The appendix is\nnot visualized. Surgical clips noted right lower quadrant.\n\nPELVIS: Limited by streak artifact from right total hip arthroplasty. There\nare punctate calcifications in the left posterior aspect of the bladder\n(series 2:81) Bladder is unremarkable.. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post posterior fusion of L5 and S1. There is\nanterolisthesis of L5 over S1 and arthrodesis of L4 and L5, minimally changed\nas compared to CT ___.\n\nSOFT TISSUES: There is stranding of the subcutaneous tissues of the anterior\nabdominal wall midline with surgical staples, likely postoperative. There is\nno evidence of a fluid collection.", "output": "1. No acute abnormality in the abdomen or pelvis to explain patient's reported\nabdominal pain. No evidence of an abscess.\n2. No obstruction.\n3. Stranding of the subcutaneous tissues of the anterior abdominal wall at\nmidline which is likely postoperative. There is no evidence of a fluid\ncollection." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality. Hypodensity at the inferior margin of the images (series 2;\nimage 56) likely represents the dome of the bladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. Partially visualized loops of\nsmall large bowel are unremarkable. There is no mesenteric collection\nidentified.\n\nLYMPH NODES: There is no abdominal lymphadenopathy identified.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "No etiology identified for nausea or vomiting. No left upper quadrant\ncollection identified." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN: The liver, spleen, pancreas adrenal glands and kidneys are\nunremarkable except for a stable 1.7 cm left renal angiomyolipoma. \nCholecystectomy changes and dropped clip are redemonstrated.\n\nGASTROINTESTINAL: There is no intestinal obstruction. The appendix is normal.\n\nPELVIS: Fibroid uterus is decreased in size with improved postoperative\nchanges. The adnexa are unremarkable on CT for age. Again seen are adhesions\nwithin the anterior uterus and pelvic wall.\n\nLYMPH NODES: There are a few nonspecific aortocaval lymph nodes measuring up\nto 0.8 cm. A few prominent pelvic lymph nodes are stable, for instance right\nobturator measuring 0.8 cm in short axis, stable. No enlarged mesenteric\nlymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Rectus diastasis is noted.Stable 9 mm posterior right breast\nnodule.", "output": "1. No enlarged abdominal or pelvic lymph nodes.\n2. Fibroid uterus with improved postoperative changes.\n3. Stable size of left renal angiomyolipoma." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAgain seen is a 1.6 x 1.4 cm, previously 1.7 x 1.5 cm, lesion in the lower\npole of the left kidney compatible with a renal angiomyolipoma, as previously\ndescribed. There is no evidence hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Heterogeneous fibroid uterus is again noted.\n\nLYMPH NODES: Again seen are multiple subcentimeter aortocaval and pelvic\nsidewall lymph nodes, similar to the prior study.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Subcentimeter retroperitoneal and pelvic lymph nodes, similar to the prior\nstudy from ___.\n2. Fibroid uterus.\n3. Stable left renal angiomyolipoma." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThe no hydronephrosis. A 1.6 x 1.8 cm AML in the lower pole of the left\nkidney is grossly stable in size and appearance compared to the prior exam. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and contains fibroids. A right\nadnexal cyst measures up to 3.3 cm, new from prior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. Multiple small retroperitoneal and\npelvic lymph nodes are not pathologically enlarged and are overall similar in\nsize and number compared to the prior exam.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Rectus diastasis and a small fat containing umbilical hernia are\nnoted.", "output": "1. No abdominal or pelvic lymphadenopathy.\n2. Unchanged left renal angiomyolipoma.\n3. Please refer to report from concurrent CT chest for description of findings\nabove the diaphragm." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver is significantly enlarged.A 7 x 7 mm hypodense lesion\nin segment 7 of the liver is likely a hemangioma but is indeterminant. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is significantly enlarged at 23 cm with a large area of\nhypoattenuation in the inferior portion of the spleen is consistent with\ninfarction.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple bilateral small areas of wedge-shaped hypoattenuation within\nthe kidneys are consistent with small infarcts and areas of ischemia, most\nprominent, but still small, is a wedge-shaped infarct in the interpolar region\nof the left kidney. There is no evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Massive splenomegaly measuring 23 cm as well as splenic infarction in the\ninferior spleen.\n2. Multiple bilateral small infarcts and areas of ischemia, most prominently,\nbut still small, a wedge-shaped infarct in the interpolar left kidney.\n3. Hepatomegaly. A subcentimeter hypoattenuating lesion in segment 7 of the\nleft liver is likely a hemangioma but is indeterminant.\n\nRECOMMENDATION(S): In the absence of prior imaging of the hepatic lesion in\nsegment 7, an ultrasound could be performed if there is not underlying\ncirrhosis or an MRI if there is cirrhosis for further evaluation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged and heterogeneous in attenuation throughout\nwith evidence of a prior splenic infarct at the lateral mid body of the\nspleen. The inferior aspect of the spleen shows low attenuation and capsular\nenhancement with surrounding fat stranding consistent with an acute infarct. \nThis area measures 5.5 x 4.5 x 4.5 cm and is new from ___. At the\nsuperior aspect of the spleen there is a second area of low attenuation which\nis peripheral based, measuring 2.0 x 1.0 x 0.6 cm which represents a second\narea of infarction, also new from ___\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. At the posterior and\nposterior lateral aspects of the right kidney at the lower pole (05:33) there\nare 2 small area that are wedge-shaped and peripheral and show decreased\nenhancement and may represent small areas of ischemic injury. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmild free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Spleen is enlarged and heterogeneous in appearance with an area of acute\ninfarction at the inferior pole with surrounding inflammatory changes and a\nsecond smaller area of acute infarction at the superior pole, both are new\nfrom ___. At the midpole of the spleen there is deformity and\ncalcification from a prior splenic infarction.\n\n2. At the posterior aspect of the right kidney near the lower pole there are\n2 small areas that are peripheral and wedge-shaped and show decreased\nenhancement. These may represent additional sites of ischemic injury." }, { "input": "LOWER CHEST: Visualized lung fields shows small bilateral pleural effusion and\npassive atelectasis in both lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 7.7 x 4.5 cm multiloculated rim enhancing\npredominantly cystic lesion suggestive of an abscess in segment 7 of the liver\n(05:16), not significantly changed in size compared to the most recent\nultrasound. A CBD stent is again noted with expected pneumobilia. The\ndistal CBD is dilated containing an air-fluid level. The gallbladder is\ndecompressed.\n\nPANCREAS: Multiple calcifications are noted throughout the pancreas, with\ndilation of the main pancreatic duct, in keeping with known chronic\npancreatitis. There has been interval increase in size in a 4.5 x 3.8 cm\ncystic lesion located posterior to the pancreatic head (05:32), that measured\n3.5 x 2.7 cm on prior MRI of the abdomen. There is an additional adjacent 3.7\nx 2.3 cm cystic lesion l abutting the pancreatic head and the second portion\nof the duodenum (5:40) increased from 1.7 x 1.2 cm. Note is made of a an\nadditional 4.7 x 3.8 cm cystic lesion containing thin septation which is also\ninvolving the second portion of the duodenum (05:35). A hyperdense component\nis also noted within this lesion which could represent hemorrhage.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is similar appearance of the left adrenal gland thickening. \nThe right adrenal gland is normal.\n\nURINARY: There is a subcentimeter hypodense lesion in the lower pole of the\nleft kidney that is too small to characterize. The kidneys are of normal and\nsymmetric size with normal nephrogram. There is no evidence cir of\nhydronephrosis. . There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is moderately dilated. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Prominent 2.0 x 1.0 cm portacaval node (05:26) is likely\nreactive. There are additional smaller prominent upper abdominal and\nretroperitoneal lymph nodes that are also likely reactive. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 7.7 x 4.5 cm predominantly cystic multiloculated hepatic abscess in segment\n7.\n2. Multiple calcifications throughout the pancreas associated with dilation of\nthe main pancreatic duct in keeping with chronic pancreatitis. There has been\ninterval increase in size of pre-existing peripancreatic cystic lesions about\nthe pancreatic head, with interval development of an adjacent septated cystic\nlesion, associated with mass effect in the second portion of the duodenum,\nwith secondary moderate distention of the stomach. Hyperdense component is\nnoted within one of the cystic lesions and could represent hemorrhage. These\nfindings are concerning for infected pseudocysts.\n3. CBD stent is redemonstrated, with air-fluid level noted in the distal CBD\nand superimposed infection cannot be excluded.\n\nNOTIFICATION: The findings were discussed with ___. ___. by ___\n___, M.D. on the telephone on ___ at 10:35 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions and bibasilar\ndependent subsegmental atelectasis. No pericardial effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a large phlegmonous lesion within segment 7 of the\nliver with a large cystic medial component and multiple additional small\ncystic components. A drain has been placed with its tip in the large cystic\ncomponent medially, which has collapsed, now measuring 2.1 x 1.2 cm compared\nto 4.6 x 3.3 cm previously (image 2:16). However, the majority of the lesion\nis phlegmonous and only slightly decreased in size, now measuring 7.1 x 4.9 cm\ncompared to 7.7 x 5.0 cm previously (image 2:14). Two biliary stents are in\nplace, with pneumobilia and mild intrahepatic ductal dilation. There is\npersistent dilatation of the proximal CBD, with an air-fluid level. The\ngallbladder is within normal limits.\n\nPANCREAS: Multifocal calcifications are again noted throughout the pancreas\nwith stable dilation of the pancreatic duct. There is interval increase in\nsize of a pseudocyst posterior to the pancreatic head (image 2:32), which now\nmeasures 5.1 x 4.6 cm compared to 4.5 x 3.8 cm previously. A loculated\npseudocyst just inferior and laterally (image 2:38) measures 4.8 x 4.0 cm,\ncompared to 4.1 x 3.8 cm previously. Finally, a third pseudocyst abutting the\npancreatic head and the second portion of the duodenum (image 2:41) is also\nenlarged, and measures 4.3 x 2.5 cm compared to 3.7 x 2.3 cm previously.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is a stable subcentimeter hypodense lesion in the lower pole of left\nkidney, too small to characterize. There is no hydronephrosis or perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid.\n\n\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is increased subcutaneous edema, in keeping with anasarca.", "output": "1. Re- demonstration of a large phlegmonous lesion in the right lobe of the\nliver. There is interval drainage of a cystic component medially, but the\nmajority of lesion is phlegmonous and persists.\n2. Interval increase in size of several loculated pancreatic pseudocysts." }, { "input": "LOWER CHEST: There is a trace right pleural effusion, decreased in size. The\nsmall left pleural effusion has nearly resolved. There is bibasilar\natelectasis, left greater than right.\n\nABDOMEN:\n\nHEPATOBILIARY: The right hepatic lobe abscess has overall slightly decreased\nin size measuring 7.3 x 4.4 by 4.4 cm on series 5, image 10 and series 7,\nimage 27 (AP by transverse by craniocaudal), previously measuring 7.5 x 5.1 x\n5.7 cm. Adjacent mass effect on the right hepatic vein is slightly decreased.\nThe hepatic vasculature is patent. The medial-most collection within the\nabscess, which was previously drained, is slightly smaller in size compare to\nthe cavity seen on the prior study and continues to contain a small amount of\nfluid measuring 2.8 x 2.4 cm (series 8, image 29) previously 3.1 x 2.6 cm. No\nnew abscesses are seen. Mild intrahepatic biliary ductal dilatation is\nsimilar compared to the prior study. The common bile duct at the level of the\nhilum measures up to 2.7 cm, previously up to 2.2 cm. The stents within the\ncommon bile duct are similar in position compared to ___. The\ngallbladder is present.\n\nPANCREAS: Re-identified is atrophy of the pancreatic parenchyma with\ncalcifications and biliary ductal dilatation, compatible with the history of\nchronic pancreatitis. The dominant pancreatic pseudocyst has decreased in\nsize exam measuring 3.2 x 3.2 cm in the axial plane on series 5, image 28,\npreviously up to 5.1 cm. Other smaller adjacent pseudocyst are also decreased\nin size. No new peripancreatic fluid collections are seen. The\nperipancreatic vessels are patent and there is no evidence of aneurysm. \nPeripancreatic free fluid has largely resolved.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a large\nstool burden in the colon. A rounded calcification just distal to the\nterminal ileum measuring 7 mm is nonspecific and was not previously seen,\nprobably representing an ingested pill.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The right hepatic lobe abscess has overall slightly decreased in size and\nadjacent inflammation compared to ___. The medial most collection\nwithin the abscess which was previously drained is slightly smaller in size\ncompared to the cavity seen on the prior study and continues to contain a\nsmall amount of fluid. Continued clinical follow-up is recommended. No new\nabscesses are seen.\n2. Stable intra and extrahepatic biliary ductal dilatation. The common bile\nduct stents are similar in position compared to the prior study.\n3. Findings of chronic pancreatitis with an interval decrease in size of\nseveral pseudocysts. No new peripancreatic fluid collections are seen." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous low attenuation throughout,\ncompatible with hepatic steatosis. There is no evidence of focal lesions\nwithin the limitations of an unenhanced scan. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland appears normal. The left adrenal gland\nagain demonstrates an adrenal adenoma measuring 2.3 x 2.5 cm, which is mildly\nincreased in size compared to the prior study in ___, previously 1.7 x 1.3\ncm.\n\nURINARY: The visualized portions of the left kidney appears normal within the\nlimitations of this nonenhanced exam.\n\nGASTROINTESTINAL: Patient is status post gastric lap band placement with the\nband seen in unchanged position as compared to the prior study in ___. \nVisualized small bowel loops demonstrate normal caliber and wall thickness. \nThe visualized colon is unremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. No atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Mild interval increase in size of the left adrenal adenoma, measuring up to\n2.5 cm, previously 1.7 cm in ___.\n2. Unchanged positioning of the known gastric lap band.\n3. Hepatic steatosis." }, { "input": "There is minimal bibasilar atelectasis. No pleural effusion or pericardial\neffusion is identified.\n\nCT of the abdomen: The liver enhances homogeneously, with no focal hepatic\nlesions identified. There is no intrahepatic biliary ductal dilatation. The\ngallbladder has been surgically removed. Surgical clips are seen in the right\nupper quadrant. The adrenal glands, pancreas and spleen are within normal\nlimits. The bilateral kidneys enhance symmetrically and excrete contrast\nwithout evidence of hydronephrosis or renal masses.\n\nThe stomach is grossly unremarkable. There is no small bowel obstruction. The\nduodenum and jejunum are grossly unremarkable. Previously described hyper\nenhancement of the ascending colon and terminal ileum appears improved as\ncompared to prior CT examination. Small mesenteric lymph nodes in the right\nlower quadrant are not pathologically enlarged. There is no evidence of\nabscess formation or fistula. Surgical sutures are seen in the left lower\nquadrant. There is re- demonstration of a fat containing ventral hernia.\n\nThe abdominal aorta is of normal diameter. The celiac axis, SMA, bilateral\nrenal arteries and ___ are patent. There is no fluid. There is no free air.\n\nCT of the pelvis: The urinary bladder terminal ureters are within normal\nlimits. The rectum appears predominately collapsed. There is no pelvic free\nfluid. The uterus is normal. There is redemonstration of small bilateral\nhyperdense inguinal lymph nodes measuring up to 8 mm on the right.\n\nOsseous structures: No blastic or lytic lesion concerning for malignancy.", "output": "Previously described mucosal hyper enhancement of the terminal ileum and\nascending colon appear improved. There is no evidence of active ileitis,\nabscess or fistula formation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A subcentimeter hypodensity within the interpolar region of the left\nkidney is too small to characterize (series 2, image 27), but likely\nrepresents a small cyst. Otherwise, the kidneys are of normal and symmetric\nsize with normal nephrogram. There is no evidence of enhancing renal lesions\nor hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. A normal appearing anastomosis\nis seen within the left hemi abdomen. There are multiple nondilated fluid\nfilled loops of small bowel. No bowel wall thickening or obstruction is seen.\nThe appendix is not identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A fat containing ventral hernia measures approximately 5.2 cm,\nwith a 1.5 cm fascial defect. Otherwise, the abdominal and pelvic wall is\nwithin normal limits.", "output": "Nondilated fluid filled loops of small bowel are nonspecific, but may\nrepresent gastroenteritis in the appropriate clinical setting. Otherwise, no\nacute intra-abdominal process. Specifically, no evidence of active Crohn's." }, { "input": "LOWER CHEST: Emphysema noted at the imaged lung bases with mild basal\ndependent atelectasis. The imaged portion of the heart is unremarkable.\n\nABDOMEN:\n\nThe liver enhances normally and no focal concerning lesions are identified. \nThe main portal vein and central branches appear patent. No biliary ductal\ndilation. The common bile duct appears normal in caliber. The gallbladder\nappears normal.\n\nPANCREAS: The pancreas appears normal.\n\nSPLEEN: The spleen is unremarkable. There is a small aneurysm of the splenic\nartery again seen, not significantly changed measuring 13 mm in diameter.\n\nADRENALS: Adrenal glands appear normal.\n\nURINARY: The kidneys enhance symmetrically with prompt excretion of contrast\nnoted. No focal abnormality or signs of pyelonephritis or hydronephrosis. No\nperinephric abnormality is seen.\n\nGASTROINTESTINAL: The stomach and duodenum appear normal. Small bowel loops\ndemonstrate no signs of ileus or obstruction. No secondary signs of\nappendicitis. The colon is thin walled and contains a mild fecal load. No\ndiverticulosis or diverticulitis.\n\nPELVIS: The urinary bladder is mostly decompressed. The prostate is normal in\nsize. Distal ureters are nondilated. Trace free pelvic fluid is noted which\nis nonspecific.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute findings to account for abdominal pain. Trace free pelvic fluid\nis nonspecific.\n2. Nonemergent findings as detailed above." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is smaller than the right with the cortical scars . \nOtherwise the kidneys have symmetric and normal normal nephrogram. There is\nno evidence of solid focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\nmultiple diverticula scattered throughout the colon. With no secondary signs\nof diverticulitis. No obstructing mass seen in the colon. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate appears minimally enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen pelvis.\n2. Mild diverticulosis of the colon with no signs of diverticulitis.\n3. Scarred and the relatively small left kidney with no signs of the active\ninfectious or neoplastic process." }, { "input": "The lung bases are clear. Limited imaging of the heart reveals no pericardial\neffusion or cardiomegaly.\n\nCT ABDOMEN: The lack of intravenous contrast limits evaluation of the solid\norgans. Within this limitation, the liver shows no gross abnormality. The\ngallbladder, pancreas, spleen, accessory spleen and bilateral adrenal glands\nare normal in appearance. 2 nonobstructing renal calculi are identified in the\ncalices of the right kidney measuring 2 mm in the lower pole and 4 x 3 mm in\nthe interpolar region (2:27). A simple cyst arising from the lower pole of the\nright kidney measures 2.6 cm. Smaller hypodense areas in the bilateral\ninterpolar regions in the upper pole the right kidney are too small to\ncharacterize on this unenhanced study. No hydronephrosis or hydroureter is\nseen.\n\nThere is no retroperitoneal or abdominal adenopathy. No free air or free fluid\nis present. The stomach and intra-abdominal loops of bowel are normal in\ncaliber. There is no abnormal thickening of the small bowel wall. Multiple\ncolonic diverticula are noted.\n\nThere is moderate to severe aortoiliac atherosclerotic disease. The infrarenal\nabdominal aorta is mildly ectatic, measuring 2.5 cm in maximum diameter\n(2:36). Calcified plaques noted at the ostia of the celiac artery and SMA.\nPatency of the vessels cannot be evaluated without intravenous contrast.\n\nCT PELVIS: There is diffuse diverticulosis and thickening of the sigmoid\nbowel wall, as seen on the preceding CT of ___. In the proximal\nsigmoid colon, there is apparent asymmetric thickening of the bowel wall\n(2:57) with convex borders but no central diverticulum is identified. There is\nmild surrounding fat stranding. No extraluminal air or fluid collection is\nidentified. The bladder is underdistended and, therefore, not well evaluated\non the current exam. There is no inguinal or pelvic adenopathy. There is a\nsmall fat containing left inguinal hernia.\n\nOSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesion\nidentified. Mild multilevel degenerative changes are noted in the imaged\nthoracolumbar spine.", "output": "1. Asymmetric thickening of the proximal sigmoid colon with surrounding fat\nstranding may represent diverticulitis although no central diverticulum is\nidentified. An inflammatory mass cannot be excluded. Followup with direct\nvisualization by sigmoidoscopy/colonoscopy is recommended following an\nappropriate course of treatment.\n2. Nonobstructing right nephrolithiasis.\n3. Extensive aortoiliac atherosclerotic disease with mild ectasia of the\ninfrarenal abdominal aorta measuring 2.5 cm.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 15:24 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensity adjacent to the gallbladder is too small to\ncharacterize by CT (02:33). Otherwise, there is no evidence of focal lesions.\nThere is mild prominence of the intrahepatic biliary ducts. The common bile\nduct is also mildly prominent, unchanged from prior exam. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small bowel loops are\nmildly distended and filled with fluid. The wall thickness is mildly\nincreased when compared to prior exam. However, the terminal ileum in the\nmost distal segment now demonstrates diffuse edema and thickening (02:50),\ninvolving approximately 6.8 cm of the bowel. In addition, the cecum is mildly\nedematous with mucosal hyperenhancement. The mesenteric vasculature are\nengorged and hyperenhancing. The remaining colon is mildly distended with\ngas. Patient is status post resection of the sigmoid colon. The anastomosis\nis intact and patent. The distal colon and the rectum are collapsed. The\nappendix is not definitely visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: No acutely fracture. Mildly sclerotic lesion in the greater trochanter\nof the left femur is stable (series 601, image 30).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New edema and wall thickening of the terminal ileum with diffuse, mild\ndistension of the remaining small bowel with fluid in the setting of edematous\ncecum, concerning for typhlitis and reactive ileitis due to drug reaction,\ninflammatory or infectious etiology. No drainable fluid collection.\n2. Postsurgical changes from sigmoidectomy." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodensity adjacent to the gallbladder (3:77) is too small to\ncharacterize. Otherwise, there is no evidence of focal lesions. No\nsignificant intrahepatic and extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. A possible mass\nprotrudes into the lumen of the sigmoid colon, best seen on series 3, image\n92, but this is difficult to ascertain definitively. Otherwise, the colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Rib deformity of the right posterior twelfth rib, likely chronic. Loss\nof vertebral body height of T9, of indeterminate chronicity. There is no\nevidence of worrisome osseous lesions.\n\nSOFT TISSUES: Small, bilateral inguinal hernias. Otherwise, the abdominal and\npelvic wall is within normal limits.", "output": "1. Probable lesion of the sigmoid colon, compatible with the patient's known\nadenocarcinoma. No evidence of local or regional spread. No lymphadenopathy.\n2. Please refer to the separate report of the CT chest performed on the same\nday for thoracic characterization." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings including a 12 x 13 mm right lower lobe\npulmonary nodule.\n\nABDOMEN:\nAgain demonstrated is a hypoenhancing partially necrotic pancreatic body and\ntail lesion unchanged to slightly decreased in size currently measuring 5.6 x\n4.3 cm, previously 5.8 x 4.5 cm. Fat stranding around the pancreatic lesion is\ngrossly unchanged. This lesion encases the patent splenic artery. The splenic\nvein is occluded. There are unchanged gastric varices. There is improvement\nin left peritoneal carcinomatosis with mild residual nodularity (6:82).\n\nSegment III hypodensity measuring 6 mm is unchanged in size. There is a 7 x 8\nmm hypodensity at the junction of segments VII/VIII similar prior study. There\nis no new hepatic lesion. There is no intrahepatic or extrahepatic biliary\nductal dilatation. The gallbladder is unremarkable.\n\nThe spleen is not enlarged. Unchanged soft tissue densities medial to the\nspleen likely represent accessory splenic tissue. There are unchanged\nbilateral renal cysts. Subcentimeter right upper pole and left lower pole\nhypodensities are too small to accurately characterize but are unchanged and\nlikely represent renal cysts. There is no evidence of hydronephrosis. Urinary\nbladder is moderately distended without gross abnormality.\n\nThere are no dilated loops of bowel. There are diverticula of the distal\ntransverse and descending colon without evidence of diverticulitis. There is\nno bowel wall thickening. The appendix is unremarkable.\n\nThe abdominal aorta is of normal course and caliber. There are no enlarged\ninguinal, iliac chain, retrocrural, retroperitoneal lymph nodes. There is no\nsuspicious osseous lesion. There is an unchanged left iliac sclerotic lesion.\n\nThere is a 4.8 x 1.8 cm lipoma in the posterior right subcutaneous tissues\n(6:61). There is a 4.4 x 4.6 cm lipoma anterior to the right gluteus medius\nmuscle anterior to the right hip.", "output": "1. Unchanged to slightly decreased size of pancreatic tail lesion with central\nnecrotic component. There is unchanged encasement of the splenic artery and\nocclusion of the splenic vein.\n2. Unchanged subcentimeter hepatic hypodensities.\n3. Improvement in peritoneal carcinomatosis.\n4. Please see separate CT dictation for dedicated thoracic findings including\nright lower lobe pulmonary nodule." }, { "input": "CHEST: The visualized lung bases are clear of focal consolidation, pleural\neffusion or pneumothorax. The visualized heart is unremarkable. Coronary\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: A perfusion abnormality is noted in the anterior liver (8:20)\nThere is no evidence of worrisome focal lesions. No intrahepatic or\nextrahepatic biliary dilation is noted. The hepatic veins and portal veins\nare patent. The splenic vein is patent. The hepatic veins and portal veins\nare patent. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Mild stranding over the\npancreatic tail is concerning for mild pancreatitis. No peripancreatic fluid\ncollections or pseudocysts are noted.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis.\n\nBOWEL: The stomach is mildly distended and unremarkable. The small bowel does\nnot appear distended or have wall thickening. The visualized colon contains\nstool without wall thickening or evidence for obstruction. There is no\nabdominal free air. Mild amount of free fluid is noted in the left paracolic\ngutter.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: The abdominal aorta does not have any aneurysmal dilation. The\nsplenic artery is unremarkable.\n\nBONES:\n\nThere is no evidence of worrisome lesions.", "output": "Mild amount of stranding adjacent to pancreatic tail and mild left paracolic\ngutter free fluid is consistent with mild pancreatitis. No peripancreatic\nfluid collections, pseudocysts or other complications are noted." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Mild dependent atelectasis is\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. There is no liver laceration. The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: A 2.5 x 2.6 cm exophytic fibroid is seen arising from the\nfundus.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions or fractures.\nAbdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Fibroid uterus." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Moderate coronary artery\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable aside for steatosis with regions of\nsparing around the gallbladder fossa. No biliary ductal dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: Unremarkable. There is no peripancreatic stranding.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable except for a hypodensity in th left\nkidney is too small to characterize CT. There is no hydronephrosis.\n\nGASTROINTESTINAL: Again seen is an adjustable laparoscopic gastric band. \nThere is no evidence of small bowel obstruction. There is thickening of the\nwall of the sigmoid colon with mild fat stranding concerning for sigmoid\ndiverticulitis. No evidence of fluid collection or pneumoperitoneum.The\nappendix is normal.\n\nPELVIS: There is no free fluid in the pelvis. The uterus and ovaries are \nunremarkable on CT for age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Mild degenerative changes of the thoracolumbar spine are noted. There\nis mild anterolisthesis of L4 on L5. A few vascular collaterals are seen in\nwithin the anterior abdominal wall", "output": "Acute sigmoid diverticulitis. No fluid collection or pneumoperitoneum.\n\nHepatic steatosis." }, { "input": "Lung bases: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. There is a small hiatal hernia.\n\nAbdomen: The liver appears slightly hypoattenuating relative to the spleen\nsuggesting a component of steatosis. Main portal vein is patent. No\nconcerning focal liver lesion is seen. No biliary ductal dilation. The\ngallbladder appears normal. The common bile duct is normal in size. The\npancreas enhances normally. The spleen is normal in size. The adrenal glands\nare normal bilaterally. The kidneys enhance symmetrically and there is no\nhydronephrosis or worrisome renal lesion. The abdominal aorta is mildly\ncalcified and normal in course and caliber. A gastric band is in place with\nport located in the mid anterior abdominal wall. The stomach and duodenum are\nmostly decompressed. No free air or free fluid. No lymphadenopathy.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is normal. The colon contains a mild fecal load. There is\ndiverticulosis most pronounced along the sigmoid colon with mild\nperidiverticular inflammation best seen on series 2, image 123 consistent with\nacute diverticulitis. No evidence of perforation, free air, or drainable\nfluid collection. The rectum is unremarkable. The uterus and adnexal regions\nare unremarkable. The urinary bladder appears normal. No pelvic free fluid. \nNo pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion. Grade 1 anterolisthesis\nis again seen of L4 on L5. Facet arthropathy is noted in the lower lumbar\nspine.", "output": "1. Mild sigmoid diverticulitis.\n2. Gastric band in place.\n3. Normal appendix.\n4. Mild fatty liver.\n5. Small hiatal hernia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. \nBilateral peripelvic cysts without hydronephrosis is unchanged from prior. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild multilevel degenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Limited examination without intravenous contrast shows no obvious source of\nthe patient's bloody diarrhea.\n2. Renal peripelvic cysts bilaterally unchanged from prior examination." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a relatively hyperdense appearance of the liver which\nis a nonspecific finding but can be seen in the setting of increased iron\ndeposition. No evidence of focal lesions within limitation of an unenhanced\nstudy. No intra or extrahepatic biliary dilatation. The gallbladder appears\nmildly distended without definite wall thickening or pericholecystic\nstranding, correlate for NPO status.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There\nare bilateral peripelvic cysts without hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Stomach is unremarkable. There is no small bowel\nobstruction. Relative increased wall thickening of the cecum and ascending\ncolon in comparison to ___ may in part be related to\nunder-distention however the finding does raise the possibility of neutropenic\ncolitis in this patient population (05:18). Appendix is normal.\n\nPELVIS: Urinary bladder and distal ureters are normal. There is no free fluid\nin the pelvis. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Visualized reproductive organs are normal for the\npatient's age.\n\nLYMPH NODES: No lymphadenopathy within the abdomen or pelvis\n\nVASCULAR: No abdominal aortic aneurysm. Mild calcified atherosclerotic burden\nin the abdominal aorta and its great branches.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Relative increased wall thickening and the cecum and ascending colon in\ncomparison to ___ may in part be related to under-distention,\nhowever the finding does raise the possibility of neutropenic colitis in this\npatient population.\n2. Relatively hyperdense appearance of the liver measuring 73 Hounsfield units\nis at a nonspecific finding but can be seen in the setting of increased iron\ndeposition." }, { "input": "LOWER CHEST: There is interval increase in central ground-glass opacities in\nthe visualized lung bases suggestive of edema. There also appears to be\nredemonstration with slight interval increase in bilateral ___ nodules\nsimilar to slightly increased compared to prior which may represent infectious\nor inflammatory in etiology. There is no evidence of pleural or pericardial\neffusion. Partially visualized chest port terminates in the right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is decompressed with possible wall thickening\nsuggestive of third spacing.\n\nTrace fluid is noted in the peritoneal cavity.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are bilateral\nperipelvic cysts. There is no hydronephrosis. Evaluation for focal lesions\nis limited in this unenhanced scan. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No acute process is noted in the abdomen or pelvis.\n2. There is mild bilateral pulmonary edema in the visualized bilateral lung\nbases.\n3. Similar to slightly increased peribronchovascular nodules are seen in\nbilateral visualized lung basis again suggest infectious or inflammatory\netiology.\n\nNOTIFICATION: The initial findings were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 1:54 am, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. Subcentimeter hypodense lesion in the\nleft upper pole is too small to characterize but likely represents renal\ncysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Suture material is noted along the greater curvature of the\nstomach from prior gastric surgery. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is not visualized but there are no\nsecondary signs of inflammation.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: IUD is in appropriate position within the uterus. There\nis a right adnexal cyst measuring 2.5 x 3.6 cm (2; 70).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal pathology to explain patient's abdominal pain." }, { "input": "LOWER CHEST: No evidence of a pleural or pericardial effusion. The heart\nappears mildly enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: A 2.2 cm bilobed hypodensity in the right hepatic lobe is\nunchanged (series 2, image 18). Hepatic hypodensities are too small to\naccurately characterize on CT, also unchanged. No evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Coarse calcifications spleen are unchanged, likely\nsequelae of prior granulomatous disease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cortical hypodensities are too small to accurately\ncharacterize on CT, statistically most likely cysts, unchanged. Multiple left\nparapelvic cysts are again demonstrated. No hydronephrosis or perinephric\nabnormality.\n\nGASTROINTESTINAL: Small axial hiatal hernia. There is a moderate proximal\nduodenal diverticulum. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is moderate colonic stool burden\nin the ascending colon. The rectum is unremarkable. The appendix is normal. \nNo bowel obstruction or free air.\n\nPELVIS: The urinary bladder is markedly distended and unremarkable. The\ndistal ureters are unremarkable. There is no free fluid in the pelvis.\n\nThe uterus is unremarkable. A 4.3 x 2.9 cm homogeneous, circumscribed oval\nstructure in the right adnexa may be slightly larger compared to ___ (series\n2, image 65; series 601, image 23). No left adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. Slight misty mesentery is\nunchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Left gonadal vasculature is markedly prominent which can be seen\nwith pelvic congestion syndrome (series 601, image 29). Right gonadal\nvasculature is also slightly prominent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThe patient is status post left hip replacement. Degenerative changes in the\nlumbar spine are most pronounced at L5-S1. Loss of T10 and T11 vertebral body\nheight is similar to the prior exam.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence for acute intra-abdominal process.\n2. 4.3 x 2.9 cm homogeneous oval structure in the right adnexa, perhaps\nslightly larger from ___. Consider nonurgent pelvic ultrasound to further\nevaluate if not already performed.\n3. Prominent gonadal veins can be seen with pelvic congestion syndrome. \nCorrelate with clinical history.\n\nRECOMMENDATION(S): Consider nonurgent pelvic ultrasound to further evaluate\nif not already performed." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post percutaneous transhepatic biliary\ndrainage with the distal aspect of the pigtail catheter coiled in the fourth\nportion of the duodenum. There has been interval PTBD exchanged. There is\nmild periportal edema with residual intrahepatic or extrahepatic biliary\ndilatation. However, there is now a focal region of peripheral, wedge-shaped\nhypodensity involving segment VI of the liver (02:24). Redemonstrated are\nnumerous foci of expected pneumobilia. No focal hepatic lesion is identified.\nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass surgery\nwith expected postoperative appearance. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Oral contrast is seen\nextending into the distal small bowel without evidence of holdup or\nobstruction. The colon and rectum are within normal limits. The appendix is\nnot discreet visualized without secondary signs of appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. The uterus\nis unremarkable in appearance. A corpus luteum is noted within the right\nadnexa. Trace free pelvic fluid is likely physiologic.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Status post right PTBD exchange with resolved intrahepatic biliary ductal\ndilation.\n2. New focal wedge-shaped hypodensity involvement segment VI of the liver is\nnoted, likely secondary to transsection of a portal vein during the PTBD\nexchange with resultant anomalous perfusion versus infarction.\n3. Stable postoperative appearance status post Roux-en-Y gastric bypass. No\nevidence of bowel obstruction." }, { "input": "LOWER CHEST: There is a small left pleural effusion with associated\ncompressive atelectasis, and a trace right pleural effusion. The heart is\nnormal in size. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nfocal lesion is identified. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The patient is status post distal pancreatectomy for focal chronic\npancreatitis. Heterogeneity of the pancreatic neck and body which could be\npostoperative in nature and/or represent acute pancreatitis. There is no\nfluid collection to suggest pancreatic leak. Peripancreatic stranding is also\npresumably postoperative in nature.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The bilateral adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size and demonstrate normal bilateral\nnephrograms. Again seen is a 2.0 x 1.7 cm hypodense lesion in the lower pole\nof left kidney, measuring higher than fluid attenuation ___ 32), but\npreviously characterized as a simple cyst on MRCP from ___. \nThere is no right renal lesion. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are\nnondilated. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPERITONEUM: There is trace pneumoperitoneum (series 601b, image 22), likely\npostoperative in nature.\n\nPELVIS: A focus of gas in the urinary bladder is presumably from recent Foley\ncatheter. There is a small amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size. The seminal vesicles\nare symmetric.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta and major mesenteric branch vessels are normal\n___ caliber and patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 3.9 x 1.9 x 2.8 cm heterogeneous collection in the\nleft rectus abdominis muscle in the mid abdomen (series 2, image 35), likely\nrepresenting a hematoma. There are locules of gas within this collection, as\nwell as tracking along the left chest wall musculature. No suspicious osseous\nlesion is identified.", "output": "1. Interval distal pancreatectomy and splenectomy. Heterogeneity of the\npancreatic body, which could be postsurgical nature or represent acute\npancreatitis. No fluid collection to suggest pancreatic leak or abscess.\n2. 3.9 x 1.9 x 2.8 cm heterogeneous material in the left rectus abdominis\nmuscle in the mid abdomen, likely representing a hematoma. Locules of gas\nwithin this collection, as well as tracking along the left chest wall\nmusculature likely from recent surgery.\n3. Trace pneumoperitoneum, presumably postoperative in nature.\n4. Small left pleural effusion with associated compressive atelectasis." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThe hepatic portal vein is patent.\n\nPANCREAS: Patient is status-post distal pancreatectomy with interval removal\nof a left upper quadrant/peripancreatic drain. Abutting the pancreatectomy\nmargin, within the pancreatectomy bed, there is an increased, elongated, fluid\ncollection spanning up to 6.4 cm in length with an irregular, thin, enhancing\nrim (series 6, images ___. Mild adjacent fat stranding extends into the\nleft anterior pararenal space. There is a suggestion of a narrow tract\nextending within the prior postsurgical drain course toward the splenectomy\nbed. Within the splenectomy bed, where there was significant prior\npostsurgical fat stranding, there is a new 8.7 x 4.9 x 4.5 cm heterogeneous,\npartially rim enhancing collection of both fluid and fat. Mild fat stranding\naround the residual pancreatic neck/body extending into the transverse\nmesocolon is decreased in inferior extent since the prior examination. The\nresidual pancreatic parenchyma is unremarkable without pancreatic ductal\ndilatation or focal lesions.\n\nSPLEEN: Status-post splenectomy with a fluid and fat collection in the\nsplenectomy bed as described above.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.6 x 1.2 cm hypoattenuating lesion in the interpolar left kidney is\nunchanged and, though intermediate density, was previously characterized on\nMRI as a simple cyst. No new or suspicious renal lesion. No hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Incidental note is made of a small accessory right inferior hepatic\nvein. The hepatic portal and superior mesenteric veins are patent. The\nsplenic vein stump is unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nsmall bone island is again seen in the right femoral head.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Focal\nareas of fat stranding in the anterior abdominal wall are presumably\npostsurgical in nature.", "output": "1. Intervally increased fluid collection in the pancreatectomy bed abutting\nthe pancreatic resection margin and extending slightly into the transverse\nmesocolon. New partially rim enhancing area of fat and fluid in the\nsplenectomy bed likely reflects omental fat necrosis. Cannot exclude a\npancreatic leak at some point during the postoperative course resulting in\nthese findings, though active leak is very unlikley.\n2. Fat stranding around the remaining pancreatic parenchyma is decreased \nsince the prior examination. The residual pancreatic parenchyma is\nunremarkable." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The patient is status post distal pancreatectomy. In comparison to\nprior studies there is new or increased peripancreatic stranding and fluid\nmost conspicuous adjacent to the pancreatic suture chain (series 2, image 22)\nand centered about the second and third portion of the duodenum.\n\nSPLEEN: The patient is status post splenectomy. There is persistent soft\ntissue measuring 3.4 x 1.5 cm in the splenectomy bed (series 2, image 9) which\nis better evaluated on the prior MR and again may represent fat necrosis or\nresolving hematoma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A 12 mm hemorrhagic cyst is noted in the interpolar left kidney,\nbetter evaluated on the prior MR. ___ kidneys are otherwise unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Increased peripancreatic stranding and fluid, concerning for recurrent\nacute pancreatitis, much less likely a leak. No organized fluid collection or\nevidence of pancreatic necrosis.\n2. Soft tissue in the splenectomy bed again may represent fat necrosis or\nresolving hematoma." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low homogeneous attenuation throughout\nwith areas of focal fatty sparing. There is no evidence of focal lesions\nwithin the limitations of an unenhanced scan. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A gastrojejunostomy tube appears appropriately positioned\nwith balloon residing in the stomach and tubing terminating in the jejunum in\nthe left lower quadrant. Visualized small bowel loops demonstrate normal\ncaliber and wall thickness. The visualized colon is unremarkable. Partially\nvisualized normal-appearing appendix.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. No atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Interval decreased post treatment changes in the anterior\nabdominal wall. Minimal residual straightening in the fat adjacent to the\ngastrojejunostomy tube insertion site. No drainable fluid collection\nidentified.", "output": "1. Gastrojejunostomy in appropriate position with minimal surrounding\ninflammatory change. No drainable fluid collection or bowel obstruction.\n2. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.Left-sided gynecomastia noted. \nPreviously identified left-sided axillary lymph node appears stable, measuring\n1 cm x 1 cm.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver shows irregular in contour and prominence of the\nhepatic left lobe, consistent with cirrhosis. Small volume perihepatic\nascites is demonstrated. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent and clips are\nvisualized in the gallbladder fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows enlargement at 16 cm in size, yet normal attenuation\nthroughout and no evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no mesenteric lymphadenopathy. Small retroperitoneal\nlymph nodes identified, consistent with cirrhosis. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative disc disease is noted at L3-L4 level. Pars defect again\nnoted at L5.\n\nSOFT TISSUES: The previously identified soft tissue collection in the anterior\nabdominal wall is collapsed. There is remaining minimal soft tissue density\nat the site of previous drainage with focal thickening. Extensive abdominal\nwall collateral vasculature is noted, consistent with cirrhotic disease.", "output": "1. Nearly complete resolution of soft tissue collection in the anterior\nabdominal wall.\n2. Nodular liver concerning for cirrhosis with small volume perihepatic\nascites and mild splenomegaly.\n3. Pars defect at L5." }, { "input": "LOWER CHEST: Mild scattered subsegmental atelectasis and mild bronchial wall\nthickening in the visualized lung bases.. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is distended without\nevidence of pericholecystic fluid, gallbladder wall thickening, or adjacent\nfat stranding to suggest acute cholecystitis.\n\nPANCREAS: The pancreas appears diffusely atrophic, without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size with mild diffuse cortical\nthinning. There is a right 6.4 cm simple cortical cyst in the lower pole of\nthe right kidney. Additionally, there is a 4.0 cm parapelvic simple cyst in\nthe interpolar region of the right kidney. A few other tiny hypodensities in\nboth kidneys are too small to characterize. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is mildly prominent\nat the base, measuring up to 9 mm, without adjacent fat stranding to suggest\nacute appendicitis (7:22)..\n\nPELVIS: The urinary bladder minimally distended. There is no distal\nhydroureter. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrium appears mildly thickened, measuring up to\n9 mm (08:54). There is no adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes are seen along the visualized spine\nwith mild lumbar dextrocurvature and grade 1 anterolisthesis at the L4-L5\nvertebral level. There also degenerative changes of both hip joints.\n\nSOFT TISSUES: Note is made of a small fat containing umbilical hernia.", "output": "1. Distended gallbladder without pericholecystic fluid, gallbladder wall\nthickening, or adjacent fat stranding to suggest acute cholecystitis.\n2. No acute findings in the abdomen or pelvis to correlate with patient's\nsymptoms.\n3. Endometrial thickening measuring up to 9 mm. Further evaluation with\npelvic ultrasound on a nonurgent basis is suggested, based on goals of care.\n4. Small hiatal hernia.\n\nRECOMMENDATION(S): Pelvic ultrasound to evaluate the endometrium." }, { "input": "LOWER CHEST: Persistent diffuse bronchial wall thickening at the partially\nimaged lung bases. Mild atelectasis. No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. The portal veins are patent. No evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is distended\nwithout wall thickening or adjacent fat stranding, similar to the ___ CT abdomen/pelvis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are relatively symmetric in size. There are scattered\nfoci of bilateral cortical scarring. A simple right renal cyst measures 6.7 x\n5.8 cm. There are multiple right-sided peripelvic cysts measuring up to 4.2 x\n3.3 cm. No hydronephrosis.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops are unremarkable. No\nbowel obstruction. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: Bladder is underdistended and likely accounts for the mild bladder\nwall thickening. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrium continues to appear mildly thickened, not\nsignificantly changed since ___. The adnexae are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic disease.\n\nBONES/SOFT TISSUES: There is no aggressive osseous lesion or acute fracture. \nThoracolumbar scoliosis with moderate to severe multilevel degenerative\nchanges. There is grade 1 anterolisthesis of L4 on L5. Multilevel posterior\nosteophytes and disc bulges or protrusions result in spinal canal narrowing,\nprobably severe at L4-L5, but unchanged compared to prior examinations. \nModerate, fat containing umbilical and ventral hernias. No associated fat\nstranding to suggest active inflammation. Soft tissue nodules in the anterior\nabdominopelvic wall presumably reflect medication injection sites. A coarse\ncalcification in the right gluteal region also probably reflects an injection\ngranuloma.", "output": "1. No evidence of acute abdominopelvic pathology.No evidence of abdominopelvic\nmetastases.\n2. Partially imaged bronchial inflammation at the bilateral lung bases.\n3. Mild endometrial thickening is essentially unchanged since ___. \nThis could be further assessed with dedicated pelvic ultrasound on a\nnonemergent basis if clinically indicated.\n4. Moderate to severe thoracolumbar spine degenerative changes with probably\nsevere spinal canal narrowing at L4-L5 is unchanged since ___.\n5. Small hiatal hernia.\n6. Diverticulosis.\n\nRECOMMENDATION(S): Mild endometrial thickening is essentially unchanged since\n___. This could be further assessed with dedicated pelvic ultrasound on\na nonemergent basis if clinically indicated." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis. There is no\nperinephric abnormality. There are bilateral renal cysts. Additional\nbilateral subcentimeter hypodensities are too small to characterize.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. There is a large\nstool burden in the colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Again seen is hypodensity within the endometrium\nmeasuring up to 7 mm which is more prominent than what would be expected in a\npatient of this age. No adnexal masses seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable degenerative changes in the spine and sacroiliac joints including grade\n1 anterolisthesis of L4 on L5 related to degenerative facet hypertrophy.\n\nSOFT TISSUES: Small fat containing ventral hernia at the level of the uterus\nis similar with the neck measuring 1.7 cm. Infra-umbilical skin thickening in\nthe midline is similar compared to prior study. Two small soft tissue nodules\nin the subcutaneous fat of the anterior abdominal wall are new and may be\nrelated to subcutaneous injections. Trace left trochanteric bursitis.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Two small soft tissue nodules in the subcutaneous fat of the anterior\nabdominal wall are new and may be related to subcutaneous injections. \nCorrelate with history. These can be re-evaluated on follow up studies.\n3. Similar appearance of hypodensity within the endometrium measuring 7 mm\nwhich is more prominent than what would be expected in a patient of this age. \nPelvic ultrasound and/or biopsy should be considered. No adnexal masses are\nseen.\n4. Please see the separately dictated report for the CT of the chest performed\non the same day for description of intrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple right renal cysts again identified, without significant change from\n___. The largest arises from the midportion of the anterior right\nkidney and measures 6.3 x 5.8 x 6.4 cm (2:63) and likely represents a\nexophytic simple cyst. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is moderate to severe degenerative disease of the lower thoracic and\nlumbar spine, unchanged from prior. Moderate anterolisthesis of L4 over L5 is\nunchanged.\n\nSOFT TISSUES: A small, mesenteric fat containing ventral hernia appears\nunchanged from prior (2:85). The abdominal and pelvic wall is otherwise\nwithin normal limits.", "output": "1. No suspicious masses or osseous lesions within the abdomen or pelvis.\n2. Moderate to severe thoracolumbar spine multilevel degenerative disease,\nunchanged from prior." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. Mild coronary\ncalcifications are noted. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\nSubcentimeter hypodense lesion in the right lobe of the liver is unchanged\nfrom ___ (2; 11). There are multiple calcifications along the periphery of\nthe liver, the largest measuring 0.6 cm (2; 26) likely calcified granulomas. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Hypodense 1.7 cm lesion in the spleen is new since ___ but\nstatistically is likely benign (2; 25). The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n3.1 cm hypodensity in the left interpolar region with ___ of 4 is consistent\nwith a simple renal cyst (2; 29). There is no evidence of hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. In the sigmoid\ncolon, there is an inflamed hyperemic diverticulum with adjacent fatty\nstranding and colonic wall thickening consistent with acute uncomplicated\ndiverticulitis. There is no evidence of extraluminal air or drainable fluid\ncollections. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring up to 5.9 x 5.3 x 5.6\ncm. The seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Short-segment thrombosed focal dissection involving the infrarenal\nabdominal aorta is noted (02:32). There is no abdominal aortic aneurysm. \nExtensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes are noted most severe at L4-L5.\n\nSOFT TISSUES: No concerning soft tissue abnormalities are noted.", "output": "1. Acute uncomplicated diverticulitis of the sigmoid colon without evidence of\nextraluminal air or drainable fluid collections.\n2. Short segment thrombosed focal dissection of the infrarenal abdominal\naorta." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates a large approximately 9.9 x 9.6 cm\n(03:40) peripherally enhancing lesion with central hypodensity and associated\nmoderate bile duct dilatation mostly within the right lobe, but spanning\nsegments 1, 4a, and 8. Central areas tumor demonstrate progressive\nenhancement (series 6, image 8). Multiple additional ring-enhancing satellite\nlesions measuring approximately 2.9 x 2.4 cm (03:51) within segment 8, 1.7 x\n1.3 cm within segment 4a/8 (3:50), 1.8 x 1.8 cm (03:51) within segment 2, and\n2.5 x 2.6 cm (3:61) within segment 5 are noted, also demonstrating similar\nenhancement characteristics. There is mild hypodensity distal to the large\ncentral peripherally enhancing mass, likely reflecting altered perfusion. \nHeterogeneous expansile lesion is seen within the left portal vein with\nextension to the portal confluence worrisome for tumor thrombus (series 3,\nimage 53). The right portal vein, right anterior and right posterior portal\nveins, and main portal vein are patent. The splenic vein, SMV, and IMV are\npatent. Multiple periportal lymph nodes are noted largest measuring 1.9 x 1\ncm (03:54) and 1.4 x 1 cm (03:55). The gallbladder is decompressed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is top-normal in size measuring 13 cm. Attenuation is\nnormal throughout without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A 1.8 x 2.2 cm (3:76) left lower pole renal cyst is noted. An\nadditional 2.5 x 2.4 cm (3:65) indeterminate lesion demonstrates 33 Hounsfield\nunits within the upper pole of the right kidney. An additional 3.2 x 2.7 cm\n(3:73) heterogeneously enhancing lesion is seen with areas of fat within the\nlower pole of the right kidney. The kidneys are otherwise of normal and\nsymmetric size. There is no evidence of stones, or hydronephrosis. There are\nno urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix contains air and has normal caliber without evidence of fat\nstranding. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. The\nabdominal and pelvic wall is within normal limits.", "output": "1. 9.9 cm peripherally and progressively enhancing mass within the right lobe\nof the liver (segments I, ___ and ___ with multiple satellite\nlesions/metastases within segments II, V, ___, and ___, with intrahepatic\nbiliary duct dilatation. The enhancement and infiltrative pattern are most\ncompatible with cholangiocarcinoma, however, the presence of left portal vein\ntumor thrombus is atypical and suggestive of mixed cholangio-hepatocellular\ncarcinoma.\n2. 3.2 cm heterogeneously enhancing, fat containing right lower pole renal\nlesion is most compatible with an angiomyolipoma.\n3. Indeterminate 2.5 cm right upper pole renal lesion, statistically likely a\nbenign cyst. Consider dedicated renal ultrasound or attention on subsequent\nMR or CT.\n4. Top-normal spleen size, measuring 13 cm.\n\nRECOMMENDATION(S): 2.5 cm right upper pole renal lesion can be evaluated\nnon-urgently with ultrasound.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 6:11 ___, 5 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: There are multiple pulmonary metastases the visualized lung\nbases, with representative examples measuring 1.0 cm in the right middle lobe\n(series 9:9) and 0.9 cm in the left lower lobe (series 9:11), unchanged\ncompared to the prior CT from ___.\n\nABDOMEN:\n\nHEPATOBILIARY:\nProgressively enhancing peribiliary soft tissue in the central liver remains\nunchanged compared to CT abdomen and pelvis ___ and is compatible with\nknown infiltrative periductal cholangiocarcinoma. Hypoattenuating,\nmass-forming lesions in the liver are slightly increased in size from prior,\nfor example, a lesion in the right lobe near the dome measures 3.9 x 2.9 cm\n(series 9:19), previously 3.2 x 2.5 cm; a lesion in segment ___ measures 4.2 x\n2.7 cm (series 9:22), previously 3.7 x 2.1 cm; and a lesion in segment VI\nmeasures 2.2 x 1.8 cm, previously 1.8 x 1.5 cm.\n\nThe degree of intrahepatic biliary dilatation in the left lobe remains\nunchanged. There is a CBD stent with internal foci of air. There is a second\nstent in a segment VII intrahepatic duct. There is no pneumobilia. Mural\nedema of the gallbladder is likely due to third spacing.\n\nThere is chronic thrombosis of the main portal vein with cavernous\ntransformation and extensive perihepatic collateral vessels. Near occlusive\nthrombus in a short segment of the cranial aspect of the superior mesenteric\nvein remains unchanged. There is small volume ascites, unchanged. Again seen\nare numerous esophageal, gastric, and splenic varices.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged measuring 16.8 cm in length, unchanged from prior,\nwithout evidence of lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAgain seen is an angiomyolipoma in the right kidney, measuring 2.0 x 2.4 cm\n(9:70), unchanged. There is a simple cyst in the upper pole the right kidney\nmeasuring 2.0 x 1.6 cm (series 9:50). Sub-centimeter hypoattenuating foci in\nthe left kidney are too small to characterize. There is no hydronephrosis or\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diffuse mural\nedema of the colon likely reflects portal colopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with some mild protrusion into\nthe base of the bladder. Ascitic fluid tracks into the right scrotum.\n\nLYMPH NODES: Enlarged periportal and aortocaval lymph nodes, measuring up to\n1.7 cm in short axis (series 9:38) remains unchanged. There is no mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Ascitic fluid tracks into the right inguinal canal. The\nabdominopelvic wall is within normal limits.", "output": "1. Slight interval increase in size of mass-forming intrahepatic\ncholangiocarcinoma lesions since the prior study from ___. Unchanged\ninfiltrative peribiliary soft tissue in the central liver.\n2. No interval change in degree of intrahepatic biliary dilatation in the left\nhepatic lobe. CBD stent with internal foci of air and a second stent in a\nsegment VII intrahepatic duct.\n3. Redemonstration of chronic thrombosis of the portal vein with cavernous\ntransformation and extensive perihepatic collateral vessels. Near occlusive\nthrombus in a short segment of the superior aspect of the superior mesenteric\nvein, unchanged.\n4. Small volume ascites, which tracks into the right inguinal canal and\nscrotum, unchanged.\n5. Enlarged periportal and aortocaval lymph nodes, likely metastatic,\nunchanged.\n6. Diffuse mural edema of the colon, likely reflecting portal colopathy.\n7. Multiple pulmonary metastases in the lung bases, unchanged." }, { "input": "LOWER CHEST: Visualized lung bases are clear. There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is mildly distended but\notherwise unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n9 mm hypodensity within the interpolar region of the right kidney is too small\nto characterize but likely a cyst. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is fluid-filled and dilated up\nto 1.4 cm with approximately 3 mm hyperdense focus within the lumen of the mid\nappendix which likely represents an appendicolith given its abrupt dilation\ndistally (2:64). There is mild periappendiceal fat stranding and fascial\nthickening as well as a small adjacent reactive lymph node (2:67). No\nevidence of perforation or drainable fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Prominent right lower quadrant mesenteric nodes are likely\nreactive. There is no retroperitoneal lymphadenopathy. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta and IVC are normal in course and caliber. \nPortal vasculature is patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute uncomplicated appendicitis with probable appendicolith within the mid\nappendiceal lumen. No evidence of perforation or fluid collection. Reactive\nright lower quadrant mesenteric lymph nodes. Small amount of free fluid in\nthe pelvis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:51 am, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please see separate dictation on the same day for the evaluation\nof the supradiaphragmatic structures.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Scattered retroperitoneal and mesenteric lymph nodes are not\npathologically enlarged.\n There is no pelvic or inguinal lymphadenopathy.\n\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Sclerotic lesions involving multiple levels of the spine are consistent\nwith history of metastatic prostate cancer.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multilevel sclerotic lesions in the spine consistent with metastatic\nprostate cancer\n2. Scattered non-pathologically enlarged retroperitoneal and mesenteric\nlymph nodes. No evidence for lymphadenopathy\n3. Please see separate dictation on the same day for evaluation of the chest" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nInterval decrease in size of irregular hypodense lesion in segment 3 measuring\n1.7 x 1.7 cm, previously 2.1 x 1.8 cm. No new focal liver lesion identified. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. There is no evidence of enteritis or\ncolitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nRedemonstration of multiple peritoneal/omental nodules which overall improved.\nIndex lesions are as follows:\nPeritoneal nodule in the left subdiaphragmatic space (series 5, image 11)\nmeasures 2.3 cm, previously 2.3 cm\nConglomerate peritoneal mass in the left mid abdomen (series 5, image 25)\nmeasures 2.7 x 3.8 cm, previously 4.1 x 6.2 cm\n\nPreviously seen free fluid in the abdomen and pelvis has almost completely\nresolved. There is no fluid collection in the abdomen and pelvis.\n\nREPRODUCTIVE ORGANS:\nBulky fibroid uterus is noted.\nRedemonstration of a large lobulated solid and cystic mass in the pelvis\nextending to the bilateral pelvic sidewalls consistent with patient's known\novarian malignancy. This has decreased in size in the interval measuring 10 x\n11.6 cm, previously 11 x 14.5 cm.\n\nLYMPH NODES:\nRetroperitoneal and pelvic lymphadenopathy is also improved. Index nodes are\nas follows:\nLeft periaortic node (series 5, image 35) measures 11 mm, previously 15 mm\nLeft external iliac node (series 5, image 78) measures 14 mm, previously 20 mm\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSmall bony fragment along the anterior superior endplate of is unchanged and\nlikely represents a limbus vertebra.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of enteritis or colitis. No evidence of abscess in the abdomen\nand pelvis.\n2. Slight interval decrease in size of the solid and cystic pelvic mass\nconsistent with patient's known ovarian malignancy.\n3. Overall improvement in metastatic disease burden with decreased size of the\nliver metastasis, peritoneal carcinomatosis and retroperitoneal\nlymphadenopathy as documented above." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere has been interval decrease in size of a hypodense lesion in segment\n4A/B, now measuring 0.9 cm, previously up to 1.7 cm. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nMultiple omental/peritoneal metastatic deposits are decreased in size compared\nto prior exam. For example, a nodule in the left subdiaphragmatic space,\nanterior to the spleen measures 7 mm, previously 2.3 cm (02:49). A nodule\nadjacent to the transverse colon near the splenic flexure measures 1.9 cm,\npreviously up to 3.8 cm (2:60). A deposit in the upper left pelvis measures\nup to 2.4 cm, previously up to 3.9 cm (2:95). Several additional\npredominantly left-sided deposits are seen throughout the abdomen and pelvis\n(e.g. 2:102, 99, 78).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There has\nbeen interval decrease in size of a lobulated solid and cystic mass in the\npelvis. Component in the left hemipelvis now measures 5.5 x 7.3 cm. This\ncomponent previously measured 8.8 x 11.1 cm. Component along the right pelvic\nsidewall now measures 7.4 x 3.1 cm, previously 8.2 x 3.7 cm. These two\ncomponents appeared more contiguous on the prior exam and now appear separated\nby loops of bowel and by the uterus. The large left pelvic component of the\nmass continues to abut the uterus as well as the bladder.\n\nREPRODUCTIVE ORGANS: Uterus contains fibroids but is otherwise unremarkable. \nThe right and left ovaries are not well visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nPreviously enlarged 11 mm left periaortic node now measures 7 mm (2:71). \nThere has been interval improvement in size of enlarged left external iliac\nnodes. Largest measures up to 10 mm, previously up to 14 mm (2:114).\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Significant interval decrease in size of a large cystic and solid pelvic\nmass.\n2. Interval decrease in size of metastatic liver lesion, multiple metastatic\nomental deposits, and left external iliac adenopathy.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n0.9 cm hypoattenuating lesion in segment IV is unchanged, previously 0.9 cm\n(5:22). No new focal lesions are identified. The portal and hepatic veins\nare patent.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. There is direct contact between the sigmoid colon and the adjacent\npelvic mass (2:108), as seen on prior. The appendix is normal (2:115).\n\nMultiple omental nodules are again seen, predominantly in the left lower\nquadrant, and are overall smaller, with representative measurements as\nfollows:\n\n1. 1.8 cm nodule adjacent to the junction of descending and sigmoid colon\n(2:100), previously 2.4 cm\n2. 2.4 cm oval-shaped nodule in the low left lower quadrant (2:108),\npreviously 3.0 cm\nPELVIS: The urinary bladder is unremarkable.\n\nA large multilobulated solid and cystic mass in the left pelvis is smaller,\nnow measuring approximately 6.8 x 4.6 cm (2:111-112), previously 6.9 x 6.9 cm,\nas remeasured today. The right pelvic component of this mass is also smaller,\nmeasuring 8.1 x 2.1 cm (02:13), previously 8.2 x 3.1 cm, as remeasured today.\n\nREPRODUCTIVE ORGANS: There is a fibroid uterus. The ovaries are not\ndefinitely seen.\n\nLYMPH NODES: A 7 mm left periaortic node is unchanged (2:69). An 8 mm left\nexternal iliac node (2:106) is smaller, previously 10 mm. No new or enlarging\nnodes are seen in the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Compared to ___, continued interval decrease in size of pelvic\nsolid/cystic masses and omental nodules.\n2. Additional findings, as above.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is fascial thickening involving the right lateral\nConal fascia, with asymmetric an irregular wall thickening of the proximal\nascending colon just beyond the ileocecal valve (05:56). There is surrounding\ninflammatory change and lymphadenopathy in this area, some of which appear\nslightly ill-defined and misty in appearance. The lymphadenopathy extends to\nthe root of the mesentery, and in addition there are mildly prominent\nretroperitoneal lymph nodes seen.\n\nRemainder of the visualized colon and appendix are within normal limits. The\nterminal ileum appears grossly uninvolved by the above described findings, and\nthe remainder of the small and large bowel loops are unremarkable. There\npostsurgical gastric changes with a small hiatus hernia is seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Once again a\ntubular, cystic-appearing structure seen in the left hemipelvis measuring 2.1\nx 5.0 cm. The patient is status post hysterectomy and bilateral oophorectomy,\nand this may represent residual fallopian tube or alternatively postsurgical\nseroma. Its stability over a ___ year period is reassuring.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Fascial thickening involving the right lateral Conal fascia, with asymmetric\nan irregular wall thickening of the proximal ascending colon just beyond the\nileocecal valve (05:56). There is surrounding inflammatory change and\nlymphadenopathy in this area, some of which appear slightly ill-defined and\nmisty in appearance. The lymphadenopathy extends to the root of the\nmesentery, and in addition there are mildly prominent retroperitoneal lymph\nnodes seen. Primary concern is for neoplastic process at this level, and\ncorrelation with endoscopy is recommended. Alternatively, these may represent\nsequela of an infectious/inflammatory process. Clinical and endoscopic\ncorrelation is recommended.\n\nRECOMMENDATION(S): Recommend endoscopic correlation for further evaluation of\nthe ascending colon and cecal abnormalities detailed above, and for exclusion\nof an underlying neoplastic process." }, { "input": "Scout images demonstrate hyperdense enteric contrast in the transverse colon.", "output": "CT scan was not performed due to allergic reaction to iodinated contrast." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions, greater on the left.\nThere also bibasilar consolidations, also increased compared to the prior CT. \nThe heart is normal in size without pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A 10\nmm hypodensity in the dome of the liver was not definitely on the prior CT,\nalthough this may be due to a technique (series 3, image 12). No other focal\nliver lesions are definitely seen. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass. Oral\ncontrast is seen within the excluded stomach, consistent with a gastrogastric\nfistula (series 3, image 28). Small bowel loops are mildly dilated without a\nzone of transition. Oral contrast of a higher density is seen in the colon,\nwhile less dense oral contrast is seen within the distal small bowel. The\npresence of oral contrast in the colon argues against the presence of a\nhigh-grade obstruction. There is no extravasation of oral contrast material\nor free air to suggest perforation. A portion of the ascending colon is not\nopacified with oral contrast. The known ascending colon mass is not well\nassessed on the current study. The colon remains normal in caliber. The\nappendix is not visualized.\n\nAssessment for peritoneal nodularity is limited in the absence of IV contrast.\nModerate ascites is increased since the prior CT.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: An enlarged cardiophrenic lymph node is increased in size since\nthe prior study, now measuring 13 mm in short axis (series 3, image 12). \nMultiple enlarged mesenteric lymph nodes are similar to perhaps slightly\nincreased since the prior study. There is no retroperitoneal lymphadenopathy.\nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse anasarca is present.", "output": "1. No free air or extravasation of oral contrast to suggest bowel perforation.\nNo abscess.\n2. Dilated loops of small bowel without definite zone of transition . Transit\nof oral contrast all the way to the colon argues against high-grade small\nbowel obstruction.\n3. The known colonic mass not well evaluated on the current study. Absence of\nIV contrast limits assessment for peritoneal carcinomatosis.\n4. 10 mm hypodense lesion in the liver dome, not definitely seen on the prior\nstudy, although this may be due to differences in technique.\n5. Status post Roux-en-Y gastric bypass with the presence of a gastrogastric\nfistula, given the presence of oral contrast within the excluded stomach.\n6. Moderate ascites and anasarca, increased since the prior study." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. There is a moderate size left\nand small right pleural effusion which have increased from prior examination.\n\nABDOMEN:\n\nHEPATOBILIARY: There are numerous hypodense liver lesions, several appear new\ncompared to prior examination. Differential includes hepatic abscess disease\nand metastases. The gallbladder is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is shrunken.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. Perinephric stranding is\nnonspecific.\n\nGASTROINTESTINAL: Patient status post gastric bypass. Mildly dilated small\nbowel loops in the lower abdomen pelvis likely represent a ileus. Known colon\nmasses not well evaluated. Extensive inflammatory changes in the right lower\nquadrant with significant inflammation and thickening of the proximal and mid\nappendix is similar in appearance to prior examination dating back to ___. . There is a large volume ascites, increased when compared to prior\nexam.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Moderate\nfree fluid in the pelvis noted.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is extensive mesenteric adenopathy and stranding.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. When compared to prior examination from ___, there are numerous\nnew hypodense liver lesions measuring up to 1 cm that are incompletely\nevaluated on this non-contrast study with differential including hepatic\nabscess as well as metastatic disease. If clinically indicated a MRI could be\nobtained for more complete evaluation.\n2. Extensive inflammatory changes in the right lower quadrant with significant\ninflammation and thickening of the cecum, terminal ileum, and proximal and mid\nappendix is similar in appearance to prior examination dating back to ___. Most likely the appendiceal findings are secondary to the surrounding\ninflammatory process.\n3. Extensive mesenteric adenopathy with stranding highly concerning for\nmetastatic disease. Known colonic mass is not visualized.\n4. Large volume ascites. Evaluation for peritoneal carcinomatosis limited\nwithout intravenous contrast.\n5. Please see separate chest CT report for chest findings.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 11:53 AM, 30 minutes after\ndiscovery of the findings." }, { "input": "The heart is mild to moderately enlarged. Streaky opacities at the lung bases\nare most suggestive of atelectasis although there may be mild underlying\ninterstitial changes. Trace pleural effusions are present. The apex of the\nleft ventricle is calcified suggesting prior infarct. Blood pool attenuation\nof 15 Hounsfield units is low consistent with anemia.\n\nThe gallbladder is collapsed with wall thickening that suggests third-spacing\nphenomenon, for example this could be seen following fluid resuscitation. The\npancreas, adrenal glands, and spleen appear within normal limits. No focal\nliver lesions are identified. There is no biliary dilatation.\n\nThe stomach and small bowel appear within normal limits. The small and large\nbowel appear within normal limits. There is a small fat-containing\nperiumbilical hernia to the left of midline with a sac measuring 36 mm in\ndiameter and neck of 12 mm in width.\n\nThe prostate is normal in size. The seminal vesicles, distal ureters and\nbladder are unremarkable. There is no evidence of hematoma. There is no\nlymphadenopathy or ascites. A penile implant is in place. Vascular\ncalcification is mild to moderate.\n\nNo fracture is identified. There are no suspicious lytic or blastic bone\nlesions. Mild degenerative changes affect the L5-S1 facet joints.", "output": "No evidence of hematoma or other acute intra-abdominal process." }, { "input": "LOWER CHEST: Clear visualized lung bases. Small hiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: No suspicious lesions.\n\nNodular shrunken liver with caudate hypertrophy consistent with cirrhosis.\nTrace perihepatic ascites. No ductal dilation.\n\nPatent hepatic vasculature. Recanalized umbilical vein. Splenic and\ngastroesophageal varices with splenorenal shunt. Near complete occlusion of\nsplenic vein at the confluence, not significantly changed.\n\nCholelithiasis without signs of acute cholecystitis.\n\nPANCREAS: 6 mm lesion dorsal aspect body of pancreas (series 3, image 52)\nabutting the pancreatic duct, likely side branch IPMN.\n\nSPLEEN: 13.8 cm splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY: 7 mm nephrolith right inferior pole, unchanged. No hydronephrosis. \nUnremarkable left kidney. Sub cm left inferior pole cyst.\n\nGASTROINTESTINAL: No intestinal obstruction. Unremarkable appendix. No\npneumoperitoneum.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Patent aorta and major branches. Mild arteriosclerosis.\n\nBONES AND SOFT TISSUES: No acute fracture or suspicious osseous lesion. No\nsoft tissue mass.", "output": "1. Cirrhosis, trace ascites, varices, and 13.8 cm splenomegaly. No suspicious\nlesion. Patent hepatic vasculature.\n2. Stable focal near complete thrombosis of the splenic vein and the\nconfluence.\n3. 6 mm hypodense pancreatic lesion, likely side branch IPMN.\n4. Similar 7 mm right nephrolith. No hydronephrosis.\n5. Cholelithiasis.\n\nRECOMMENDATION(S): Pancreatic MRCP followup in ___ year for pancreatic lesion." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular in contour and parenchyma\nconsistent with cirrhosis. There is a 1.2 cm focus of irregular peripheral\narterial phase enhancement in hepatic segment 6 without associated washout or\npseudo capsule. This is more prominent when compared to the MRI from ___. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is slightly contracted and the gallbladder wall is\nmildly thickened, which may be due to underlying liver disease. There are\nmultiple gallstones.\n\nThere is a mild amount of ascites, increased when compared to CT from ___\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions . There is no peripancreatic stranding. There is focal\npancreatic main duct dilation with abrupt transition in the body of the\npancreas to a normal size main pancreatic duct. This may be due to chronic\npancreatitis as it is stable when compared to MRI from ___ and\nthere is no underlying lesion identified\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. There is a nonobstructing 5 mm interpolar right\nrenal stone.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Appendix is normal\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is a replaced right hepatic artery off the SMA. There are\nparaesophageal and perigastric varices. There is a splenorenal shunt. \nHepatic veins are patent. There is a patent para umbilical vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cirrhosis with portal hypertension with a moderate to large splenorenal\nshunt which is grossly unchanged compared to ___.\n2. There is a nonspecific 1.2 cm hepatic segment 6 focus of irregular\nperipheral arterial phase enhancement without washout or pseudo capsule. This\nis more prominent when compared to the MRI from ___ and was not\nseen on the MRI from ___. Follow-up in 3 months is recommended.\n3. Again seen is the pancreatic duct dilation within the tail with abrupt\ntransition without underlying mass identified as seen on MRI from ___. This is likely due to chronic pancreatitis.\n\nRECOMMENDATION(S): CT or MRI in 3 months to follow-up an indeterminate\nhepatic segment 6 lesion.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:15 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Small bilateral pleural effusions, left greater than right with\noverlying compressive atelectasis. No focal consolidation. Mild coronary\ncalcifications are present.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a left adrenal myelolipoma measuring 17 x 21 mm. The right\nadrenal is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Interval placement of a right-sided catheter extending from\nthe right lateral abdomen along the undersurface of the liver. Patient is\npost Roux-en-Y gastric bypass. There postsurgical changes related to partial\ngastrectomy. Interval improvement of the previously seen discontinuity of the\nsecond portion the duodenum in comparison to the prior study from ___. There is no evidence of bowel obstruction. There is no evidence of\ncontrast extravasation to suggest active bleed. Round hyperdense material\nwithin the ascending colon, likely represent ingested pills. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. A replaced left hepatic artery to left gastric is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Multiple\nmetallic surgical staples overlying the mid abdomen.", "output": "1. Post partial gastrectomy, with mild postsurgical changes in the upper\nabdomen. No evidence of contrast extravasation to suggest active bleed.\n2. Post Roux-en-Y gastric bypass. No evidence for bowel obstruction.\n3. Small bilateral, left greater than right, pleural effusions.\n4. Stable left adrenal myelolipoma." }, { "input": "LOWER CHEST: There is trace bibasilar dependent atelectasis. The visualized\nlung fields are otherwise within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is mild splenomegaly, measuring up to 13.7 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. No abscess identified.\n\nGASTROINTESTINAL: The stomach is unremarkable, not well assessed on CT. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is pan-colonic diverticulosis without evidence of\ndiverticulitis. The colon and rectum are otherwise within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. The bladder\nwall does not appear thickened. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A hyperdensity within the right ovary likely represents\nan involuting hemorrhagic cyst (601:30). The visualized reproductive organs\nare otherwise unremarkable.\n\nLYMPH NODES: No lymphadenopathy within the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process. No evidence of pyelonephritis.\n2. Mild splenomegaly measuring up to 13.7 cm." }, { "input": "LOWER CHEST: A separate chest CT is performed and will be reported\nindividually. Few tiny subcentimeter pulmonary nodules are identified. No\nevidence for pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is mild dilation of the\nsmall bowel loops up to 2.9 cm. Several decompressed loops of small bowel\nalso identified in the pelvis. No acute transition point is seen. No\nevidence for hernias or masses. The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. There is ballooning of the levator a muscles\nconsistent with pelvic floor descent.\n\nREPRODUCTIVE ORGANS: Fibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No explanation for the patient's weight loss. 2. There is mild dilation\nof some of the small bowel loops in the abdomen without identifiable\nabnormality such as a mass or hernia. 3. Gastrostomy. 4. Fibroid uterus. \n5. Pelvic floor descent." }, { "input": "Chest is reported separately.\n\nNo focal liver lesions are identified. There is no biliary dilatation. \nGallbladder appears normal. Spleen is normal in size and appearance. \nPancreas is unremarkable. Adrenals appear normal. There is no evidence for\nsolid mass or hydro nephrosis involving either kidney. In the lower pole of\neach kidney, there is a subcentimeter hypodense focus that is too small to\ncharacterize but doubtful in clinical significance.\n\nThere is a small hiatal hernia. Stomach is collapsed but with questionable\nfold thickening along the body and fundus. Small bowel appears normal. \nQuantity of stool along the colon is mildly prominent.\n\nUterus, adnexa and bladder are unremarkable. Mixed type atherosclerotic\nchanges are moderate. Major vascular structures are widely patent. There is\nno lymphadenopathy, free air, or free fluid.\n\nPatient is status post open reduction internal fixation of each proximal\nfemur. There are no suspicious bone lesions. Moderate degenerative changes\naffect lumbar facet joints throughout the lumbar spine. Moderate L1, mild\nL2, and mild to moderate L4 compression deformities appear chronic and\nassociated with marked demineralization.", "output": "1. Questionable fold thickening along the gastric fundus and body. This\ncould be evaluated with endoscopy or upper GI series when/if clinically\nappropriate.\n\n2. No convincing evidence of malignancy however although differential\ndiagnosis for fold thickening includes low-grade lymphoma. This seems less\nlikely, however, than artifact of underdistention versus gastritis or other\ncauses of benign fold hypertrophy." }, { "input": "LOWER CHEST: Imaging of the lower lung fields in the upper abdomen is\nmoderately degraded by motion artifact, however the lung fields appear within\nnormal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 7 mm hypodensity in segment 2 that likely represents a cyst. \nOtherwise there is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a right exophytic renal cyst measuring 2 cm and a left\nexophytic renal cyst measuring 1 cm. The kidneys are otherwise are of normal\nand symmetric size with normal nephrogram. There is no evidence of\nhydronephrosis or perinephric abnormality bilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are moderate degenerative changes in the lumbar spine most\nprominently at L5-S1. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of intra-abdominal/pelvic mass or inflammation." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is a small amount of ascites, increased from prior (7:20).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A hypodense soft tissue nodule in the left upper\nquadrant anterior to the spleen is increased in size, measuring 2.1 x 1.5 cm,\ncompared with 1.4 x 1.1 cm previously (4:37, 7:32).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nTwo intermediate density lesions in the right kidney measuring up to 1.5 cm\nare incompletely characterized, however are stable from prior (4:53, 63). \nMultiple additional bilateral cortical hypodensities are too small to\ncharacterize, however likely represent cysts. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized. Thickening\nof the peritoneum on the inferior edge of the liver is increased from prior,\nand was consistent with peritoneal metastases on biopsy ___ (4:56).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and bilateral\nsalpingo oophorectomy.\n\nLYMPH NODES: Small retroperitoneal nodes are new or increased in size from\nprior, the largest being a left periaortic node measuring 9 mm (4:57). \nBilateral common iliac nodes measuring up to 8 mm are new compared with prior\n(4:79, 80, 84).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are multiple ill-defined soft tissue densities in the\nbilateral posterior subcutaneous tissue, some of which appear increased in\nsize compared to prior (4: 81, 87, 94, 113). Although these are lesions are\nnot very nodular in appearance, foci of metastatic disease cannot be excluded.", "output": "1. Interval progression of disease, with increase in peritoneal thickening and\nsize of a 2.1 cm soft tissue nodule anterior to the spleen, as well as\nincrease in small amount of ascites compared with prior.\n2. Multiple small retroperitoneal and bilateral common iliac nodes do not meet\nCT size criteria for lymphadenopathy, however are new or increased in size\ncompared with prior, and are concerning for metastatic disease.\n3. Multiple ill-defined soft tissue densities in the bilateral posterior\nsubcutaneous tissue are not very nodular in appearance, however metastatic\ndisease cannot be excluded. Recommend correlation with history of\nsubcutaneous injections.\n4. Two indeterminate lesions in the left kidney are stable from prior and may\nrepresent hyperdense cysts\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 13:52 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nPostsurgical changes from laparoscopic cholecystectomy. No abscess or\nresidual fluid collection identified.\n\nHEPATOBILIARY: Small left hepatic lobe hypodensity, characterized as cysts on\nprior MRI. The liver otherwise demonstrates homogenous attenuation\nthroughout. There is no evidence of concerning focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Tiny hypodensity in the lower pole the left kidney, too small to\naccurately characterize but likely cyst. The kidneys are otherwise of normal\nand symmetric size with normal nephrogram. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The terminal ileum is somewhat\nfeatureless and contains some proliferation of intramural fat, possibly from\nprior episode of ileitis. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Postsurgical changes from laparoscopic cholecystectomy. No abscess or\nresidual fluid collection identified." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable. Again seen is a mildly\nthickened appearance of the left adrenal, unchanged from prior study.\n\nURINARY: There is an unchanged subcentimeter hypodense lesion in the\ninterpolar aspect of the left kidney (___), characterized on prior MRI as a\ncyst. The kidneys are otherwise of normal and symmetric size with normal\nnephrogram. No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Again seen is\ndiverticulosis throughout the colon without diverticulitis. The appendix is\nnot visualized.\n\nMESENTERY: Again seen is ill-defined stranding in the mid and left mesentery\nwith multiple enlarged mesenteric, bilateral para-aortic, common iliac and\nretroperitoneal lymph nodes, not significantly changed from prior studies.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted. There is atherosclerotic calcification at the ostia of the\nceliac axis and superior mesenteric artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAgain seen are multilevel degenerative changes with minimal retrolisthesis of\nL2 on L3.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of small bowel obstruction, as clinically questioned.\n2. Again seen is ill-defined stranding in the mid/left mesentery with multiple\nenlarged mesenteric, periaortic and retroperitoneal lymph nodes, consistent\npatient's history of sclerosing mesenteritis and not significantly changed\ncompared to ___.\n3. Diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: New, small, left lower lobe posterior basal segment\nconsolidation. The remaining visualized lung bases are clear. No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Diffuse left adrenal gland thickening is unchanged compared to ___. The right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA hypoattenuating lesion in the anteromedial interpolar left kidney is\nunchanged, but otherwise too small to completely characterize, likely a simple\ncyst. No suspicious renal lesion identified. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Probable small hiatal hernia. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not seen.\n\nLYMPH NODES: Retroperitoneal lymphadenopathy measuring up to 1.1 cm in short\naxis is unchanged since ___ (series 2, image 39). Mesenteric\nlymphadenopathy and fat stranding are not appreciably changed since ___. Prominent subcentimeter pelvic lymph nodes, for example in the right\nexternal iliac station, are also unchanged (series 2, image 61).\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDiffuse osseous heterogeneity likely related to diffuse osseous\ndemineralization. Minimal retrolisthesis of L2 on L3 is unchanged. A small\nposterior disc bulge at L2 on L3 results in at least mild spinal canal\nnarrowing.\n\nSOFT TISSUES: Small, fat containing umbilical hernia.", "output": "1. Left lower lobe posterior basal segment pneumonia.\n2. No acute abdominopelvic process.\n3. Mesenteric lymphadenopathy and fat stranding and retroperitoneal\nlymphadenopathy are unchanged since ___, compatible with sclerosing\nmesenteritis.\n4. Colonic diverticulosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.4 cm lesion in segment 7 with irregular peripheral enhancement is present. \nAn additional 2.4 cm lesion in segment 6 also demonstrates irregular\nperipheral enhancement. A subcentimeter enhancing lesion in segment 4A is too\nsmall to characterize. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There are a 1 point 6 x 1.7 cm simple\ncyst arises from the inferior pole of the right kidney. Multiple additional\nsubcentimeter hypodensities in both kidneys are too small to characterize but\nalso likely represent simple cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. A 7 mm dependent hypodensity arising from\nthe wall of the cecum (02:50 and 601b:34) appears contiguous with stool, but\nmay represent the lesion seen on colonoscopy. The appendix is surgically\nabsent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nare prominent, nonspecific ileocolic nodes. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 7 mm hypodensity arising from the wall of the cecum is equivocal for a\nsubmucosal or mucosal lesion seen at the appendiceal orifice on recent\ncolonoscopy, but is difficult to differentiate from a small focus of stool. \nNo extramural tumor detected.\n2. Nonspecific prominent ileocolic lymph nodes.\n3. 3 hypoenhancing hepatic lesions are incompletely characterized on this\nsingle phase examination, but demonstrate enhancement patterns favoring\nhemangiomas. If further evaluation is desired, MRI could be considered.\n4. No ascites." }, { "input": "LOWER CHEST: There are moderate bilateral pleural effusions with associated\ncompressive atelectasis. There is also mild subsegmental atelectasis of the\nlingula. The heart is normal in size. There is a small pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation. There is a 4 mm cyst\nor biliary hamartoma in segment II (series 5, image 17). No suspicious\nhepatic lesion is identified. There is trace perihepatic ascites. There is\nno evidence of intra- or extrahepatic biliary dilatation. The gallbladder\ncontains sludge but no calcified stones. There is no gallbladder wall\nthickening or pericholecystic fluid.\n\nPANCREAS: The pancreas is homogeneous in attenuation, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged, measuring 13.6 cm in length. No focal\nlesions are identified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size and demonstrate normal nephrograms.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are normal\nin caliber. There is wall thickening of the terminal ileum, cecum and\nascending colon, with surrounding fat-stranding and a small amount of fluid\nwithin the right paracolic gutter, compatible with colitis, specifically\ntyphlitis in this patient with history of AML and recent stem-cell\ntransplantation. The appendix is normal.\n\nPELVIS: The urinary bladder is under distended and therefore suboptimally\nassessed. There is a moderate amount of free fluid in the pelvis. The\nperianal fistula seen on the MR pelvis of ___ is not well assessed by\nCT.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are mild multilevel endplate degenerative changes. No suspicious\nosseous lesions are identified.\n\nSOFT TISSUES: There is diffuse anasarca of the body wall.", "output": "1. Wall thickening of the terminal ileum, cecum and ascending colon, with\nsurrounding fat-stranding and a small amount of fluid within the right\nparacolic gutter, compatible with colitis, specifically typhlitis in this\npatient with history of AML and recent stem-cell transplantation.\n2. Trace perihepatic ascites. Moderate amount of free fluid in the pelvis.\n3. Mild splenomegaly.\n4. Moderate bilateral pleural effusions with associated compressive\natelectasis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:42 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST:\nImaged lung bases are unremarkable without evidence of pulmonary nodule or\nmass. There is no pleural or pericardial effusion. Heart size is within normal\nlimits. There is a mitral valve prosthesis. Elevation of the right\nhemidiaphragm is unchanged.\n\nABDOMEN:\nEvaluation of abdominal and pelvic structures is limited due to lack of\nintravenous contrast.\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion, however sensitivity is markedly limited\nwithout intravenous contrast. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation. There is no peripancreatic stranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion.\nADRENALS: Adrenal glands are not well visualized in this noncontrast\nexamination..\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof stones, focal renal lesions or hydronephrosis. There are no urothelial\nlesions in the kidneys or ureters. There is no perinephric abnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. There is moderate distension of the rectum with stool,\nimproved since severe distension CT ___.. There is persistent rectal\nwall thickening with surrounding fat stranding. Lack of intravenous contrast\nprecludes evaluation for rectal wall enhancement.\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is severe calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Dextroconvex rotoscoliosis with\nassociated degenerative changes is unchanged. Abdominal and pelvic wall is\nwithin normal limits.", "output": "1. Moderately distended rectum secondary to stool, improved since severe\ndistension ___. Persistent rectal wall thickening and perirectal fat\nstranding may be secondary to resolving episode of rectal distention. Lack of\nintravenous contrast precludes evaluation for mucosal enhancement.\n2. Rotoscoliosis with degenerative changes of the lumbar spine.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 5:05 ___, 20 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney contains multiple large renal stones, the largest\nstably measuring up to 17 mm. The right kidney is slightly atrophic compared\nto the left. 2.7 cm hypodensity in the upper pole of the kidney likely\nrepresents a caliceal diverticulum or a cyst (601b:44). There are\nwedge-shaped parenchymal hypodensities in the interpolar region of the left\nkidney (601b:38, 02:35). There is no perinephric abnormality. The right\nkidney enhances symmetrically when compared to the left.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. However, the\nterminal ileum is mildly distended with fecal as material without evidence of\nbowel wall thickening, likely representing slow transit. There is\ncircumferential thickening of the descending colon, the sigmoid colon and the\nrectum, likely due to underdistention. Diverticula of the colon demonstrate\nno focal bowel wall thickening. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Scattered retroperitoneal lymph nodes are prominent, though not\npathologically enlarged. The portacaval node measures up to 10 mm (02:32). \nRight retrocaval node measures up to 5 mm in the short axis. Scattered pelvic\nwall lymph nodes are prominent, though not pathologic by CT size criteria. \nThere is no inguinal lymphadenopathy by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSmall bone island in the proximal left femur is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Wedge-shaped hypodensities in the left kidney, likely represent\npyelonephritis, without significant fat stranding. Renal infarct is less\nlikely. Please correlate with urinalysis.\n2. Multiple dense obstructing right renal stones with mild atrophy of the\nright kidney, unchanged from prior exam. However, enhancement of the atrophic\nright kidney and some contrast excretion is present.\n3. No pneumonia in the visualized lower lobes." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable.\n\nABDOMEN: A nodular soft tissue lesion is seen in the right mid abdomen along\nthe anterior abdomen, series 2, image 35 measuring 1.4 x 1.3 x 2.6 cm. A\nsecond similar appearing nodular lesion is seen subumbilical along the\nanterior abdomen, series 2 image 55 measuring 1.4 x 1.0 x 1.3 cm. Larger\nsimilar appearing lesions noted in the right and left lower quadrants,\nmeasuring 3.9 x 4.5 x 2.4 cm on the right, series 2, image 69, and 3.4 x 2.3 x\n3.2 cm in the left anterior pelvis, series 2, image 66.\n\nHEPATOBILIARY: The liver enhances normally without focal lesion of concern. \nMain portal vein is patent. No biliary ductal dilation is seen. The\ngallbladder is not fully distended. No common bile duct dilation.\n\nPANCREAS: The pancreas appears normal without focal abnormality or signs of\nacute inflammation.\n\nSPLEEN: The spleen is normal in size without focal abnormality.\n\nADRENALS: The adrenal glands appear normal.\n\nURINARY: There is a solid-appearing lesion arising exophytically from the\nupper pole of the left kidney measuring 1.9 x 1.4 x 1.5 cm. This lesion is\nbest seen on series 601, image 53. Evaluation with ultrasound is advised for\notherwise the kidneys appear unremarkable.\n\nGASTROINTESTINAL: The stomach contains enteric contrast and appears normal. \nThe duodenum is unremarkable. Small bowel loops demonstrate no signs of ileus\nor obstruction. The appendix is not visualized. There is a rounded lesion in\nthe right lower quadrant measuring 4.8 x 4.4 x 4.3 cm, series 2, image 54 and\nseries 601, image 30. This lesion appears slightly hypodense centrally with\ncentral attenuation of approximately 38 ___ units. There is\nsurrounding fat stranding. The adjacent colon appears normal. No free air.\n\nPELVIS: An intramural fibroid is noted within the posterior wall of the\nanteverted uterus measuring approximately 3.8 x 4.2 x 5.3 cm. A corpus luteum\nis noted within the right ovary. The left ovary appears grossly unremarkable.\nAnterior pelvic masses described above measures 3.9 x 4.5 x 2.4 cm on the\nright, series 2, image 69, and 3.4 x 2.3 x 3.2 cm in the left anterior pelvis,\nseries 2, image 66. Small volume free fluid is noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerosis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.", "output": "1. Recurrent fibroid (versus leiomyosarcoma) within the posterior uterine wall\nin this patient with history of prior fibroid resection. Several solid\nappearing masses in the abdomen/pelvis as described, with central hypodensity\nand stranding associated with a right lower quadrant mass suggesting necrosis.\nFindings are concerning for malignancy, possibly leiomyosarcoma, and\ncorrelation with biopsy is advised.\n2. Indeterminate lesion arising from the left renal upper pole for which renal\nultrasound is recommended to further assess.\n\nRECOMMENDATION(S): Pelvic MRI, biopsy.\nRenal ultrasound\n\nNOTIFICATION: Findings discussed with Dr. ___." }, { "input": "CT OF ABDOMEN.\n\nThe lung bases are clear. There are no pleural or basal pericardial effusions\nidentified. Specifically the previously described trace effusions and \natelectasis have resolved.\n\nMultiple cystic lesions are identified within the liver parenchyma some of\nwhich demomstrate mural calcification. A 7.5 x 6.4 x 6.8 cm fluid collection\nis identified in a cyst arising from the left hepatic lobe. Again this\ncollection contains multiple foci of nondependent gas in keeping with thick\nfluid. Note is made of a percutaneous drainage catheter in satisfactory\nposition within the fluid collection. On comparison with the post drain\nplacement and aspiration study of ___ the collection has reduced\nsomewhat in size where the lesion measured 8.9 x 7.1 cm in maximal axial\ndimension. Nevertheless, there is a persistent fluid which is likely\nsemisolid in nature within the cavity. The catheter will require regular\nflushing and irrigation to ensure further drainage and if this is unsuccessful\ncatheter upsizing to a larger caliber tube may be required . \n\nChanges of polycystic kidney disease are noted with innumerable cysts arising\nfrom the native kidneys bilaterally.Again some cysts appear hyperdense or have\nareas of mural calcification. There is extensive abdominal aortic\ncalcification with evidence of stenosis of the celiac axis at the origin\n(2:18). Both adrenal glands are normal in size. There is no free\nintra-abdominal fluid. Normal appearance of the spleen. Note is again made\nof a 2.4 x 3.9 cm hyperdense focus in the gall bladder in keeping with a\ncalculus or tumefactive sludge. There is no evidence of intrahepatic biliary\ndilatation.\n\nCT OF PELVIS: There is a right lower quadrant renal transplant graft in situ.\nNote is again made of a 3.2 x 4.8 cm cyst seen posteromedially which is stable\nsince ___. \nNo free fluid in the pelvis. Satisfactory appearance of the bladder, rectum\nand sigmoid colon. There are no pathologically enlarged pelvic side wall or\ninguinal lymph nodes. Extensive venous collaterals are seen in both inguinal\nregions.\n\nOSSEUS STRUCTURES: Vertabra plana of T12 is again noted along with marked\ndegenerative in the lumbar spine with disc space vacuum phenomenon at\nL2-3,L3-4,L4-5 and L5-S1.", "output": "1. Slight decrease in size of the left infected hepatic cyst on comparison\nwith prior study since upsizing of the percutaneous drain. \n2. There is persistant fluid with non dependant gas indicating complexity. The\ncatheter requires regular flushing and aspiration and possible upsizing to\nimprove drainage. \n\nFindings were conveyed to Dr. ___ at 11:00 hours." }, { "input": "LOWER CHEST: There are bilateral pleural effusions with adjacent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nPreviously characterized cyst and hemangioma in the liver are stable. No new\nliver lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are bilateral percutaneous nephrostomy tubes in place. The\nkidneys are atrophic. Hyperdensity within the right renal collecting system\nmay represent residual contrast or hematoma. There is persistent dilatation\nof the bilateral collecting system and ureter.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: There is diffuse thickening of the urinary bladder. The prostate is\nnot well delineated from the urinary bladder. There is a Foley catheter in\nplace. There is no free fluid in the pelvis. Large hydroceles noted in the\nscrotum.\n\nLYMPH NODES: There is extensive retroperitoneal lymphadenopathy which has\nsignificantly worsened compared to prior examination for example left\nperiaortic lymph node currently measures up to 3.7 cm, previously 1.8 cm. \nThere are new or interaortocaval lymph nodes which measure up to 2.7 cm on\nseries 3, image 47. Congenital decrease in size of bilateral pelvic sidewall\nlymph nodes, for example right pelvic sidewall lymph node mass now measures\napproximately 5.3 x 2.6 cm, previously 5.8 x 3.8 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. There is edema within the right lower extremity greater\nthan left base concern for possible venous obstruction/thrombosis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval increase and retroperitoneal lymphadenopathy consistent with\nprogression of disease.\n2. When compared to most recent prior there is decrease in pelvic\nlymphadenopathy representing treatment response to pelvic radiation from ___.\n3. Bilateral hydronephrosis with percutaneous nephrostomy tubes in place. \nHyperdensity in the right renal collecting system may represent hematoma\nversus residual contrast from procedure.\n4. There is new edema in the right lower extremity raising concern for\npossible venous thrombosis versus venous compression. A right lower extremity\nDVT ultrasound be obtained for further evaluation.\n5. Previously characterized liver cyst and hemangioma appear unchanged. No\nnew liver lesions.\n\nRECOMMENDATION(S): Right lower extremity in ultrasound to evaluate for DVT\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:10 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Bibasilar dependent atelectasis is noted. There is no pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. A percutaneous cholecystostomy drain appears to be in appropriate\nposition with pigtail tip coiled within the gallbladder fundus.\n\nPANCREAS: The pancreas is fatty replaced without evidence of focal lesions. \nThere is no pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A nasogastric tube terminates within the proximal stomach. \nThe stomach is unremarkable. Small bowel loops demonstrate normal caliber and\nwall thickness throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is not\nvisualized. There is no evidence of pneumoperitoneum or pneumatosis.\n\nPELVIS: The bladder is collapsed around a Foley catheter. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Right groin arterial and venous catheters are noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative disease is noted, most pronounced at L5-S1 with\nloss of intervertebral disc space height and endplate sclerosis.\n\nSOFT TISSUES: There is a soft tissue nodule measuring 3.4 x 2.4 cm in the\nright lower anterior subcutaneous fat, which may represent a hematoma from\nprior subcutaneous injection. Partially visualized is a left pectoral chest\nport.", "output": "1. Within the limitations of a noncontrast study, there is no acute\nintra-abdominal or intrapelvic process. No secondary signs suggest bowel\nischemia.\n2. A percutaneous cholecystostomy tube appears to be in appropriate position\nwithin the gallbladder fundus.\n3. Soft tissue nodule measuring 3.4 x 2.4 cm in the right lower anterior\nsubcutaneous fat, which may represent a hematoma from prior subcutaneous\ninjection." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Pacing leads are seen in the\nright atrium and right ventricle, and the heart is mild-to-moderately\nenlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. A pigtail catheter via a right subcostal\napproach is demonstrated, with the distal tip curled within a decompressed\ngallbladder.\n\nPANCREAS: The pancreas is atrophic, most prominently at the head and neck,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a small duodenal\ndiverticulum. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 3.7 cm left flank lipoma. There is stranding seen\nalong the anterior abdominal wall and near the umbilicus.", "output": "1. No acute intra-abdominal or intrapelvic findings.\n2. Redemonstration of a pigtail catheter coiled within a decompressed\ngallbladder via a right subcostal approach.\n3. Small duodenal diverticulum.\n4. Subcutaneous stranding along the anterior abdominal wall near the\numbilicus.\n5. Hepatic steatosis." }, { "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerosis is seen at the inferior endplates, consistent with degenerative\nchanges. There is right asymmetric sacroiliac joint fusion on the right,\nparticularly anterior and inferiorly. This finding could be sequela of prior\ninfection but should exclude inflammatory causes of sacroiliitis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No intra-abdominal or intrapelvic findings to account for patient's left\nlower abdominal pain.\n2. Right asymmetric sacroiliac joint fusion, particularly on the anterior and\ninferior joint aspect, may be a sequela of prior infection but inflammatory\ncauses of sacroiliitis should be excluded if the etiology is not known." }, { "input": "CHEST:\n\nLUNGS AND AIRWAYS: Evaluation of the lung parenchyma is limited by extensive\nmotion artifact. However, there are innumerable solid hypoattenuating masses\nthroughout both lungs, corresponding to the lesions identified on recent chest\nradiograph. The largest measures approximately 9.2 x 7.1 cm in the right\nlower lobe. These findings are consistent with pulmonary metastases. The\ntracheobronchial tree is patent.\n\nPLEURA/PERICARDIUM: No pleural or pericardial effusion.\n\nMEDIASTINUM: There is mediastinal and bilateral hilar adenopathy, with largest\nmediastinal lymph node measuring 16 mm in short axis (right lower\nparatracheal, axial series 6, image 26), right hilar measuring 24 mm, and left\nhilar measuring 22 mm.\n\nHEART AND VESSELS: No cardiomegaly. The aorta and major vessels to the neck\nare unremarkable. The main pulmonary trunk is normal in caliber. No evidence\nof right ventricular strain. There is a Port-A-Cath in situ, with tip at the\ncavoatrial junction.\n\nESOPHAGUS AND NECK: Unremarkable.\n\nBONES AND SOFT TISSUES: There is deformity of several right-sided ribs\nposterolaterally consistent with old healed fractures. Unremarkable soft\ntissues.\n\n\nABDOMEN:\n\nHEPATOBILIARY: 13 mm hypoattenuating lesion within segment 2 is most in\nkeeping with a cyst or hamartoma. Uncomplicated cholelithiasis. No biliary\nductal dilatation.\n\nPANCREAS: Evaluation of the pancreas is limited by motion artifact, however\nthe pancreas appears grossly unremarkable without focal mass. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis. There is a duplex\ncollecting system on the left with complete duplication of the left ureter. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: 14 mm abnormally enlarged lymph node the paraesophageal\nregion. The stomach is unremarkable. The small bowel is normal in caliber. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is evidence of a prior abdominal perineal resection with\ndiverting left lower quadrant colostomy. The residual colon appears\nunremarkable. Normal appendix. There is confluent soft tissue within the\npresacral space measuring 4.9 x 8.6 x 8.5 cm which appears to invade the\nposterior aspect of the prostate, is also inseparable from the posterior\naspect of the bladder, and is highly concerning for recurrent disease.\n\nPELVIS: The bladder appears circumferentially thickened, which may be\nsecondary to underdistention. Confluent soft tissue within the presacral\nspace with suspected invasion of the prostate as described above.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size but is inseparable from\nconfluent soft tissue within the presacral space.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Left lower quadrant diverting colostomy. Otherwise unremarkable\nsoft tissues.", "output": "1. Confluent masslike soft tissue within the presacral space with suspected\ninvasion of the posterior prostate and seminal vesicles is highly concerning\nfor recurrent disease. This process is also inseparable from the posterior\naspect of the bladder.\n2. Innumerable bilateral pulmonary masses with hilar and mediastinal\nadenopathy is consistent with metastatic disease." }, { "input": "CHEST:\n\nLUNGS AND AIRWAYS: Evaluation of the lung parenchyma is limited by extensive\nmotion artifact. However, there are innumerable solid hypoattenuating masses\nthroughout both lungs, corresponding to the lesions identified on recent chest\nradiograph. The largest measures approximately 9.2 x 7.1 cm in the right\nlower lobe. These findings are consistent with pulmonary metastases. The\ntracheobronchial tree is patent.\n\nPLEURA/PERICARDIUM: No pleural or pericardial effusion.\n\nMEDIASTINUM: There is mediastinal and bilateral hilar adenopathy, with largest\nmediastinal lymph node measuring 16 mm in short axis (right lower\nparatracheal, axial series 6, image 26), right hilar measuring 24 mm, and left\nhilar measuring 22 mm.\n\nHEART AND VESSELS: No cardiomegaly. The aorta and major vessels to the neck\nare unremarkable. The main pulmonary trunk is normal in caliber. No evidence\nof right ventricular strain. There is a Port-A-Cath in situ, with tip at the\ncavoatrial junction.\n\nESOPHAGUS AND NECK: Unremarkable.\n\nBONES AND SOFT TISSUES: There is deformity of several right-sided ribs\nposterolaterally consistent with old healed fractures. Unremarkable soft\ntissues.\n\n\nABDOMEN:\n\nHEPATOBILIARY: 13 mm hypoattenuating lesion within segment 2 is most in\nkeeping with a cyst or hamartoma. Uncomplicated cholelithiasis. No biliary\nductal dilatation.\n\nPANCREAS: Evaluation of the pancreas is limited by motion artifact, however\nthe pancreas appears grossly unremarkable without focal mass. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis. There is a duplex\ncollecting system on the left with complete duplication of the left ureter. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: 14 mm abnormally enlarged lymph node the paraesophageal\nregion. The stomach is unremarkable. The small bowel is normal in caliber. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is evidence of a prior abdominal perineal resection with\ndiverting left lower quadrant colostomy. The residual colon appears\nunremarkable. Normal appendix. There is confluent soft tissue within the\npresacral space measuring 4.9 x 8.6 x 8.5 cm which appears to invade the\nposterior aspect of the prostate, is also inseparable from the posterior\naspect of the bladder, and is highly concerning for recurrent disease.\n\nPELVIS: The bladder appears circumferentially thickened, which may be\nsecondary to underdistention. Confluent soft tissue within the presacral\nspace with suspected invasion of the prostate as described above.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size but is inseparable from\nconfluent soft tissue within the presacral space.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Left lower quadrant diverting colostomy. Otherwise unremarkable\nsoft tissues.", "output": "1. Confluent masslike soft tissue within the presacral space with suspected\ninvasion of the posterior prostate and seminal vesicles is highly concerning\nfor recurrent disease. This process is also inseparable from the posterior\naspect of the bladder.\n2. Innumerable bilateral pulmonary masses with hilar and mediastinal\nadenopathy is consistent with metastatic disease." }, { "input": "LOWER CHEST: Please see separately dictated chest CT report for additional\nfindings.\n\nABDOMEN: The unenhanced liver is unremarkable. The pancreas appears atrophic.\nMild left adrenal thickening is present. The right adrenal gland and kidneys\nunremarkable\n\nThere are regions of peripheral wedge-shaped hypoattenuation in the spleen\nconcerning for infarcts. A 3 cm splenic cyst is also noted.\n\nGASTROINTESTINAL: No intestinal obstruction demonstrated. The appendix is\nunremarkable. There is a small amount of ascites.\n\nPELVIS: A Foley catheter is seen decompressing the urinary bladder with\nexpected air within the lumen. The pelvic fluid extends into a patent left\nvaginal process.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted.\n\nBONES: No aggressive osseous lesions.\n\nSOFT TISSUES: There is diffuse anasarca.", "output": "Hypodense wedge-shaped lesions in the superior aspect of the spleen concerning\nfor infarcts. Otherwise, markedly limited exam due to the lack of intravenous\ncontrast medium. No intestinal obstruction or free air. Anasarca." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. Visualized lung fields\nare otherwise within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffuse hypoattenuation throughout,\ncompatible with hepatic steatosis. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent. No adnexal abnormality\nidentified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative change of the thoracolumbar spine, most\nnotably including significant disc space narrowing and endplate sclerosis at\nT9-T10.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of acute intra-abdominal or intrapelvic process which would\ncorrelate with patient's reported symptoms.\n2. Hepatic steatosis." }, { "input": "LUNG BASES: The imaged lung bases are clear aside from mild dependent\natelectasis. Pacemaker leads enter the right atrium and right ventricle. The\nheart is normal in size and shape without pericardial effusion. Coronary\nartery calcification and aortic valvular calcification is seen.\n\nABDOMEN: The liver and spleen appear normal. The gallbladder is not\nvisualized and may be surgically absent. The adrenals are normal bilaterally.\nThe pancreas is somewhat atrophic but otherwise unremarkable. There is a\nlobular left renal cyst arising from the mid to lower pole which appears\ngrossly unchanged in overall size and shape measuring approximately 5.8 x 3.2\nx 3.0 cm. There is no hydronephrosis or renal stone. No perinephric\nabnormality. The abdominal aorta is mildly calcified though normal in\ncaliber. There is no retroperitoneal lymphadenopathy. No free air or free\nfluid. The stomach is unremarkable. There is a periampullary duodenal\ndiverticulum. Otherwise the duodenum is unremarkable.\n\nPELVIS: Proximal small bowel loops appear unremarkable. There is fluid\ndistension of distal small bowel loops containing fluid levels without\ntransition point. The colon appears mildly thickened also containing\nair-fluid levels. Findings may reflect a mild colitis and/or gastroenteritis.\nColonic diverticulosis without diverticulitis. The appendix is not clearly\nvisualized though there are no secondary signs of appendicitis. No free air. \nTrace free pelvic fluid noted. The uterus is atrophic containing calcified\nfibroids. No adnexal mass. The urinary bladder is moderately distended\nappearing normal. Hyperdensities in the region of the rectum seen best on\nseries 2, image 153 appear unchanged from prior, of unclear etiology though of\ndoubtful clinical significance. No pelvic sidewall or inguinal adenopathy.\n\nBONES: No worrisome lytic or blastic osseous lesion. Grade 1 anterolisthesis\nof L4 on L5 with severe degenerative disc disease at L4-5. Marked facet\narthropathy in the lower lumbar spine noted. No fracture.\n\nBODY WALL: Unremarkable.", "output": "1. Fluid distension of small and large bowel loops with air-fluid levels may\nreflect gastroenteritis. Mild thickening of the colonic wall noted diffusely,\nraises concern for a mild colitis.\n2. Additional nonemergent findings as above." }, { "input": "The visualized lung bases appear clear. There are no pleural effusions.\n\nThe patient is status post cholecystectomy. There is no fluid collection. \nTwo subcentimeter hypodense foci in the right lobe of the liver are too small\nto characterize but doubtful in significance and unchanged. There is no\nbiliary dilatation. The spleen is normal in size and appearance. Adrenal\nglands and kidneys appear within normal limits.\n\nThere is a moderate-sized hiatal hernia. The wall of the distal antrum is\nmildly dense suggesting murla hyperenhancement and the pyloric channel appears\nslightly thickened. On coronal images there is slight irregularity to the\nwall of the duodenum bulb for which the possibility small shallow ulcerations\ncould be considered.\n\nThe distal ureters, bladder, and uterus appear will within normal limits. \nTubal ligation clips are present bilaterally. A few vascular calcifications\nare noted. Major mesenteric arteries and veins appear patent. There is no\nascites.\n\nThere are no suspicious bone lesions. Narrowing of the T11-T12 interspace is\nunchanged.", "output": "Suspected inflammatory change along the distal antrum and pylorus. \nQuestionable shallow ulcers along duodenum bulb. Anticipated postoperative\nfindings after cholecystectomy." }, { "input": "LOWER CHEST: 4 mm right lower lobe nodule is stable from ___, for\nwhich no additional imaging is needed. The lungs are otherwise clear. There\nis no pleural effusion or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensities in the right lobe of the liver are too small to\ncharacterize, though likely cysts. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small to moderate hiatal hernia. There is a loop\nof mildly prominent small bowel in the left side of the abdomen. There is no\nevidence of perforation or fluid collection. The remaining bowel loops are\nnormal in caliber with normal enhancement. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. Patient is status post tubal ligation bilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the thoracic spine is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of perforation or fluid collection. No pneumoperitoneum.\n2. Small to moderate hiatal hernia." }, { "input": "LOWER CHEST: The lung bases are clear. There is a small pericardial effusion.\nThere is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. An accessory spleen is present.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nfocal renal lesions or hydronephrosis. There is a punctate nonobstructing\nstone in the lower pole of the left kidney. There is no perinephric\nabnormality.\nGASTROINTESTINAL: There is a moderate hiatal hernia with fluid in the distal\nesophagus. The stomach is decompressed. The small bowel is normal in caliber\nwithout focal wall thickening. There is wall thickening involving the sigmoid\ncolon with focal fat stranding in in the region of multiple diverticula\n(series 2, image 69), in the region of prior diverticulitis as seen in ___. The cecum is unremarkable in appearance without wall thickening or\nsurrounding fat stranding to suggest typhlitis. The appendix is\nwell-visualized and normal There is no evidence of mesenteric lymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions.\nAbdominal and pelvic wall is within normal limits.", "output": "1. Acute uncomplicated diverticulitis of the sigmoid colon, in the site of a\nprior episode, suggesting recurrent disease.\n2. Punctate nonobstructing stone in the lower pole of the left kidney.\n\nRECOMMENDATION(S): Colonoscopy is recommended after the acute episode has\nresolved.\n\nNOTIFICATION: The recommendations were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 11:38 ___, 20 minutes after discovery\nof the findings." }, { "input": "Detailed evaluation of the solid organs, soft tissues, and vessels is limited\nwithout the use of intravenous contrast. Within this limitation:\n\nLOWER CHEST: The partially imaged lower lungs are clear. No evidence of a\npleural pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: Pancreas is atrophic. The pancreas has normal attenuation\nthroughout, without evidence of focal lesions within the limitations of an\nunenhanced scan. There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient has had prior right nephrectomy for renal tumor. An 1.9\nx 1.2 cm soft tissue lesion in the right nephrectomy bed is unchanged from the\nPET-CT, now with an adjacent fiducial marker (series 2, image 32). Slight\ndeformity in the contour of the left kidney is unchanged (series 2, image 28).\nNo evidence of focal left renal lesions within the limitations of an\nunenhanced scan. No hydronephrosis, nephrolithiasis, or perinephric\nabnormality on the left.\n\nGASTROINTESTINAL: Ingested oral contrast reaches the rectum. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. Colonic diverticulosis is most pronounced in the sigmoid colon\nwhere is moderate. No bowel obstruction, free air, or fluid collection.\n\nPELVIS: Urinary bladder is distended. The urinary bladder and distal ureters\nare unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes in the imaged spine are moderate with\nprominent anterior osteophytes. Degenerative changes in the SI joints are\nmoderate.\n\nSOFT TISSUES: There is a 12 mm soft tissue lesion at the umbilicus, overall\nunchanged in size from the prior PET-CT (series 2, image 53).", "output": "1. No acute intra-abdominal process. No CT evidence of colitis.\n2. 12 mm soft tissue lesion at the umbilicus, similar in size to prior PET-CT.\nCorrelate with direct visualization.\n3. Status post right nephrectomy with unchanged 1.9 x 1.2 cm soft tissue\nlesion in the right nephrectomy bed, now with fiducial marker.\n\nRECOMMENDATION(S): 1. Direct visualization of umbilicus lesion." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Subtle hypoattenuating focus at the periphery of segment V was\nbetter characterized on the contrast-enhanced CT of ___ but appears\ngrossly similar, likely focal fat deposition. The liver otherwise\ndemonstrates homogeneous attenuation throughout. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding. \nCalcification in the region of the midbody is likely vascular.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is mild colonic\ndiverticulosis without evidence of diverticulitis within the limitations of\nunenhanced scan. The rectum is unremarkable. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus appears grossly similar to the previous\nCT. No adnexal abnormality.\n\nLYMPH NODES: Left external iliac and inguinal lymphadenopathy is again seen,\ngrossly similar in size compared to prior. However, there is ulceration from\nthe left inguinal nodes to the skin surface (2:81) which is new. No definite\nthickening of adjacent fascial planes or subcutaneous emphysema. There is no\nmesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple foci of gas seen within the groin are likely within\nskin clefts. Significant edema in the left upper thigh is noted without soft\ntissue gas.", "output": "1. Interval development of left groin ulceration extending to known metastatic\nleft inguinal lymphadenopathy. No fascial thickening or subcutaneous\nemphysema to suggest necrotizing fasciitis. Burden of pelvic and inguinal\nlymphadenopathy appears grossly similar within the limitations of unenhanced\nscan. No new lymphadenopathy.\n2. No other acute findings to explain the patient's signs and symptoms within\nthe abdomen or pelvis.\n3. Left thigh edema. Please correlate clinically, consider benefits of lower\nextremity DVT exam.\n\nNOTIFICATION: The findings were discussed with Dr. ___ by ___, M.D. in\nperson on ___ at 3:50 pm, 2 minutes after discovery of the findings." }, { "input": "LOWER CHEST: The visualized lower lungs are clear other than mild bibasilar\natelectasis. No pleural effusion or evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver appears enlarged, similar to the prior exam. The\nhepatic parenchyma enhances heterogeneously with diffuse background decreased\nattenuation, suggesting hepatic steatosis, similar to the prior exam at better\nevaluated on the MR from ___. An approximately 1.4 cm homogeneously\nenhancing lesion in segment 5 that had an indeterminate MRI appearance in\n___ is overall unchanged (series 2, image 29). The known hemangioma\nwith nodular enhancement in segment 6 is overall unchanged (series 2, image\n26). The approximately 1 cm cyst in the hepatic dome is overall unchanged\n(series 2, image 9). No definite new hepatic lesions. The main, left, and\nright portal veins appear patent. No evidence of significant ascites. No\nevidence of intrahepatic or extrahepatic biliary ductal dilatation. The\ngallbladder is surgically absent with clips in the fossa.\n\nPANCREAS: The patient is status-post cystogastrostomy. The distal proximal\nmost portions of the tube appear appropriately positioned within the stomach\nlumen and the cavity of the pancreatic pseudocyst in the head of the pancreas.\nThe exact boundaries of this pseudocyst are less defined compared to the prior\nexam by measures approximately 6.5 x 6.2 cm in the maximum dimension on the\naxial images from the see series 2, image 33), compared to 7.2 x 8.1 cm on the\nprior CT, slightly decreased. The wall of this collection is slightly\nthickened. The contents of this collection is heterogeneous in attenuation\nwith an area of hyperdense material (138HU) dependently within the collection,\nmost consistent with acute hemorrhage and contrast extravasation (series 2,\nimage 35). Small pockets of air within the lumen of the cyst are new no and\ncompatible with communication with the stomach. There is extensive the\nstranding around the collection, increased perhaps slightly from the prior\nexam. The collection distorts the proximal duodenum, as also seen previously,\nbut there does not appear to be a fistulous connection. The distal pancreas\nhas extensive fatty atrophy, unchanged. No evidence of pancreatic main ductal\ndilatation distally. No new focal fluid collection. The splenic vein, SMV,\nSMA, and celiac axis overall appear patent.\n\nSPLEEN: The spleen is enlarged, measuring 16.2 cm, perhaps slightly enlarged\nfrom the prior CT on ___ where measured 15.3 cm. No focal splenic\nlesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post cystogastrostomy. The stomach is\notherwise unremarkable. Partially visualized small large bowel loops are\ngrossly unremarkable. No bowel obstruction.\n\nLYMPH NODES: Several periportal lymph nodes are enlarged (e.g. Series 2,\nimage 21), likely reactive. Several retroperitoneal lymph nodes are also\nenlarged, more conspicuous from the prior exam, likely reactive. The largest\nof these nodes measures approximately 1.8 x 9 cm (series 2, image 18). \nScattered mesenteric nodes are visualized.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Mild\ndegenerative changes are similar the prior exam.\n\nSOFT TISSUES: Surgical material is noted in the ventral midline abdomen, mesh\nfrom hernia repair.", "output": "1. Status-post cystogastrostomy, which appears appropriately placed. Slight\ninterval decrease in size of pancreatic head pseudocyst but heterogeneous\nintraluminal appearance with small amount of hyperattenuating material\nconcerning for hemorrhage and active extravasation.\n\n2. Increased fat stranding around the pancreatic collection with periportal\nand retroperitoneal lymphadenopathy, likely reactive.\n\n3. Hepatosplenomegaly, similar to the prior exam.\n\nNOTIFICATION: Findings, images, impression were discussed and reviewed in\nperson with the ACS resident, Dr. ___, on ___ at 143 am." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is slightly decompressed\nwith mild wall thickening, though no evidence of active inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is moderately distended, though unremarkable. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. There is a phlebolith in the left lower quadrant.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abdominopelvic process. No CT findings correlating to the reported\nhistory of left abdominal or pelvic pain." }, { "input": "Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nAgain seen are numerous hepatic lesions, representing metastases, incompletely\nevaluated on this noncontrast examination, the largely unchanged in size and\nnumber since the ___ examination. For example the largest lesion\nwithin segment VII measures 20 x 18 mm, unchanged (series 2 image 50). No new\nhepatic lesions are identified. There is no intrahepatic bile duct dilation. \nThe gallbladder is normal.\n\nExtensive right pararenal and perirenal nodular soft tissue masses and\nenlarged nodes are again seen, extending across Gerota's fascia (series 2\nimage 71, 79), minimally changed in configuration since the ___ CT. \nFor example, the largest conglomeration of nodules lying posterior to the\nright kidney spans approximately 5.4 x 6.9 cm axially (series 2 image 73),\nunchanged. A large nodule or mass abutting the posterior aspect of the cecum\nmeasures 2.9 x 2.2 cm, also stable (series 2 image 94).\n\nWidespread omental micronodular implants (series 2 image 78, 71, 97) have\nmarkedly increased since the ___ examination. A small amount of\nintrapelvic ascites has increased (series 2 image 106).\n\nThe spleen, pancreas, adrenal glands, left kidney, stomach, and\nintra-abdominal loops of small and large bowel remain within normal limits.\n\nThe bladder is underdistended (series 6 image 37). There is no intrapelvic\nlymphadenopathy.\n\nThe abdominal aorta is normal in caliber, demonstrating mild less for chronic\ncalcifications.\n\nThere are no osseous lesions concerning for malignancy or infection.", "output": "1. Marked increase in omental metastases since ___. Small amount\nof intrapelvic ascites has increased.\n2. Unchanged appearance of extensive right pararenal and perirenal masses and\nlymphadenopathy. Unchanged multiple hepatic metastases.\n3. Please see the separate chest CT dictation regarding intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for a description of the thoracic findings.\n\nABDOMEN:\nThe evaluation of solid organs is limited without the use of intravenous\ncontrast.\n\nHEPATOBILIARY: Multiple, scattered hypodensities of varying sizes throughout\nthe liver are overall unchanged in distribution and size from the prior exam\nwhen accounting for differences in measurement technique and slice selection.\nThe largest lesion is still in Segment VII and now measures 2.1 x 1.9 cm, and\npreviously measured 2.1 x 2 cm (Series 2, Image 49). No definite new\nsuspicious focal lesion. The remaining hepatic parenchyma demonstrates lower\nattenuation, suggesting fatty infiltration. The liver surface contour is\nsmooth. No intrahepatic or extrahepatic biliary dilatation. The gallbladder is\nnot abnormally distended and appears normal, without calcified stones or wall\nthickening. Moderate ascites, measuring simple fluid, is increased around the\nperihepatic region and new around the perisplenic region.\n\nPANCREAS: The pancreas is normal in attenuation throughout. No evidence of a\nfocal lesion, pancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Innumerous right renal, perinephric, and retroperitoneal soft tissue\nmasses and lymph nodes are overall unchanged in appearance, configuration, and\ndistribution, but are slightly increased in size from the prior exam. The\nlargest conglomerate is in the right posterior perinephric space and now\nmeasures 7 x 6.2 cm in the axial plane and 6.1 x 4.5 cm in the coronal plane,\npreviously measuring 7.2 x 5.8 cm in the axial plane and 5.7 x 4.3 cm in the\ncoronal plane (Series 2, Image 74; Series 601b, Image 48). The left kidney is\nunchanged in appearance and unremarkable. The urinary bladder is collapsed,\nlimiting evaluation, but appears grossly unremarkable.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The colon and rectum are within normal limits. No\nbowel obstruction or pneumoperitoneum.\n\nRETROPERITONEUM: Numerous predominantly right-sided retroperitoneal soft\ntissue masses lymph nodes are re-demonstrated and slightly increased in sizes\nas described above. Multiple mesenteric nodes are prominent and overall\nsimilar to the prior exam. Thickening of the omentum with diffuse nodularity\nis increased from the prior study (Series 2, Images 75, 97). Simple free fluid\nwithin the abdomen and has also increased compared to the prior study (Series\n601b, Image 39).\n\nVASCULAR: The abdominal aorta is tortuous but without aneurysmal dilatation.\nMild to moderate atherosclerotic plaques are unchanged.\n\nPELVIS: Several prominent pelvic nodes are again seen. Free fluid in the\npelvis is simple and also slightly increased from the prior exam (Series 2,\nImage 106).\n\nBONES AND SOFT TISSUES: No suspicious lytic or sclerotic bony lesion. Diffuse\nbony demineralization is unchanged. Mild levoconvex scoliosis centered at\nL2-L3 is unchanged. Mild degenerative changes in the lumbosacral spine are\nalso unchanged. Stable appearance of a small, fat-containing left inguinal\nhernia (Series 2, Image 117).", "output": "1. Interval progression of metastatic disease involving the right perinephric,\nrenal, and retroperitoneum as well as omentum.\n\n2. Interval increase in ascites.\n\n3. Unremarkable left kidney.\n\n4. Interval stability overall in numerous hepatic hypodense lesions, probable\nmetastatic in etiology." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is dilated to 9 mm with mild\nstranding. There is no free fluid around the appendix.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Findings concerning for early acute appendicitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:37 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is again appreciated. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. Thickening and dilation of the\nappendix is again appreciated, and there is persistent periappendiceal fat\nstranding. There is no extraluminal air or drainable fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: A few reactive lymph nodes are again appreciated in the right\nlower quadrant. There is no other retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nNote is again made of sclerosis on the iliac side of both SI joints which may\nrepresent osteitis condensans ilii.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Redemonstration of acute appendicitis without evidence of perforation or\nabscess formation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder the gallbladder is mostly\nunremarkable, except for the fundus, which demonstrate slight thickening of\nthe gallbladder wall with mildly hyperattenuating gallbladder mucosa, likely\nrepresenting adenomyomatosis. There is no significant fat stranding\nsurrounding the gallbladder to suggest acute cholecystitis. There is no\ncholelithiasis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (5:62).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There are multiple enlarged lymph nodes in the central mesentery\nwith increased stranding. For example, the lymph node adjacent to the SMV\nmeasures 1.0 cm in the short axis. The right mid abdominal mesenteric lymph\nnode measures 1.0 cm (05:40, 06:21). There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is rudimentary disc at S1-S2. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple pathologically enlarged lymph nodes around the central mesentery\nwhich is nonspecific. Otherwise no acute intraabdominal or intrapelvic\nabnormality.\n2. Unremarkable pancreas with imaging findings to suggest acute pancreatitis.\n3. Adenomyomatosis of the gallbladder fundus. No imaging evidence of acute\ncholecystitis. No cholelithiasis." }, { "input": "LOWER CHEST: There is bibasilar dependent atelectasis. Visualized lung fields\nare otherwise within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Hypodensity along the falciform\nligament may be perfusional or could be from focal fat, unchanged from prior. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic, with normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n7 cm cyst within the left interpolar kidney has a focal subcentimeter\nhyperdensity along its posterior wall which is likely a small area of\ncalcification, new from prior. Roughly 5 cm lower pole left renal cyst and\n1.5 cm right lower pole renal cyst appear simple. There are bilateral\nmultifocal areas of cortical thinning consistent with scarring. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild right lateral listhesis of L3 on L4, similar to prior.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted without\ncomplication.", "output": "No acute intra-abdominal process or evidence of trauma.No acute fracture.\n\n7 cm left renal cyst with a posterior mural hyperdensity that is likely\ncalcification." }, { "input": "Heart size is normal. The imaged lung bases are clear.\n\nCT abdomen with and without contrast: There is re- demonstration of the\nseveral scattered hypodense hepatic lesions measuring up to 23 mm in segment 4\nwith peripheral arterial enhancement with centripetal enhancement on portal\nvenous phase compatible with hemangiomas, similar to the prior study. The\nliver otherwise enhances homogeneously without a new lesion, intra or\nextrahepatic biliary dilatation. The portal vein is patent. The gallbladder is\nunremarkable.\n\nThe adrenal glands are unremarkable. Patient status post splenectomy and\ndistal pancreatectomy. Several surgical clips are noted at the pancreatic\nresection margin. There is a small, tubular fluid density focus leading from\nthe resection bed to the diaphragm compatible with a postsurgical tract. The\nresidual pancreas is unremarkable without evidence for recurrence.\n\nMillimetric left interpolar renal hypodensity is too small to fully\ncharacterize but likely represents a cyst. The kidneys otherwise present\nsymmetric nephrograms without focal solid lesion, hydronephrosis or\nperinephric abnormality.\n\nThe stomach, duodenum and remainder of the visualized small bowel loops are\nunremarkable without evidence of obstruction. The imaged large bowel is\nthin-walled and unremarkable.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment.\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size\ncriterion. There is no ascites, pneumoperitoneum or hernia.\n\nOsseous structures: There is no suspicious focal osseous lesion.", "output": "1. Postsurgical changes from distal pancreatectomy with a fluid density tract\nleading from the resection margin to the diaphragm.\n2. No evidence of local or metastatic disease recurrence in the abdomen.\n3. Stable hepatic hemangiomas." }, { "input": "LOWER CHEST: There is streak like left basilar atelectasis. Trace bilateral\npleural effusions with adjacent atelectasis, left greater than right. \nVisualized lung fields are otherwise within normal limits. There is no\nevidence of pericardial effusion. A right breast implant is partially\nvisualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nStable appearance of a 1.7 cm hypodensity within the posterior right hepatic\ndome (3:12), likely representing a simple cyst. Few additional subcentimeter\nhypodensities in the liver are too small to characterize, likely compatible\nwith simple cysts or biliary hamartomas. The percutaneous cholecystostomy\ndrain appears in similar position within the gallbladder. A 1.5 cm radiopaque\ngallstone is in unchanged position within the region of the gallbladder neck. \nThere is slight interval increase in extrahepatic bile duct dilatation,\ncurrently measuring 2.8 cm compared to 2.3 cm on the previous study.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is markedly atrophic and calcified. The right kidney\ndemonstrates diffuse cortical atrophy with multiple subcentimeter\nhypodensities, too small to characterize but statistically likely representing\ncysts. There is no suspicious renal lesions within the limitations of an\nunenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nunremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Extensive\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A percutaneous abdominal drain is partially visualized in the\nright lower quadrant. The abdominal and pelvic wall is otherwise within\nnormal limits.", "output": "1. Percutaneous cholecystostomy drain remains in similar position within the\ngallbladder, with unchanged appearance of a 1.5 cm radiopaque gallstone\nlayering near the region of the gallbladder neck.\n2. Slight interval increase in extrahepatic biliary dilatation, currently\nmeasuring up to 2.8 cm. Additionally, the gallbladder is slightly more\ndistended than prior despite the presence of the percutaneous cholecystostomy\ntube.\n3. Markedly atrophic and calcified left kidney and diffusely atrophic right\nkidney with multiple subcentimeter hypodensities, not well characterized on a\nnoncontrast study.\n4. Trace bilateral pleural effusions, left greater than right, with left\nbasilar atelectasis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is within normal limits. Cholelithiasis is present. \nThere is mild enhancement at the gallbladder fundus, likely representing\nadenomyomatosis.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The kidneys unremarkable except for a few small cysts and a few\nminute hypodense lesions too small to characterize. No hydronephrosis.\n\nGASTROINTESTINAL: No bowel obstruction. No ascites.\n\nPELVIS: The uterus and adnexa are unremarkable for age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ncalcifications are noted.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Rectus diastasis with broad-based bulge of the anterior\nabdominal wall is noted", "output": "1. No findings of metastatic disease in the abdomen or pelvis.\n2. Cholelithiasis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nTwo renal cortical hypodensities in the right kidney measuring 1.4 cm are\nincompletely characterized but appear unchanged from prior studies. There is\nno evidence of stones or hydronephrosis. There are no urothelial lesions in\nthe kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening and fat stranding. The colon and\nrectum are otherwise within normal limits.. Appendix contains air, has normal\ncaliber without evidence of fat stranding.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: The hepatic and portal veins are patent. There is no abdominal\naortic aneurysm. There is mild calcium burden in the abdominal aorta and\ngreat abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis. \nThere is small fat containing left inguinal hernia.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Multilevel degenerative changes in\nthe thoracolumbar spine are most pronounced at the L5-S1 level. Healed\nbilateral posterior rib fractures are noted.\n\nThere is a rim enhancing fluid-filled subcutaneous sinus tract arising from\nthe umbilicus and extending inferiorly in the midline subcutaneous fat of the\nanterior abdominal wall (602b:44). The tract measures approximately 10 mm in\ndiameter and extends 6.6 cm in overall length. The track enters the right\nabdominus rectus muscle. There is trace stranding deep to the muscle in the\nfascia and mesenteric fat, but no definite connection to underlying loops of\nsmall bowel. There is surrounding fat stranding.", "output": "1. Rim enhancing fluid-filled sinus tract within the subcutaneous fat\nextending to the skin surface at the umbilicus, with inflammatory changes\nwhich could represent infection. The track extends into the right abdominis\nrectus muscle in the midline with stranding in the subjacent fascia and\nmesenteric fat but no definite enteric connection. No intraabdominal fluid\ncollection.\n2. Sigmoid diverticulosis without evidence of diverticulitis. Normal appendix.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\ntelephone on ___ at 12:55 AM, 2 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Bibasilar consolidations with air bronchograms and mucous\nplugging.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: No significant change in 2.0 cm mass in the right interpolar kidney\nwith central peripheral calcifications, concerning for renal cell carcinoma. \nSimple cyst may lower pole left kidney is unchanged.\n\nGASTROINTESTINAL: Postsurgical changes from partial gastric resection and\nRoux-en-Y, with revisions for afferent limb syndrome, bile leak, duodenectomy,\nand enteric cutaneous fistula. There is a mixed gas and fluid filled pocket\n(2:33) which is hepatic colonic flexure (in this site on the prior CT from\n___ this may have been a site of leaking and source of adjacent\nintra-abdominal collection) that appears to be contiguous with descending and\ntransverse colon. There is an additional feeding loop that is likely small\nbowel, which may be postsurgical in nature versus fistulous tract (2:40-2:50).\nThere is hyper enhancement of bowel wall in this region likely representing\nongoing inflammatory changes. Mild diffuse mesenteric stranding is present. \nNo definite intra-abdominal leak or loculated fluid collection/abscess is\nidentified. No obstruction or evidence of bowel ischemia.\n\nGastrojejunostomy tube is present with tip in small bowel near the\njejunojejunostomy anastomosis. Of note, the gastrostomy balloon is in the\nsubcutaneous fat tissue.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small amount\nof non loculated free fluid is present in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are present.\n\nSOFT TISSUES: There is some fluid tracking along the anterior abdominal wall\nmidline open incision with wound VAC in place. Surgical drain is in place\ntracking along the anterior abdominal wall. Mild body wall edema is present.", "output": "1. Postsurgical changes from multiple gastrointestinal surgeries as detailed\nabove without definite leak or abscess identified on today's exam. There\nlikely ongoing inflammatory changes present in the right upper quadrant bowel.\nNo evidence of obstruction or bowel ischemia.\n2. Gastrojejunostomy balloon is in subcutaneous adipose tissue.\n3. Right renal mass is again noted, concerning for renal cell carcinoma.\n\nRECOMMENDATION(S): The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 9:52 AM, 2 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again seen, is a rim calcified lesion in the right midpole measuring\napproximately 1.8 x 1.7 cm, better evaluated on recent MRI. A 1.3 cm\nintermediate density lesion in the left lower pole was characterized as a cyst\non recent MRI. Incidental note is made of a duplicated left renal collecting\nsystem. There is no hydronephrosis. The ureters are normal in caliber along\ntheir course to the bladder.\n\nGASTROINTESTINAL: There is a small hiatal hernia. There is wall thickening of\nthe pylorus along the side adjacent to the gastroduodenal artery (series 4,\nimage 53). There is a prominent gastric lymph node adjacent to the opposite\nwall of the pylorus which measures 8 x 10 mm (series 4, image 53). The small\nbowel is normal in caliber without focal wall thickening. There is\ndiverticulosis of the sigmoid colon without evidence of diverticulitis. The\nlarge bowel is normal in caliber without focal wall thickening. The appendix\nis not visualized but there are no secondary signs of appendicitis in the\nright lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: The bones are diffusely demineralized. There are multilevel\ndegenerative changes. There are no concerning focal osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Coarsely calcified right renal lesion measuring 1.8 cm, better\ncharacterized on recent MRI.\n2. Wall thickening of the pylorus with a prominent adjacent gastric lymph\nnode, correlate with recent EGD and pathology.\n3. No evidence of metastatic renal cell carcinoma in the abdomen and pelvis.\n4. Please refer to separate dictation for details on intrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate CT chest dictated on the same day for\nfindings regarding the thorax.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: A 1 cm accessory spleen is noted. The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.5 x 1.2 cm (02:58) incompletely characterized left lower pole renal cystic\nlesion is stable and measures 48 Hounsfield units. Additional bilateral\nsubcentimeter renal hypodensities are too small to characterize. No\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Multiple fluid-filled dilated small bowel loops measuring up\nto 5.3 cm in a patient who is status post partial gastrectomy with\ngastrojejunostomy and transition point at the gastrojejunostomy, worrisome for\nafferent limb closed loop obstruction. The stomach and distal esophagus are\nalso distended with contrast (series 2, image 43, 34). Small amount of free\nfluid. Preserved mucosal hyper enhancement. No pneumatosis. Gastrojejunostomy\ntube is in appropriate position with a collapsed efferent (enteric) limb. The\ncolon is unremarkable and decompressed. The appendix is not visualized,\nhowever no secondary signs of acute appendicitis.\n\nPELVIS: Air within the urinary bladder is expected in a patient who is status\npost Foley placement. The distal ureters are unremarkable. There is small\namount of nonhemorrhagic free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not visualized. No large adnexal masses seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Moderate multilevel degenerative changes are seen throughout the\nthoracolumbar spine including large anterior flowing osteophytes, and\nsubchondral sclerosis. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: Anasarca is noted. Midline staples are present. The abdominal\nand pelvic wall is otherwise within normal limits.", "output": "1. Findings worrisome for afferent limb closed loop obstruction in a patient\nwho is status post partial gastrectomy with gastrojejunostomy. Transition\npoint at gastrojejunostomy. Small amount of free fluid. Preserved mucosal\nhyperenhancement. No pneumatosis.\n2. Distended stomach and esophagus with oral contrast may reflect gastric\noutlet obstruction, also at the gastrojejunostomy.\n3. Percutaneous gastrojejunostomy tube in appropriate position, extending\ninto the collapsed efferent (enteric) limb.\n4. Stable intermediate density 1.5 cm left renal lesion, incompletely\ncharacterized.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 3:20 ___, 5 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Moderate bibasilar atelectasis and moderate size bilateral\npleural effusions are demonstrated. Coronary artery calcifications are noted.\nCentral line terminates at the SVC/right atrial junction. Please review same\nday dedicated chest CT report.\n\nABDOMEN:\n\nHEPATOBILIARY: Subcapsular and heterogeneous parenchymal ___\ninvolving segments II, III, IV appears somewhat improved, likely reflective of\nretractor injury/ postoperative changes (series 2, image 51, 53, and 55.\n\nNo discrete or new hepatic lesion identified. No ductal dilation is seen. \nStatus post cholecystectomy. Mild to moderate amount of ascites is present.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY: Again noted is a 20 mm mass in the central interpolar aspect of the\nright kidney with central and peripheral calcifications, concerning for renal\ncell carcinoma.Simple left lower pole renal cyst is unchanged. No new renal\nlesion is otherwise noted. No hydronephrosis or hydroureter.\n\nGASTROINTESTINAL: Percutaneous gastrojejunostomy tube balloon remains within\nthe stomach remnant and courses beyond the gastrojejunostomy anastomosis,\nterminating in a left lower quadrant small bowel loop near the\njejunojejunostomy anastomosis. The stomach is unremarkable and not dilated. \nThe patient is status post partial gastrectomy, gastrojejunostomy and\nduodenojejunostomy.\n\nInjected oral contrast through the gastrojejunostomy tube fills the small\nbowel. Injected rectal contrast refluxes to the cecum. Oral contrast\nextravasation is noted in the subhepatic right abdomen with adjacent free\nfluid at the site of prior air and fluid containing collection where two right\nabdominal subhepatic JP drains are located. Oral contrast exits the\nperitoneal cavity through an abdominal wall defect in the right abdomen with\nsubsequent infiltration of the the overlying subcutaneous soft tissue and\nwound vac. The previously noted air and fluid collection in the right abdomen\nwhich contains the JP drains appears smaller with only a few locules of extra\nluminal gas identified. The largest pocket of fluid measures approximately\n3.5 x 3.8 cm (2:68).\n\nIn the region of oral contrast extravasation, there are 2 loops of bowel\ncoursing through this region, one of which is a segment of small bowel within\nthe right anterior abdomen (2:76) containing oral contrast and the other is\nthe hepatic flexure (2:65) which is decompressed and difficult to visualize\nwith ill-defined walls. The leak could be arising from either intestinal\nloop. Exact site is difficult to discern given the presence of oral contrast\nwithin these 2 bowel loops simultaneously.\n\nThe biliary limb proximally is difficult to identified though more distally no\noral contrast is seen within it, and appears normal in caliber. The\nappearance of the biliary limb small bowel appears diffusely abnormal with\nmildly thickened walls and hyperenhancing mucosa, as seen previously. Diffuse\nstranding within the mesentery is noted along with peritoneal enhancement. \nThese findings likely reflect ongoing peritonitis and inflammation. As seen\npreviously, the hepatic flexure and proximal transverse colon demonstrate\ndiffuse wall thickening and relative mural ___, potentially\nrelated to ischemia. Sigmoid diverticulosis again noted.\n\nPELVIS: Unremarkable rectum. Decompressed bladder with Foley catheter. \nStatus post hysterectomy. Unremarkable adnexa.Small amount of free fluid is\nnoted.\n\nLYMPH NODES: No definite mesenteric, retroperitoneal, pelvic or inguinal\nadenopathy.\n\nVASCULAR: Patent aorta and major branches. No abdominal aortic aneurysm. \nMild calcified atherosclerotic disease is demonstrated.\n\nBONES AND SOFT TISSUES: Small subxiphoid hernia containing fat. Midline scar\nwith wound vac in place. Diffuse anasarca. Thoracolumbar spine degenerative\nchange is re- demonstrated.", "output": "1. Enteric contrast extravasation in the right subhepatic abdomen, in the\nregion of prior air and fluid collection containing 2 JP drains, with enteric\ncontrast infiltrating the overlying subcutaneous soft tissue and wound vac\ndressing compatible with a cutaneous fistula. Suspected sites are the\nhepatic flexure and adjacent small bowel however the exact site is difficult\nto determine given the presence of oral contrast simultaneously within the\nupper and lower GI tracts.\n2. Persistent abnormal appearance of the hepatic flexure and proximal\ntransverse colon with thickened hypoenhancing walls, again thought to be\nrelated to ischemia.\n3. Abnormal bowel wall thickening and mucosal hyper enhancement primarily\ninvolving the biliary limb with mesenteric stranding, peritoneal enhancement\nand free fluid likely due to ongoing reactive inflammation and peritonitis.\n4. Diffuse anasarca with moderate bilateral pleural effusions and small to\nmoderate amount of abdominal free fluid. No new fluid collection otherwise\nidentified.\n5. Unchanged suspected right renal cell carcinoma.\n6. Heterogeneous hypodensity within the left lobe of the liver is somewhat\nimproved, again thought to relate to retraction injury/postoperative changes." }, { "input": "Chest is reported separately.\n\nA few very small hypoattenuating liver lesions show no evidence of\nenhancement; although too small to optimally characterize, these appear\nunchanged and very likely to represent small biliary hamartomas or cysts. The\ngall bladder is mostly empty. There is no biliary dilatation. The pancreas\nappears normal. Spleen is normal in size and appearance. Adrenals are\nunremarkable. There is no evidence for stones, solid masses, or\nhydronephrosis involving either kidney.\n\nStomach is mildly distended. Small bowel is unremarkable. Quantity of stool\nalong the whole colon is mildly prominent. Sigmoid diverticulosis is\nmoderate. There also is mild-to-moderate cecal diverticulosis.\n\nUterus shows lobular appearance and calcifications consistent with fibroid\nuterus, unchanged. No adnexal masses are identified. Small physiologic\ncorpus luteum found in the right ovary. Bladder appears normal. Major\nvascular structures appear widely patent. There is no lymphadenopathy or free\nfluid.\n\nThere are no suspicious bone lesions.", "output": "Fibroid uterus. No evidence of metastatic disease." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusion is seen.\n\nABDOMEN: The liver enhances normally. Main portal vein is patent. No biliary\nductal dilation. The gallbladder appears normal. The pancreas enhances\nnormally. The spleen is normal in size. No adrenal abnormality. Kidneys\nenhance symmetrically and excretion of contrast is prompt and equal. The\nabdominal aorta is normal in course and caliber. No retroperitoneal\nlymphadenopathy. The stomach is moderately distended with fluid and ingested\ncontent. The duodenum appears normal. Mesenteric lymph nodes are upper\nlimits of normal likely reactive.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. \nMildly prominent right lower quadrant lymph nodes may be reactive. The\nappendix is normal though contains an appendicular list. The colon is thin\nwalled and contains a mild fecal load. No signs of colitis or bowel\nobstruction. No free air or free fluid. The urinary bladder is mostly\ndecompressed. Ureters appear normal in caliber. Prostate is normal in size. \nNo pelvic sidewall or inguinal adenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nL5 pars defects are noted bilaterally without alignment abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Mildly prominent mesenteric lymph nodes, may be reactive, otherwise\nunremarkable exam." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. The main pancreatic duct proximally measures at the upper\nlimits of normal. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a large\namount of liquid stool in the colon. A large at the fecalith is seen within\nthe appendix, however the appendix otherwise looks within normal limits.\n\nPELVIS: Moderate bladder wall thickening may be due to underdistention. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Large amount of liquid stool in the colon without evidence of colonic wall\nthickening or inflammation.\n2. Moderate bladder wall thickening may be due to underdistention but\ncorrelation with urinary analysis is recommended." }, { "input": "LOWER CHEST: The visualized lung bases demonstrate mild dependent bibasilar\natelectasis. There is no pleural or pericardial effusion. A small hiatal\nhernia is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nADRENALS: The right and left adrenal glands are normal.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly\nwithout hydronephrosis. A 1 cm hypodensity in the left renal superior pole\nhas indeterminate density (3:25, 601b:36) with equivocal enhancement and was\nnot clearly identified on prior ultrasound ___.\n\nGASTROINTESTINAL: The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits. Appendix\ncontains air, has normal caliber without evidence of fat stranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free fluid and no free air.\n\nVASCULAR: The abdominal aorta is normal in caliber throughout with mild\natherosclerotic change along its course and moderate atherosclerotic\ncalcifications at the bifurcation. The main portal vein, splenic vein and SMV\nare patent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\npelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nProstate is enlarged. Seminal vesicles are within normal limits.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. A nonaggressive appearing sclerotic focus in the left iliac wing is\nlikely a bone island.", "output": "1. Indeterminate left renal upper pole hypodensity density with equivocal\nenhancement, not clearly seen on ultrasound ___. Renal ultrasound is\nrecommended for further evaluation.\n2. Prostatic enlargement.\n3. Small hiatal hernia.\n4. No CT findings to explain patient's symptom of weight loss.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 16:22 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "CT OF THE ABDOMEN: LUNG BASES DEMONSTRATE NO ABNORMALITIES. AGAIN\nAPPRECIATED IS A 7 MM RELATIVELY HYPODENSE AREA WITHIN SEGMENT 2 OF THE LIVER\nLIKELY REPRESENTING A SIMPLE CYST. OTHERWISE, THE LIVER ENHANCES\nHOMOGENEOUSLY WITHOUT FOCAL MASSES, NO DILATED INTRAHEPATIC BILIARY RADICLES. \nTHE GALLBLADDER IS UNREMARKABLE, THE PORTAL VEIN IS WIDELY PATENT.\n\nTHE KIDNEYS, ADRENAL GLANDS, SPLEEN, PANCREAS AND VISUALIZED LOOPS OF LARGE\nAND SMALL BOWEL IN THE ABDOMEN ARE UNREMARKABLE.\n\nTHE PREVIOUSLY DESCRIBED VASCULAR MALFORMATION IN THE REGION OF THE HEAD AND\nUNCINATE PROCESS OF THE PANCREAS, LIKELY JUST REPRESENTS A PROMINENT\nPANCREATICODUODENAL ARCADE WHICH IS EXPECTED IN THIS PATIENT WITH A HIGH-GRADE\nSTENOSIS OF THE CELIAC AXIS. THIS LEVEL OF STENOSIS IS UNCHANGED FROM THE\nPRIOR EXAM OF ___.\n\nCT CT OF THE PELVIS: AGAIN APPRECIATED IS MINIMAL DILATATION OF THE SEGMENTAL\nAREAS WITHIN THE TERMINAL ILEUM, LIKELY SEQUELA OF OLD INFLAMMATORY BOWEL\nDISEASE. FINDINGS ARE UNCHANGED WITHOUT ANY EVIDENCE OF PROXIMAL DILATATION\nTO SUGGEST OBSTRUCTION. THERE REMAINS SOME MILD HYPEREMIA AND STRANDING OF\nTHE ADJACENT FAT OF THE TERMINAL ILEUM WHICH IS UNCHANGED. NO OTHER\nSUSPICIOUS AREAS IDENTIFIED, THE COLON APPEARS UNREMARKABLE, NO FREE FLUID,\nSCATTERED MESENTERIC LYMPH NODES, NOT MEETING SIZE CRITERIA FOR PATHOLOGIC\nENLARGEMENT AND UNCHANGED.\n\nBONE WINDOWS DEMONSTRATE NO SUSPICIOUS AREAS.", "output": "1. NO CHANGE COMPARED TO THE EXAM OF ___. SOME MILD MUCOSAL\nHYPEREMIA AND STRANDING OF THE ADJACENT FAT OF THE 10 CM OF THE DISTAL ILEUM\nIS AGAIN IDENTIFIED. BASED ON IMAGING, FINDINGS APPEAR CHRONIC GIVEN\nIDENTICAL APPEARANCE TO ___, SUPERIMPOSED ACTIVE INFLAMMATION WOULD REQUIRE\nCLINICAL DIAGNOSIS.\n2. NO CHANGE IN HIGH-GRADE STENOSIS OF THE CELIAC AXIS WITH ASSOCIATED\nPROMINENT PANCREATICO- DUODENUM ADDITIONAL ARCADE, HYPODENSITY WITHIN SEGMENT\n2 OF THE LIVER." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 7 mm\nhypodensity in segment 2 is stable and too small to characterize, but may\nreflect a cyst or biliary hamartoma. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Proximal small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis interval increase in wall thickening, mucosal hyperenhancement, and\nadjacent mesenteric fat stranding of a 15 cm segment of distal ileum in the\nregion of known Crohn's disease. There are two new foci of phlegmonous change\nwithout discrete, drainable fluid collections. The superior and more distal\nphlegmon is located between two adjacent loops of bowel, causing a matted\nappearance. There is no evidence of a fistulous tract. The inferior and more\nproximal phlegmon is located posterior to a loop of distal ileum. There is no\nevidence of small bowel obstruction. The colon and rectum are within normal\nlimits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles appear unremarkable\nwithin the limitations of CT technique.\n\nLYMPH NODES: There are multiple, prominent mesenteric lymph nodes without\nevidence of pathologic enlargement. There is no retroperitoneal\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is unchanged,\nhigh-grade stenosis at the origin of the celiac trunk with unchanged\nprominence of the pancreaticoduodenal arcade in the head and uncinate process\nof the pancreas.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Two new foci of phlegmonous change adjacent to the distal ileum in the\nregion of known Crohn's disease with a 15 cm segment of increased wall\nthickening, mucosal hyperenhancement, and mesenteric fat stranding. There is\nno evidence of fistula formation or discrete, drainable fluid collections.\n2. Unchanged, high-grade stenosis at the origin of the celiac trunk with\nunchanged, prominence of the pancreaticoduodenal arcade in the head and\nuncinate process of the pancreas." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere stable appearance of 7 mm hypodensity in segment 2, likely representing\na cyst or biliary hamartoma. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is decompressed and otherwise unremarkable. \nThere is worsening appearance of the previously described distal ileum in the\nregion of known Crohn's disease with increased fat stranding around the 2\nphlegmonous areas. The extent of bowel involvement has not significantly\nchanged. There is mild layering fluid near the aforementioned collection. \nThere is no extraluminal air. There is no apparent fistulous track. There is\nno evidence of small-bowel obstruction. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmild amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Again seen are multiple prominent lymph nodes that are not\npathologic by CT criteria. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Again noted is high-grade\nstenosis of the origin of the celiac trunk (602 B: 41) and prominent\npancreaticoduodenal arcade in in the head and uncinate process of the pancreas\n(601b:27).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Worsening appearance of the previously described distal ileum in the region\nof known Crohn's disease with increased fat stranding around the 2 phlegmonous\nareas. No extraluminal air. Trace free fluid.\n2. No abscess formation.\n3. No evidence of small bowel obstruction.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 11:21 AM, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Gallbladder surgically absent. Millimetric hepatic\nhypodensities likely represent simple cysts (series 5 image 50).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRenal hypodensities are either too small to characterize or are compatible\nwith renal cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. Right lower quadrant\ndystrophic calcification likely represents an old torsed epiploic appendage.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is mild retrolisthesis of L2 on L3 and L3 on L4.\nOssific densities adjacent to the ischial tuberosities, likely represent old\navulsion injuries. There is non fusion of the lamina over the distal sacrum\nwith increased fat within the lower spinal canal below the level of L5 (series\n8, image 39), compatible with a lipomyelomeningocele or epidural lipomatosis.\n\nModerate atrophy and fatty replaced of the right gluteus minimus and medius\nand the left gluteus minimus.\n\nSmall bilateral fat containing inguinal hernias. Small fat containing\numbilical hernia.", "output": "No evidence of malignancy within abdomen and pelvis." }, { "input": "LOWER CHEST: Aside from mild bibasilar atelectasis, visualized lung fields are\nwithin normal limits. There is no evidence of pleural or pericardial effusion.\nThe heart is top normal in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout,\nthough slightly diffusely hypodense from steatosis. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. However, there is mild\nperipancreatic stranding especially around the proximal body, head and\nuncinate process of the pancreas. There is no fluid collection.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Accessory spleen measures 16 mm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is no evidence splenic artery aneurysm. There is no splenic\nvein or SMV thrombus formation.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are noted at L3-L4 with endplate irregularity.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "Findings consistent with acute pancreatitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is mild periportal edema. The\ngallbladder is surgically absent with surgical clips in the gallbladder fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a small nonobstructive 3 mm stone in the left renal fossa\ncollecting system(3:42). No evidence of radio-opaque stone in the ureters or\ndistal collecting systems bilaterally. There is no evidence of hydroureter or\nhydronephrosis. There is no evidence of focal renal lesions or perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is vacuum phenomenon at the T8-T9 intervertebral disc space\ncompatible with very mild degenerative change. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is\nno hernia.", "output": "1. No CT findings of malignancy.\n2. Nonobstructive left renal 3 mm stone." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are fluid\nfilled and demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is diffuse dilatation of the colon of unknown chronicity. \nThere is air seen outlining the ascending colon, some of which appears\ndependent which may represent pneumatosis. A small amount of fluid is seen in\nthe right paracolic gutters. The appendix is normal.\n\nPELVIS: A Foley catheter is seen in the bladder. the urinary bladder is\ndecompressed. The distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nExtensive degenerative changes are seen in the lumbosacral spine with\nretrolisthesis of the L2-L3, L3-L4, and L4-L5 vertebral levels.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diffuse dilatation of the colon of unknown chronicity given lack of\ncomparisons exams. Air is noted outlining the ascending colon, some of which\nappears dependent, possibly representing pneumatosis.\n2. Small amount of fluid is seen in the right paracolic gutter." }, { "input": "LOWER CHEST: Small right pleural effusion with adjacent atelectasis. Mild\nleft basilar atelectasis. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The common bile duct is dilated to\napproximately 2 cm (04:36, 8:28) with proximal, central intrahepatic biliary\nduct dilatation. The gallbladder is surgically absent.\n\nPANCREAS: A well-circumscribed fat density in the head of the pancreas (04:43)\nmeasuring 1.9 cm is most likely a pancreatic lipoma. Otherwise, the pancreas\nhas normal attenuation throughout, without evidence of pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A nodular density in the left adrenal gland measures approximately 2\ncm x 1.7 cm (04:26). The right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Widespread, diffuse sclerotic foci in the thoracolumbar spine, pelvis,\nsacrum, and proximal bilateral femurs are most likely consistent with\nmetastatic disease. There is no evidence of acute fracture.\n\nSOFT TISSUES: An irregularly bordered, soft tissue mass with small\ncalcifications in the right breast are consistent with the patient's known\nbreast cancer. Soft tissue densities in the anterior subcutaneous tissue are\nmost likely sequela of injections. The abdominal and pelvic wall is within\nnormal limits.", "output": "1. No evidence of retroperitoneal lymphadenopathy.\n2. Diffuse sclerotic punctuate lesions of the thoracolumbar spine, pelvis,\nsacrum, and bilateral femurs are most consistent with metastatic disease.\n3. An irregularly bordered, soft tissue mass in the right breast is consistent\nwith the patient's known breast cancer.\n4. Approximately 2 cm x 1.7 cm left adrenal nodule. Recommend noncontrast CT\nof the adrenal gland for further characterization.\n5. Probable approximately 1.9 cm pancreatic lipoma in the head of the\npancreas.\n6. Common bile duct dilatation, with central intrahepatic biliary duct\ndilatation.\n7. Small right pleural effusion with adjacent atelectasis. Mild left basilar\natelectasis.\n\nRECOMMENDATION(S): Recommend noncontrast CT of the left adrenal gland for\nfurther characterization of an adrenal nodule." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis is noted. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute pathology in the abdomen or pelvis." }, { "input": "LOWER CHEST: For chest findings reference is made to chest CT of the same\ndate.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense hepatic lesions are noted (series 2, image 44, 47, 55 and\n54) measuring up to 12 mm in segment 4A/8 of the liver. New hypodense lesion\nin segment 6 of the liver measuring 7 mm in diameter is too small to\ncharacterize (series 2, image 54). The hypodense lesion in segment 2 is\nslightly more conspicuous compared to prior imaging. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly with the spleen measuring 17.2 cm in the craniocaudal\nplane. This is unchanged compared to prior. No focal splenic lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral small peripelvic cysts are again noted. No hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nLeft hydrocele is incompletely imaged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. The common hepatic artery arises directly from the aorta.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are postsurgical changes in the right inguinal region,\npresumably from prior hernia repair. There is a small fat containing\numbilical hernia.", "output": "1. No acute findings in the abdomen or pelvis to explain symptoms of abdominal\nand flank pain.\n2. No lymphadenopathy. Unchanged splenomegaly. No focal splenic lesions.\n3. Four small hypodense hepatic lesions are indeterminate. One of the lesions\nis new compared to prior imaging done ___, the other one is\nslightly more conspicuous with the other two lesions being unchanged. These\nlesions are nonspecific, but are most likely benign etiology. If clinically\nindicated these lesions may be better characterized with contrast enhanced\nMRI.\n4. Right upper lobe airspace opacification is noted for which reference is\nmade to CT chest report of the same date." }, { "input": "FOR CHEST FINDINGS, PLEASE REFER TO ___ CHEST CT REPORT.\n\nCT OF THE ABDOMEN: THE LIVER IS HOMOGENEOUS, NO DEFINITE MASS LESIONS, NO\nDILATED INTRAHEPATIC BILIARY RADICLES. THE PORTAL VEIN AND HEPATIC VEINS ARE\nPATENT. OF NOTE IS AN ILL-DEFINED AREA OF SUBTLE INCREASED DENSITY WITHIN\nSEGMENT 6 (SERIES 6, IMAGE 20). THIS IS NOT DEFINITELY MASSLIKE HOWEVER,\nATTENTION ON FOLLOWUP.\n\nTHERE IS FOCAL ENLARGEMENT OF BOTH ADRENAL GLANDS. ENHANCEMENT CHARACTERISTICS\nCYST DO NOT SUGGEST THESE REPRESENT ADENOMAS AND IN LIGHT OF THE HISTORY OF A\nLUNG MASS, ARE HIGHLY SUSPICIOUS FOR METASTATIC DISEASE.\n\nTHERE ARE AREAS OF CORTICAL THINNING INVOLVING BOTH KIDNEYS. ON THE LEFT,\nTHERE ARE 2 HYPODENSE AREAS WHICH DO NOT MEET CRITERIA FOR SIMPLE CYSTS. 1\nINVOLVING THE INFERIOR POLE (SERIES 10, IMAGE 38) WHICH MEASURES 20 MM, A\nSECOND AREA WITHIN THE MEDIAL ASPECT OF THE MIDPOLE (SERIES 10, IMAGE 22)\nMEASURING 19 MM. ON THE RIGHT THERE IS A 7 MM WELL-DELINEATED HYPODENSE FOCUS\n(SERIES 6, IMAGE 31) WHICH ALSO DOES NOT MEET CRITERIA FOR A SIMPLE CYST.\n\nMILD ATHEROSCLEROTIC DISEASE, NO FREE FLUID, NO PATHOLOGICALLY ENLARGED\nADENOPATHY. THE PANCREAS AND SPLEEN APPEAR UNREMARKABLE. NOTE OF A SIMPLE\nSPLENULE. VISUALIZED LOOPS OF LARGE AND SMALL BOWEL ALSO APPEAR UNREMARKABLE.\nSIMPLE CHOLELITHIASIS IS IDENTIFIED.\n\nCT OF THE PELVIS: VISUALIZED LOOPS OF LARGE AND SMALL BOWEL APPEAR\nUNREMARKABLE. NO FREE FLUID, NO PATHOLOGICALLY ENLARGED ADENOPATHY.\n\nBONE WINDOWS DEMONSTRATE ONLY DEGENERATIVE CHANGES, NO SUSPICIOUS AREAS SEEN.", "output": "1. FOCAL AREAS OF ENLARGEMENT INVOLVING BOTH ADRENAL GLANDS, AREAS DO NOT MEET\nIMAGING CHARACTERISTICS OF SIMPLE ADENOMAS AND ARE SUSPICIOUS FOR METASTATIC\nDISEASE.\n2. 2 AREAS WITHIN THE LEFT KIDNEY AND 1 ON THE RIGHT AS DESCRIBED ABOVE, NOT\nMEETING CRITERIA FOR SIMPLE CYSTS.\n3. ILL-DEFINED AREA WITHIN SEGMENT 6 OF THE LIVER, LIKELY PERFUSIONAL BUT\nATTENTION ON FOLLOWUP.\n4. CHRONIC FINDINGS INCLUDING ATHEROSCLEROTIC DISEASE, AREAS OF RENAL CORTICAL\nTHINNING, SIMPLE CHOLELITHIASIS." }, { "input": "LUNG BASES: In the left lower lobe, there is new airspace consolidation which\nis concerning for pneumonia/aspiration. The imaged portion of the heart is\nunremarkable.\n\nABDOMEN: There is marked gastric distention similar to prior exam with an\nenlarging mass located at the level of the gastric antrum/ pylorus. Findings\nremain concerning for malignant gastric outlet obstruction. This mass measured\napproximately 4.6 x 5.0 cm on prior exam and currently measures 5.4 x 5.2 cm.\n\nThe liver enhances normally without focal lesion of concern. The gallbladder\nis decompressed. No biliary ductal dilation. The main portal vein appears\npatent. The spleen is not visualized and may be surgically absent. The\npancreas appears normal. Adrenal glands are normal bilaterally. The kidneys\nenhance symmetrically and excrete contrast promptly.\n\nThe abdominal aorta and major branches appear widely patent. There is no\nretroperitoneal lymphadenopathy.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction.\nSuture material is noted in the mid pelvic region and right mid abdomen. Mild\nfecal loading of the colon is noted. A a cluster of surgical clips are seen in\nthe deep pelvis with a surrounding hypodense rounded mass measuring\napproximately 3.2 x 3.1 cm, essentially unchanged in size and appearance from\nthe prior exam, and of indeterminate etiology. The urinary bladder is\nmoderately distended appearing normal. The left ureter opacifies normally. The\nright ureter appears normal in caliber. There is no pelvic lymphadenopathy. No\ndefinite mesenteric lymphadenopathy.\n\nBONES: Unremarkable.", "output": "1. Malignant gastric outlet obstruction with increasing size of mass at the\ngastric antrum/ pylorus as compared with most recent prior exam. This mass\nlikely represents metastasis from known appendiceal cancer.\n\n2. New consolidation in the left lower lobe compatible with\npneumonia/aspiration.\n\n3. Stable hypodense round left pelvic mass, unchanged -- attention on\nfollowup imaging recommended." }, { "input": "LOWER CHEST: Please refer to dedicated CT chest report on same day for\nintrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesion. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits. \nReflux of contrast\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nunremarkable.\n\nLYMPH NODES: Retroperitoneal lymphadenopathy, better visualized on CT pelvis\non same day, is again noted. There is retroperitoneal lymphadenopathy in the\nleft para-aortic region measuring 1.9 cm (series 3:84).\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Mild atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Retroperitoneal lymphadenopathy measuring up to 1.9 cm in the left\npara-aortic region.\n2. Please refer to dedicated CT chest report on same day for intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The right pelvic side wall has soft tissue nodule measuring 1.6 x\n5.8 centimeters, on prior study done on ___ measured 6.6 x 3.9 x 3.3 cm\n(5:115 ). The urinary bladder and distal ureters are unremarkable. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Re-demonstrated is a conglomerate of retroperitoneal lymph nodes\nthat measures 0.8 X 0.5 cm. On prior study done on ___, the same\nconglomerate of retroperitoneal lymph nodes measured 0.89 X 0.6 cm. There\nis markedly decreased in the retroperitoneal lymph nodes conglomerate. there\nare still prominent subcentimeter inguinal lymph nodes which are unchanged\nform prior study .\n\nVASCULAR: There is no abdominal aortic aneurysm. The right and left common\nilliac arteries and veins remain encased in the retroperitoneal\nlymphadenopathy conglomerate (5:96). Mild atherosclerotic disease is noted.\n\nBONES: Degenerative disease in the spine.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Marked decrease in pelvic and retroperitoneal lymphadenopathy.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: There is interval development of small bilateral pleural effusion\nwith associated relaxation bibasilar atelectasis.\n\nABDOMEN: Mild pneumoperitoneum is likely associated with recent laparoscopic\nprocedure.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small amount of perisplenic fluid.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is mild distension of\nthe fluid-filled small bowel loops measuring up to 3.4 cm, likely related to\npostop ileus, though cannot exclude early partial obstruction. Patient is\nstatus post transverse colonic resection of the previously described\ncircumferential adenocarcinoma. Suture lines are seen in the mid abdomen. No\nextraluminal contrast is appreciated around the anastomosis. There are mildly\nenlarged mesenteric nodes near the suture line, likely mesenteric lymph nodes\nthat were previously seen on CT colonography and ___. Small amount\nof free fluid in the right lower quadrant is likely postsurgical. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse subcutaneous tissue stranding, likely\nanasarca.", "output": "1. No evidence of anastomotic leak. Post surgical changes.\n2. Fluid filled small bowel loops, likely postop ileus, though cannot exclude\nearly partial obstruction. Close follow up with radiographs is recommended.\n\nRECOMMENDATION(S): Fluid filled small bowel loops, likely postop ileus,\nthough cannot exclude early partial obstruction. Close follow up with\nradiographs is recommended.\n\nNOTIFICATION: The findings were discussed with ___ , M.D. by\n___, M.D. on the telephone on ___ at 11:55 AM, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There is a 2.1 x 1.7 cm\nright ovarian corpus luteum cyst (2; 71) and appears asymmetrically larger\nthan the left.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The appendix is normal.\n2. 2.1 cm right ovarian corpus luteal cyst. The right ovary appears\nasymmetrically larger than the left. If there is high clinical concern for\novarian torsion, consider further assess with ultrasound." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The geographic hypodensity adjacent to the falciform ligament\n(series 2, image 16) likely represents focal fatty deposition. A\nsubcentimeter hypodensity within the liver adjacent to the gallbladder (series\n601b, image 18) is too small to characterize, but likely represents a cyst or\nbiliary hamartoma. Otherwise, the liver demonstrates homogenous attenuation\nthroughout. There is no evidence of enhancing lesions. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: There is a small fat containing focus in the body of the pancreas\n(series 2, image 19), interdigitating fat versus possibly a lipoma. \nOtherwise, the pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are 2 hyperdensities within the lower pole of the left kidney,\nmeasuring 11 and 16 mm (series 2, image 31, 36), both of which measure\nintermediate density, likely proteinaceous cysts. Additional tiny\nhypodensities within the left kidney are too small to characterize, but likely\nrepresent simple cysts. Otherwise, the kidneys are of normal and symmetric\nsize with normal nephrogram. There is no evidence of enhancing renal lesions\nor hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is relatively collapsed. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing inguinal hernia on the left. \nOtherwise, the abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal abnormality to explain abdominal pain.\n\nNormal appendix. No bowel obstruction or bowel wall thickening." }, { "input": "LOWER CHEST: Please refer to dedicated CT chest report.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Left\nparapelvic renal cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Uncomplicated\nsigmoid diverticulosis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal masses\nidentified.\n\nLYMPH NODES: There are enlarged bilateral external iliac lymph nodes measuring\nup to 1.6 cm in short axis on the left and 1.4 cm on the right. There is also\nan enlarged left lymph node at the left iliac bifurcation measuring 1.1 cm in\nshort axis. Numerous subcentimeter retroperitoneal lymph nodes are also\npresent.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: The patient has had a previous total right hip arthroplasty. There are\ndegenerative changes along the left hip joint, with prominent geodes along the\nleft acetabulum and left femoral head.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of intra-abdominal collection/abscess.\n2. There is bilateral external iliac lymphadenopathy, with prominent\nsubcentimeter retroperitoneal lymph nodes. While these may be reactive to a\nprevious septic arthritis, the possibility of metastatic disease or an\nunderlying lymphoproliferative is not excluded. Clinical correlation is\nrecommended." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA tiny, circumscribed, hypoattenuating lesion arising from the superior pole\nthe left kidney is too small to completely characterize, but likely a simple\nrenal cyst. There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status-post esophagectomy and gastric\npull-through without evidence of postsurgical complication. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis diverticulosis without focal wall thickening or adjacent fat stranding. \nThe appendix is normal.\n\nPELVIS: The urinary bladder is not well-distended, but grossly unremarkable. \nThere is no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The descending thoracic and abdominal aorta are very tortuous in\nkeeping with severe scoliosis. There is no abdominal aortic aneurysm. Mild\natherosclerotic disease is noted. Incidental note is made of an accessory\nright renal artery, a replaced left hepatic artery arising from the left\ngastric artery, a replaced right hepatic artery arising from the superior\nmesenteric artery, and a trifurcating hepatic portal vein.\n\nBONES: There is severe thoracoabdominal scoliosis with associated degenerative\nchanges. There are no suspicious osseous lesions. .\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of malignancy within the abdomen or pelvis.\n2. No evidence of postsurgical complication.\n3. Diverticulosis.\n4. Severe scoliosis." }, { "input": "LOWER CHEST: Subsegmental atelectasis is seen at the lung bases. No pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates morphological changes in keeping with\ncirrhosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The portal vein, hepatic\nartery, and hepatic veins are patent. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation. A large amount of\nascites is present.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen is enlarged, measuring 13.6 cm. There are no focal\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.2 cm hypodense lesion in the inferior pole of the right kidney\n___: 72) stable in size since ___. It is too small to accurately\ncharacterize, but may demonstrate internal enhancement. There is no\nhydronephrosis or perinephric abnormalities.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is low\nattenuation circumferential wall thickening of the cecum and ascending colon. \nMild diverticulosis is noted within the sigmoid colon. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. A large\namount of free fluid is noted.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Extensive perirectal gastric, and esophageal varices are noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cirrhotic liver with esophageal, gastric, and perirectal varices. There\nare no focal hepatic masses. The hepatic and portal vessels are patent\nwithout evidence of thrombosis.\n2. Hypodense lesion in the inferior pole of the right kidney, too small to\ncharacterize accurately but possibly enhancing. It is stable since ___, but a RCC cannot be ruled out and attention on followup is recommended.\n3. Edematous wall thickening of the cecum and ascending colon, likely\nsecondary to portal colopathy. However, an infectious colitis cannot be\nexcluded." }, { "input": "LOWER CHEST: Mild basilar atelectasis. Otherwise, visualized lung fields are\nwithin normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN: Hepatic cirrhosis. The gallbladder contains numerous stones. \nEvaluation of the gallbladder wall is difficult due to surrounding ascitic\nfluid. The spleen is mildly enlarged in the setting of portosystemic varices,\nreflective of portal hypertension. Subtle hyperdensity in the lower pole of\nthe right kidney is incompletely characterized, though similar in appearance\ncompared to ___. The adrenal glands, and pancreas are\nunremarkable.\n\nGASTROINTESTINAL: There is no intestinal obstruction. Small to moderate\nmoderate amount of nonhemorrhagic ascites has decreased since ___,\nstatus post paracentesis on ___. Mild colonic wall thickening is\nlikely reactive secondary to ascites, similar to ___\n\nPELVIS: The uterus and adnexa are unremarkable on CT for age. The bladder is\ndiffusely hyperdense, likely due to excretion of previously administered\nintravenous contrast from ___.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes are visualized.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are\ndemonstrated. Small amount of ascitic fluid is seen within the left inguinal\ncanal, unchanged. Chronic fracture of the left L3 transverse process.", "output": "1. Mild amount of nonhemorrhagic ascites.\n2. No evidence of intra-abdominal or intrapelvic hematoma.\n3. Cirrhosis and stigmata of portal hypertension.\n4. Incompletely characterized subcentimeter hypodensity in the lower pole of\nthe right kidney, though similar in appearance compared to ___." }, { "input": "LOWER CHEST: Ground-glass opacities in the right middle lobe and left lower\nlobe, new since ___ are suspicious for sequela of\naspiration/pneumonia (2: 97). There is no pleural effusion or pericardial\neffusion. There is relative hypodense appearance of the blood pool compared\nto the intraventricular septum, likely reflecting patient's anemic state. \nCoronary calcifications are minimal.\n\nABDOMEN:\nHEPATOBILIARY: There is hypertrophy of the left lobe and the caudate in the\nsetting of lobulated margins, consistent with cirrhosis. There is no evidence\nof focal lesions within the limitations of an unenhanced scan. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\ncontains gallstones without wall thickening or evidence of inflammation. \nPre-existing nonhemorrhagic perihepatic ascites is overall stable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size, measuring 12.7 cm in the axial plane and\nhomogeneous attenuation throughout, without evidence of focal lesions. Small\namount of perisplenic fluid is similar in size compared to prior.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. However, there is evidence of\nfecalization of the at the terminal ileum, likely representing slow transit. \nMural thickening of the ascending colon from the cecum to the hepatic flexure\n(601:27, 25 and 22) likely represents sequaelae of hepatic congestion. \nOtherwise, the colon and the rectum are unremarkable. Moderate amount of\nascites is seen interdigitating between the bowel loops. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of nonhemorrhagic free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nHealed fracture of lateral left seventh rib and left third transverse process\n(02:44).\n\nSOFT TISSUES: There is expansion of the right iliacus muscle with increased\nfat stranding.", "output": "1. Small right iliacus hematoma.\n2. Ground-glass opacities in the right middle lobe and left lower lobe,\nconcerning for multilobar pneumonia.\n3. Moderate amount of non-hemorrhagic ascites, similar to ___.\n4. Known cirrhosis with mild splenomegaly and sequelae of portal hypertension." }, { "input": "LOWER CHEST: Visualized lung fields are notable for linear right lower lobe\natelectasis. Visualized heart is unremarkable. No pericardial or pleural\neffusion. No large pneumothorax. Small hiatal hernia is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is heterogeneous in echotexture and nodular in\ncontour consistent with history of cirrhosis. Limited arterial phase study\ndue to timing of contrast, however no definite lesion identified. \nHeterogeneous areas of hyper enhancement on portal venous phase within\nsegments ___ are likely related to perfusional defects. No discrete areas of\nwashout seen. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation.Moderate volume ascites again noted. Patent portal\nvein, splenic vein, and SMV.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is top-normal in size measuring 11.5 cm. Normal\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A 1 x 1 cm (6:63) right lower pole hypodensity (previously 1 x 0.9\ncm) hypodensity is incompletely characterized and stable since prior\nexamination. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of additional focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Esophageal and perisplenic varices noted. The stomach is\nunremarkable. The visualized small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The visualized colon is within\nnormal limits. The appendix is normal.\n\nLYMPH NODES: Few top-normal para-aortic lymph nodes are stable and do not\nmeet CT size criteria for enlargement. There is no retroperitoneal or\nmesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Patent umbilical vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Patient is status post umbilical hernia repair with interval\ndecrease in size of a 3.5 x 1.4 cm (6:79) (previously 5.1 x 2.3 cm) rim\nenhancing collection within the anterior abdominal subcutaneous tissue just\ndeep to the umbilicus. No subcutaneous emphysema. No intra abdominal\nextension. The abdominal and pelvic wall is otherwise within normal limits.", "output": "1. Nodular heterogeneous liver consistent with known history of cirrhosis with\nareas of transient hepatic intensity differences within segments 5 and 6.\n2. No definite hepatic lesion, although arterial phase evaluation is slightly\nlimited.\n3. Sequelae of portal hypertension including moderate volume ascites, patent\numbilical vein, top-normal spleen, esophageal and perisplenic varices.\n4. Decrease in size of 3.5 cm rim enhancing collection within anterior\nabdominal subcutaneous tissue suggestive of a resolving hematoma. No\ndrainable collection given intermediate to high density contents.\n5. Patent portal vein and SMV." }, { "input": "LOWER CHEST: Bibasilar atelectatic changes are noted, slightly more pronounced\non the right.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular liver contour, compatible with the known history of\ncirrhosis. The liver demonstrates heterogeneous appearance, likely due to\npartial steatotic change although assessment for steatosis is limited on\npostcontrast images. There is geographic relative ___ seen in\nsegments 6 and 7. There are few rounded hypodense areas interspersed within\nthis enhancing region. Given the history of cirrhosis, dedicated liver study\nis recommended to exclude the presence of an underlying mass lesion. The\nportal vein is patent. The right hepatic vein is seen and patent. The middle\nand left hepatic veins are not well visualized, likely due to timing of the\nstudy. Again, multiple gallstones are seen. The gallbladder wall is thin. \nNo definite evidence of acute cholecystitis.\n\nModerate amount of ascites is noted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen measures 12.2 cm, borderline size. No other splenic\nabnormality is identified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n8 mm hypodense lesion in the interpolar region the right kidney, unchanged\nfrom priors. Likely represents small renal cyst. No suspicious renal mass\nlesions. No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Mild increasing caliber of the small bowel loops, measuring\nup to 3.1 cm. No transition point is seen, and contrast material is seen\nwithin the entirety of the colon. These findings are compatible postoperative\nileus. Uncomplicated sigmoid diverticulosis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Moderate\namount of free fluid in the pelvis.\n\nLYMPH NODES: Few borderline portocaval and hepatic artery nodes, likely\nreactive. Otherwise there is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Numerous esophageal and perigastric varices are noted. Portal vein\nis patent. The middle and left hepatic veins are not well visualized, likely\ndue to the timing of the study.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An ill-defined structure of heterogeneous density is seen at the\nmidline just deep to the umbilicus, containing few gas bubbles. Possibilities\ninclude hematoma versus phlegmon/early abscess. It does not appear drainable\nat this time. It measures 2.3 x 5.1 x7.9 cm.", "output": "1. 2.3 x 5.1 x 7.9 cm structure of heterogenous density with few gas bubbles\njust deep to the umbilicus, either related to hematoma or phlegmon/early\nabscess. It does not appear drainable at the current time.\n2. Heterogenous liver, at least partially due to some steatotic changes. \nThere are a few nodular hypodense areas seen in the posterior aspects of\nsegments 6 and 7, which could be due to the overlying heterogeneity of the\nliver parenchyma, although given the underlying cirrhotic change dedicated\ncross-sectional imaging of the liver (either by CT or MRI) is recommended to\nexclude underlying lesion.\n3. Diffuse mild dilation of the small bowel loops, compatible with ileus.\n\nRECOMMENDATION(S): Dedicated liver protocol CT or MRI, after the acute\nepisode has resolved." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThe liver demonstrates homogenous attenuation throughout. There is no\nevidence of focal lesions. Biliary stent is in place. There is no\nintrahepatic biliary duct dilatation.\nThe gallbladder is moderately distended. A peripherally calcified stone is\nagain noted at the level of the gallbladder neck. There is mild diffuse\ngallbladder wall thickening and pericholecystic fat stranding. Few locules of\ngas are noted in the gallbladder lumen which may be due to the presence of a\nbiliary stent.\n\nPANCREAS: There is fatty deposition within the pancreas. No focal pancreatic\nlesion seen. There is no evidence of duct dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple bilateral renal cysts including peripelvic cysts. There is\nno hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small sliding hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis apparent circumferential thickening of the colon along the splenic flexure\nwithout significant adjacent fat stranding. Diverticula are noted in the\nsigmoid colon without evidence of acute diverticulitis. There is no evidence\nof large bowel obstruction. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nThere is no free fluid or fluid collection in the abdomen and pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic disease. There is no evidence of\nabdominal aortic aneurysm. There is aneurysmal dilatation of the distal left\ncommon iliac artery measuring up to 1.8 cm. There is calcified plaque at the\norigin of both celiac axis and SMA without significant stenosis. Calcified\natherosclerotic disease is noted in the mid SMA causing moderate-severe\nluminal stenosis.\n\nBONES: Extensive degenerative changes are noted in the lumbar spine. Patient\nis status post left hemilaminectomy from L3-L5. Posterior lower lumbar\nhardware is grossly intact. There has been prior L4 vertebroplasty. No\naggressive bone lesion seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Distended gallbladder with a wall thickening and pericholecystic stranding\nconcerning for acute cholecystitis.\n2. Apparent colonic wall thickening at the splenic flexure without significant\nadjacent inflammatory change may be secondary to mild colitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:02 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "Heart size is top normal without significant pericardial fluid. Imaged lung\nbases are clear. Trace fat containing left-sided Bochdalek hernia.\n\nCT abdomen with and without contrast: Large, avidly arterially enhancing mass\nwith central hypodensity in the hepatic dome with enhancing pseudo capsule and\nrapid washout on the delayed phases has not significantly changed in size\ncompared to ___ measuring 53 x 52 mm. 2 fiducial markers are seen in\nthe periphery. Non masslike 14 mm arterial enhancement seen just caudally to\nthe mass more peripherally (04:32) has slightly decreased in conspicuity\ncompared to the prior examination and demonstrates no clear washout on the\nportal venous or equilibrium phases. Liver is otherwise morphologically\ncirrhotic with geographic redistribution and nodular contour. 6 mm nodular\nfocus of arterial hyper enhancement in segment 2 (04:21) is new demonstrating\nno definite washout on delayed phases. Gallbladder is absent.\n\nSpleen is enlarged measuring 13 x 9.1 cm in coronal plane. Pancreas and\nadrenal glands are normal. 7 mm stable left interpolar renal hypodensity is\ntoo small to fully characterize but likely represents a cyst. Kidneys present\nsymmetric nephrograms and excretion of contrast without focal solid mass or\nhydronephrosis. Diffuse varices and a recannulized umbilical vein are\nredemonstrated.\n\nHiatal hernia is small. Stomach, duodenum and remainder of the small bowel\nloops are normal caliber without evidence of obstruction. Large bowel is\nthin-walled and unremarkable without pericolonic fat stranding or fluid\ncollection.\n\nThe abdominal aorta demonstrates moderate calcified atherosclerotic plaque\nburden. Small infrarenal abdominal aortic aneurysm measuring 27 x 22 mm in\ngreatest axial dimension is unchanged (06:57). Scattered mesenteric and\nretroperitoneal lymph nodes are not pathologically enlarged. Trace non\nhemorrhagic ascites is mostly perihepatic in location. No pneumoperitoneum.\nSmall fat containing umbilical hernia with adjacent infraumbilical ventral\nmidline abdominal hernia containing fat with peritoneal defect measuring 25 mm\n(6:95).\n\nCT pelvis with contrast: The endometrium is thickened, measuring up to 13 mm\nin thickness in the fundus. Prominent dilatation of the left gonadal vein to\n11 mm with prominent collateralization of the left paraovarian venous plexus\nto maximum caliber of 8 mm the ovaries themselves are unremarkable. No free\npelvic air. Inguinal and pelvic sidewall lymph nodes are not pathologically\nenlarged.\n\nPelvic floor dysfunction is noted with portions of the lower uterine segment\nand rectum protruding into caudal to the pubococcygeal line. Bladder and\nrectum are otherwise unremarkable.\n\nBones and soft tissues: No suspicious focal bone lesion. L3-L5 posterior\nfusion hardware is in place. Bones are diffusely demineralized. Thoracolumbar\ndegenerative changes are overall moderate to severe.", "output": "1. No significant interval change of a known hepatic dome HCC measuring 53 x\n52 mm containing fiducial markers denoting CyberKnife therapy. Additional\narea of adjacent non masslike arterial hyper enhancement is less conspicuous\nthan on prior examinations and demonstrates no delayed washout. Continued\nattention on followup examination is advised.\n2. New 6 mm focus of nodular arterial hyper enhancement in hepatic segment 2\nwithout definitive delayed washout. Attention on followup imaging is advised\nto exclude an additional focus of HCC.\n3. No evidence of distant abdominopelvic metastasis.\n4. Cirrhotic liver with sequela of portal hypertension including small\nascites, varices formation and splenomegaly.\n5. Pelvic floor dysfunction with portions of the lower uterine segment and\nrectum protruding caudally past the pubococcygeal line.\n6. Thickened endometrium to 13 mm in this postmenopausal patient requires\nfurther evaluation with dedicated pelvic ultrasound.\n7. Prominent dilatation of the left gonadal vein with collateralization of the\nleft paraovarian venous plexus meets imaging criteria for pelvic congestion\nsyndrome, in this context related to portal hypertension. No associated retro\naortic left renal vein or narrowing of the aorto SMA angle. Correlate for\nclinical history of pelvic pain.\n8. Stable infrarenal abdominal aortic aneurysm measuring 27 x 22 mm in\ngreatest axial dimension.\n9. Fat containing infraumbilical ventral midline abdominal hernia containing\nfat with defect measuring 25 mm." }, { "input": "LOWER CHEST: Small left simple pleural effusion and adjacent left lower lung\natelectasis is new since ___. No right-sided pleural effusion. No\nfocal consolidation identified in the partially visualized lungs.\n\nABDOMEN:\n\nHEPATOBILIARY: Two fiducial markers are demonstrated in the region of the\nknown HCC in segment VIII with a small amount of artifact immediately\nadjacent, limiting evaluation. Since the prior exam, there is significant\nimprovement in the treated HCC. An approximately 1.9-cm hyper-enhancing focus\nin the anterior aspect of the treated lesion remains, with attenuation\nmeasuring 10 ___ pre-contrast, 140 ___ in arterial phase, 100 ___ in portal\nvenous phase, and 80 ___ at 3 min delay (e.g., Series 4, Image 4), suggesting\nresidual tumor. A posterior peripheral hyperenhancing rim on arterial phase\nalso suggests residual tumor (Series 4, Image 1). Remaining hypodense regions\nwithin the treated region may be compatible with necrosis. The previously\ndescribed 6-mm focus of arterial hyperenhancement without definite washout on\ndelayed phases in segment II is overall unchanged (Series 4, Image 16). No new\nconcerning hepatic focal lesion, including no new hyper-enhancing lesion on\nthe arterial phase, is demonstrated.\n\nThe remaining liver parenchyma is hypoattenuated, compatible with history of\nNASH, but enhances uniformly. The liver surface contour is nodular and\ncompatible with cirrhosis. Relative enlargement of the left lateral lobe is\nalso compatible with cirrhosis. No intrahepatic biliary dilatation. Surgical\nclips in the gallbladder fossa are compatible with prior cholecystectomy. Air\nwithin the extrahepatic duct is compatible with prior ERCP with sphincterotomy\nin ___ (Series 11, Image 41), although new from the prior exam. Ascites is\nincreased from the prior exam, now moderate and seen in the perihepatic and\nsplenic spaces as well as paracolic gutters and pelvis. The main portal vein,\nsplenic vein, and SMV appear patent. Diffuse varices are again noted; the\nesophageal varices appear slightly more prominent. The umbilical vein is\nrecannulized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout, without \nfocal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nThere is no stone, concerning focal renal lesion, hydronephrosis, or\nperinephric abnormality. The urinary bladder is collapsed, and thus cannot be\naccurately evaluated.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The colon and rectum are within normal limits. \nNo bowel obstruction or intraabdominal free air.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy by CT size criteria.\n\nVASCULAR: The previously described small infrarenal abdominal aortic aneurysm\nis unchanged. Moderate atherosclerosis is also unchanged.\n\nPELVIS: There is no evidence of pelvic or inguinal lymphadenopathy by CT size\ncriteria. There is a moderate amount of simple free fluid in the pelvis. \nStable appearance of the endometrium and dilatation of the left gonadal vein\nas before.\n\nBONES AND SOFT TISSUES: No suspicious lytic or sclerotic bony lesion. L3-L5\nposterior fusion hardware is unchanged and intact with artifact limiting\ndetailed assessment in this region. There is diffuse bony demineralization\nand moderate-to-severe but stable thoracolumbar degenerative changes including\nmild retrolisthesis of L1 on L2. A small, fat-containing umbilical hernia and\nadjacent inferior ventral midline hernia are stable.", "output": "1. Significant interval improvement in the treated segment VIII HCC. \nPost-treatment changes with probable 2-cm focus of residual tumor anteriorly\nand a persistent rim of hyperenhancement posteriorly as detailed above.\n\n2. No new hyperenhancing suspicious focal hepatic lesion.\n\n3. Cirrhosis with sequelae are slightly progressed with increased ascites and\nslightly more prominent varices compared to the prior exam.\n\n4. New small left pleural effusion with compressive atelectasis, likely\ntransudative.\n\n5. Spleen is not clearly enlarged on today's exam.\n\n6. Other findings detailed above are stable from the prior exam." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is fatty infiltration of liver with areas of focal fatty\nsparing. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSub cm hypodensities are noted in the kidneys bilaterally which are too small\nto characterize but likely represent simple renal cysts. There is no\nperinephric abnormality. There is mild wall thickening of the right proximal\nureter best seen on series 2, ___ 40. As well as the right renal pelvis\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple fibroids are noted within the uterus. The\nreproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild wall thickening of the right renal pelvis and proximal ureter raises\nthe possibility of infection such as pyelonephritis, differential diagnosis\nincludes recent stone passage.\n2. Hepatic steatosis\n\nRECOMMENDATION(S): Correlation with urine analysis and follow-up abdominal CT\nin 3 months is recommended to ensure resolution of ureteral wall thickening\n\nNOTIFICATION: The revised findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 4:51 ___, 30 minutes\nafter discovery of the findings." }, { "input": "Heart size is normal without significant pericardial fluid. The imaged lung\nbases are clear.\n\nCT abdomen without contrast: The liver is diffusely hypo attenuating\ncompatible is steatosis with areas of sparing. Liver is otherwise grossly\nunremarkable in the context of a noncontrast examination. Gallbladder,\nspleen, pancreas and adrenal glands are unremarkable in the context of a\nnoncontrast examination.\n\nThere is a 1.9 x 0.8 cm stone in the right interpolar kidney (02:34). There\nis a mild prominence of the right renal collecting system without frank\nhydronephrosis. There is a 1 cm simple density right interpolar renal cyst. \nLeft kidney is unremarkable without stone or hydronephrosis. No gross solid\nrenal masses seen.\n\nStomach is unremarkable. Duodenum and small bowel loops are normal caliber\nwithout evidence of obstruction. Large bowel is thin-walled and unremarkable\nwithout pericolonic fat stranding or fluid collection. Appendix is not\ndefinitely visualized however there is no secondary evidence for appendicitis.\n\nAbdominal aorta is normal caliber. There is no mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria. There is no ascites, pneumoperitoneum or\nventral abdominal hernia.\n\nCT pelvis without contrast: Bladder, uterus, adnexa and rectum are grossly\nunremarkable. There is no free pelvic fluid or air. There is no inguinal or\npelvic sidewall lymphadenopathy by CT size criteria.\n\nBones and soft tissues: There is mild degenerative changes at the pubic\nsymphysis. There is no suspicious focal bone lesion.", "output": "1. 1.9 x 0.8 cm right interpolar renal calculus with mild prominence of the\nright-sided renal collecting system without frank hydronephrosis. No left\nrenal calculus. No ureteral or bladder calculus.\n2. Hepatic steatosis." }, { "input": "Limited evaluation due to absence of IV contrast.\n\nLOWER CHEST: Visualized lung fields are notable for minimal lingular\natelectasis. The visualized lungs are otherwise clear. No pleural or\npericardial effusion. The heart is normal in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypodense consistent with hepatic\nsteatosis. There is no evidence of focal lesions within the limitations of an\nunenhanced scan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post double-J ureteral stent with proximal tip\ncoiled in the right collecting system and distal tip coiled within the bladder\nat the right UVJ. New subtle proximal right ureteral fat stranding is\npostsurgical in nature. The kidneys otherwise are of normal and symmetric\nsize. Again seen is a conglomerate of renal stones within the lower pole of\nthe right kidney measuring 1.1 x 1 cm in total (02:37) (previously 1.2 x 2.1\ncm) which demonstrates interval fragmentation. There is no evidence of focal\nrenal lesions within the limitations of an unenhanced scan. There is new small\namount of fluid within the right collecting system. No definite\nhydronephrosis. There is no left nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: No hiatal hernia. The stomach is decompressed. Small bowel\nloops demonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is not visualized, however no\nsecondary signs acute appendicitis.\n\nPELVIS: Distal end of double-J right ureteral stent is again noted within the\nbladder. The urinary bladder and distal ureters are otherwise unremarkable. \nNo bladder calculi. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval fragmentation and decrease in size of right lower pole renal stone\nconglomerate now measuring 1.1 cm in total. No new renal or bladder stones.\n2. Status post right double-J ureteral stent in appropriate position with\nassociated postsurgical changes within the proximal ureter including mild fat\nstranding and small amount of fluid within the right renal collecting system." }, { "input": "CHEST: The bases of the lungs demonstrate bilateral dependent atelectasis.\nThere is no pleural or pericardial effusion.\n\nABDOMEN: HEPATOBILIARY: The hepatic parenchyma is diffusely hypodense,\ncompatible with fatty infiltration. The hepatic contour is unremarkable, and\nthere is no intra or extrahepatic biliary ductal dilatation. Assessment for\nfocal lesions is precluded given the lack of intravenous contrast. No ascitic\nfluid is seen in the upper abdomen. No perihepatic nodes are seen. The\ngallbladder is normal with no stones or wall thickening.\n\nPANCREAS: The pancreas has normal noncontrast appearance throughout, without\nperipancreatic abnormality.\n\nSPLEEN: The spleen shows normal size, and has an unremarkable noncontrast\nappearance.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: There is persistent mild hydronephrosis on the right, similar in\ndegree compared to the prior CT and renal ultrasound, with a nonobstructing 2\nmm interpolar stone on the left (3a:25). Mild pelvicaliectasis on the left is\nalso unchanged. No perinephric fluid collections are identified. The bilateral\nproximal ureters are dilated, right greater than left.\n\nRETROPERITONEUM: No enlarged retroperitoneal or mesenteric lymph nodes are\nseen.\n\nVASCULAR: The abdominal vasculature is poorly assessed, given the lack of\nintravenous contrast.\n\nThe loops of large and small bowel in the upper abdomen are normal, with\nenteric contrast material seen to the level of the rectum. There is no\nevidence of wall thickening or obstruction.\n\nPELVIS: The patient is status post cystectomy, with ileal conduit formation.\nSince the prior CT, there has been slight increase in size of deep pelvic\nfluid collections. For example, the the organized collection on the left (3a:\n83) measures approximately 2.2 x 2.6 cm x 3.8 cm, previously 1.7 x 2.1 x 3.4\ncm when measured at a similar level, and has a slightly hyperdense rim. A\nsmall collection along the right aspect of the rectum (3a: 82) measures\napproximately 2.3 x 2.5 cm, and appears slightly more organized compared to\nthe prior study. A small amount of fluid tracks superiorly along the right\npelvis, and to a lesser degree on the left, along the rectosigmoid junction. \nThe uterus and bilateral ovaries are surgically absent. Assessment for wall\nenhancement or peritoneal enhancement as documented previously, is impossible\ngiven the lack of IV contrast.\n\nThe rectum and sigmoid colon are unremarkable, with the exception of scattered\ndiverticula, as seen previously.\n\nBONES AND SOFT TISSUES: No concerning lytic or blastic lesions are seen\nthroughout the skeleton. Postsurgical changes related to recent ileal conduit\nformation (38:60) are similar in appearance.", "output": "1. Slight interval increase in size of organized fluid collections in the\npelvis compared to the prior exam from ___, likely abscesses, although\nassessment is limited given the lack of intravenous contrast. The largest\ncollection measures 2.2 x 2.6 x 3.8 cm in the deep left pelvis. No new fluid\ncollections are identified.\n2. Stable mild bilateral hydroureteronephrosis, right greater than left,\nlikely postsurgical following cystectomy with ileal conduit.\n3. Hepatic steatosis.\n4. Nonobstructing 2 mm left interpolar renal stone." }, { "input": "CHEST: Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffusely low attenuation consistent\nwith hepatic steatosis. No evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening. The hepatic\nveins, main portal vein, SMV, and splenic vein are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen demonstrates 3 distinct peripheral wedge-shaped\nhypodensities the largest measuring approximately 1.0 cm (04:50, 40) which are\nnew since ___. Lesions were not previously seen on ___\nalthough that study was limited due to absence IV contrast.\n\nADRENALS: The left adrenal gland is unremarkable. The right is not\nvisualized.\n\nKIDNEYS: Status post cystectomy with ileal conduit. The kidneys are symmetric\nsize with normal nephrograms. Bilateral mild hydronephrosis and hydroureter,\nright greater than left, is unchanged since ___, and is likely\npostsurgical in nature. Maximal right ureter measurement is 0.9 cm. No\nobstructing renal or ureteral calculi. No perinephric stranding or fluid\ncollection.\n\nGI: Visualized esophagus, stomach, small bowel, and colon are unremarkable\nwithout mucosal hyper enhancement, fat stranding, focal mass lesion, or\nobstruction. Multiple sigmoid and descending colonic diverticula seen without\nevidence of acute diverticulitis.\n\nRETROPERITONEUM: No mesenteric lymph node enlargement. Multiple subcentimeter\nretroperitoneal nodes are stable since ___ and do not meet CT size\ncriteria for enlargement. Largest measuring 0.7 cm (4:73) (previously 0.6 cm)\nin short axis.\n\nVASCULAR: The abdominal aorta is normal in caliber without aneurysmal\ndilatation. The celiac axis, SMA, ___, and renal arteries are patent.\n\nPELVIS:\n\nStatus post cystectomy with ileal conduit formation and associated\npostsurgical changes. There is no evidence of pelvic or inguinal lymph node\nenlargement. Interval placement of a left-sided drain with improvement of\nfluid collection along the deep left pelvis now measuring 3.1 cm (4:112)\n(previously 3.4 cm). Right pelvic fluid and phlegmonous collection may be\nslightly increased in size and organization given limitations of comparison\nwith previous non-contrast study. A newly apparent hypodense 5 cm (7:61) right\npelvic fluid collection may be amenable to drainage. Additional smaller fluid\ncollections in the deep pelvis is stable compared to the prior exam.\n\nBONES AND SOFT TISSUES: No focal lytic or blastic lesions concerning for\nmalignancy.", "output": "1. New splenic hypodensities are concerning for infarctions from possibly\nseptic emboli.\n\n2. Right pelvic fluid and phlegmonous collection may be slightly increased in\nsize and organization given limitations of comparison with previous\nnon-contrast study. A newly apparent hypodense 5 cm right pelvic fluid\ncollection may be amenable to drainage. A superinfection cannot be excluded.\n\n3. Stable hydroureteronephrosis, right greater than left, likely related to\nreflux from ileal conduit. No obstructing calculi or extrinsic ureteral\ncompression.\n\n4. Interval placement of left sided drain with mild improvement in deep left\npelvic fluid collection.\n\nNOTIFICATION: WET READ was conveyed by Dr. ___ on ___.\n\n The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 10:45 AM, 10 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: There is mild dependent atelectasis bilaterally, otherwise\nvisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild prominence of the\ncentral intrahepatic biliary ducts and the CBD measures 8 mm, likely secondary\nto prior cholecystectomy. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA cortical scar seen in the lower pole of the left kidney, similar to prior. \nThere is no evidence of focal renal lesions or hydronephrosis. Subcentimeter\nhypodensities seen in bilateral kidneys are too small to characterize but are\nstatistically likely to be simple cysts. Punctate renal stones are seen in\nthe upper pole of the left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The descending\nand sigmoid colon are collapsed, however the wall thickness appears within\nnormal limits. Scattered diverticuli are seen without evidence of surrounding\nwall thickening or inflammation. Oral contrast is seen throughout colon. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Multiple small retroperitoneal lymph nodes measuring up to 7 mm\nare seen surrounding the celiac axis which do not meet the CT size criteria\nfor lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAnterior wedging compression deformities of T10 and T11 are similar to prior.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No acute intra-abdominal process.\n2. Punctate nonobstructing left renal calculi." }, { "input": "LOWER CHEST: There are innumerable subcentimeter pulmonary nodules in both\nvisualized lower lungs, the largest of which measure 5-6 mm. These are all\nnew from the previous study in ___ aside from a single 4 mm chronic\nnodule in the left lower lobe. There is no evidence of pleural effusion. A 1\ncm pericardiac node has increased from 6 mm on prior study. There is also\ninterval enlargement of several subcentimeter nodes in the posterior\nmediastinum.\n\nABDOMEN:\n\nEvaluation of the intra-abdominal structures is limited by absence of IV\ncontrast (typically not given for the indication of renal colic).\n\nHEPATOBILIARY: There are multiple hypodense Liver lesions, the largest of\nwhich measures in 2.5 cm range in segment ___. these are not identified\non the prior unenhanced exam. The gall bladder is under distended. A\ngallstone is noted. There is no evidence of biliary dilation.\n\nPANCREAS: There is a hypodense mass centered in the pancreatic tail measuring\napproximately 6.6 x 4.8 x 4.5 cm. There are multiple enlarged upper\nretroperitoneal lymph nodes, the largest of which measures 2.7 x 3.2 cm\nadjacent to the pancreatic neck. There is ill-defined soft tissue abutting\nthe left aspect of the celiac axis, but not circumferentially surrounding it. \nThere appears to be abnormal soft tissue density around the course of the\ncommon hepatic artery but is not well defined in the absence of IV contrast. \nThere is also abnormal soft tissue abutting both sides of the SMA and in the\naortocaval region.\n\nSPLEEN: The spleen is enlarged and is increased in size compared to prior\nstudy, now measuring up to 18.0 cm.\n\nADRENALS: Unremarkable.\n\nURINARY: Both kidneys contain multiple cortical cysts, better defined on the\nprevious enhanced study. There is a punctate 1-2 mm nonobstructed stone at\nthe left lower pole. There is a 1.7 cm exophytic, slightly hyperdense lesion\narising from the right upper pole, which has slowly increased over serial\nstudies. This may have been visualized on ultrasound from ___ but\nimages are not retrievable at this time. It likely represents a proteinaceous\nor hemorrhagic cyst but does not meet density criteria to confirm benignity. \nThere is no hydronephrosis and there are no ureteric stone.\n\nGASTROINTESTINAL: There is extensive colonic diverticulosis. There is mild to\nmoderate fat stranding around the hepatic flexure surrounding the diverticuli.\nThe stranding could potential be related to the process involving the\npancreas, but is more suggestive of a localized inflammatory process.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Upper retroperitoneal vascular findings as above.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are several areas of soft tissue density stranding in the\nsubcutaneous fat over the anterior abdominal wall, most prominent in the right\nmid abdomen. These are nonspecific.", "output": "1. Pancreatic tail mass most likely represents primary adenocarcinoma. There\nis evidence of retroperitoneal and thoracic nodal metastatic disease, as well\nas multiple hepatic and pulmonary metastases. Increasing splenomegaly could\nalso represent additional sites of metastases. This would be better evaluated\nwith contrast enhanced staging CT of the chest, abdomen and pelvis.\n2. Localized fat stranding around the hepatic flexure is most concerning for\nuncomplicated acute diverticulitis, particularly in the presence of acute\nright abdominal pain.\n3. Subcutaneous fat stranding over the right anterior abdominal wall is\nnonspecific and could be related to contusion or cellulitis. It is uncertain\nif this is associated with the acute presentation.\n4. Hyperdense 1.7 cm exophytic lesion arising from the upper pole of the right\nkidney, which may represent a proteinaceous or hemorrhagic cyst however\nneoplasm cannot be excluded. Further evaluation is recommended with CT or MRI\nRenal Mass protocol.\n\nRECOMMENDATION(S): Staging CT of the chest, abdomen and pelvis with contrast.\nCT or MRI Renal Mass protocol for further evaluation of the hyperdense and\nexophytic right renal lesion.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:41 pm, 30 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Coronary artery calcifications\nare partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: There are numerous hypodense masses throughout both lobes of\nthe liver. For reference, a left hepatic lobe mass measures 3.8 x 3.5 cm. A\nright hepatic lobe mass measures 6.3 x 4.4 cm. There is a large irregular\nhypodense mass at the hepatic hilum measuring 8.6 x 6.1 x 9.5 cm with multiple\nsurrounding small satellite lesions (2:34, 601:21). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is not\ndistended. The gallbladder wall appears thickened along the hepatic edge,\nlikely reactive to the adjacent process in the liver.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. Diffuse\nthickening of the left adrenal gland without focal nodule does not appear\nsignificantly changed\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.3 cm cyst in the left upper pole. Multiple additional\nsubcentimeter cortical hypodensities bilaterally are too small to\ncharacterize, however likely represent cysts. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal (2:67).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and left adnexae are within normal limits. \nThere is a 2.8 cm cyst in the right ovary (2:67).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. The portal vein, splenic vein and\nSMV are patent.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There are multilevel degenerative changes in the lower thoracic and\nlumbar spine. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Numerous masses throughout both lobes of the liver concerning for\nmetastatic disease, the largest being irregular 9.5 cm hypodense mass at the\nhepatic hilum likely representing a necrotic metastases, however hepatic\nabscess could have a similar appearance to some of these lesions.\n2. Gallbladder wall thickening along the hepatic edge is likely reactive to\nthe adjacent process in the liver. No additional findings to indicate acute\ncholecystitis.\n3. No biliary duct dilatation.\n4. Patent portal vein.\n5. Diverticulosis, with no evidence of acute diverticulitis\n6. 2.8 cm right adnexal cystic lesion, for which outpatient pelvic ultrasound\nis recommended given postmenopausal status, if clinically indicated.\n\nRECOMMENDATION(S): Outpatient pelvic ultrasound if clinically indicated." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.Atherosclerotic calcifications are\nseen in the coronary arteries and aortic annulus.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is diffuse infiltrative metastatic hypoattenuating\nlesions in the liver, mainly involving the right hepatic lobe, similar to and\nbetter described on the recent CTA study from ___. For example,\na representative hypodense lesion in the hepatic segment ___ measures 8.5 cm\n(03:14), unchanged. No new definite metastatic lesions are identified. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is minimally distended and demonstrates persistent gallbladder\nwall thickening, likely reactive.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right gland unremarkable. There is mild thickening of the left\nadrenal gland, unchanged.\n\nURINARY: The kidneys are of normal and symmetric size. A cortically based 2.1\ncm simple cyst is seen in the interpolar region of the left kidney, better\nseen on the contrast enhanced study from ___. A smaller subcentimeter\nhypodensity in the lower pole of the left kidney is too small to characterize.\nThere is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis is seen\npredominantly involving the sigmoid colon, unchanged. Otherwise, the\nremaining visualized colon and rectum are within normal limits. The appendix\nis not well demonstrated.\n\nPELVIS: The urinary bladder is mildly distended. There is no distal\nhydroureter. Small amount of non-complex free pelvic fluid is seen.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: Subcentimeter left para-aortic lymph nodes are unchanged,\nmeasuring up to 6 mm (03:28). There is no mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are again seen in the visualized spine.\n\nSOFT TISSUES: Note is made of a small fat containing umbilical hernia. \nOtherwise, the abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of fluid collection concerning for hematoma in the right upper\nquadrant.\n2. Diffuse infiltrative metastatic hypoattenuating hepatic lesions are\nunchanged since ___, although worse since ___." }, { "input": "LOWER CHEST: There is linear scarring/subsegmental atelectasis at the lung\nbases bilaterally. There is no pleural effusion. No suspicious nodules seen\nin the visualized lower lungs.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThe liver demonstrates homogenous attenuation throughout. There is no evidence\nof focal lesions.\n\nThere is moderate intrahepatic biliary duct dilatation which appears to have\nslightly progressed compared to the prior study. Common hepatic duct is\nsignificantly dilated. CBD measures 2.5 cm proximally with an abrupt cut off\nat the level of the ampulla.\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. There is diffuse dilatation of the main pancreatic duct\nmeasuring up to 10 mm. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Gastrostomy tube is in place. The stomach is mildly\ndistended. Known malignancy within the proximal duodenum is not visualized on\nCT. First portion of the duodenum is slightly irregular but collapsed. \nSecond through fourth portion the duodenum is also collapsed and the distal\nextent of disease cannot be evaluated. An enteric catheter is traverses the\npylorus and collapse/stenotic duodenum with the distal tip in the proximal\njejunum. Distal small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix contains air, has normal caliber without evidence of fat stranding. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: Note is made of a 10 mm porta hepatic lymph node (series 4,\nimage 45). No other enlarged lymph nodes identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy.\n\nThere is no ascites.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nArterial evaluation\n\nSMA involvement: absent\nCeliac Axis involvement: absent\nCommon hepatic artery involvement: absent\n\nVariant anatomy: Replaced left hepatic artery\nVariant vessel contact: absent\n\nVenous evaluation\n\nMPV involvement: absent\nSMV involvement: absent\n\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of solid organ metastatic disease in the abdomen and pelvis.\n2. No evidence of locally invasive disease\n3. 10 mm porta hepatic lymph node likely corresponding to the biopsy proven\nmetastatic lymph node" }, { "input": "LOWER CHEST: 5 mm nodule is noted in the right middle lobe unchanged since\n___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains 2 uncomplicated\ngallstones measuring up to 5 mm.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. No renal\nstones are seen.\n\nGASTROINTESTINAL: Visualized small and large bowel loops are within normal\nlimits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged measuring 5.5 x 4.2 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. No cause for hematuria identified. Specifically, no concerning ureteral or\nrenal mass, stone, or obstruction.\n2. Cholelithiasis." }, { "input": "VASCULAR:\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nThe celiac axis, SMA, ___, renal and iliac arteries and their major branches\nare patent with no signs of occlusive or aneurysmal disease. The portal system\nincluding SMV, splenic and portal veins is patent. The renal veins, iliac\nveins and IVC are patent and demonstrate normal caliber. Incidental note is\nmade of a retroaortic left renal vein.\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nmillimetric right hepatic lobe hypoattenuating lesion likely represents a\nsimple cyst or biliary hamartoma (3:94). No other focal liver lesions are\nidentified.. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder has been resected.\n\n\nPANCREAS: A hypoattenuating lesion in the pancreatic neck/body junction\nmeasures roughly 3.0 x 2.0 x 2.0 cm, at the site of pancreatic ductal\ntransition, concerning for underlying pancreatic mass (3:91, 07:27, 07:28). \nThis is associated with upstream pancreatic ductal dilatation up to 1.3 cm in\nthe pancreatic body (3:91), with tapering toward the pancreatic tail. This\narea makes contact with the superior aspect of the SMV and portal confluence\nwith less than 180 degrees of contact. This area also makes contact with the\nGDA approximately 7 mm beyond its origin. There is no vascular narrowing. \nThere is dilation of several side branch pancreatic ducts with a cystic branch\ndilation in the pancreatic body measuring up to 1.4 x 1.4 cm (3:89), similar\nto prior MR abdomen performed ___. Multiple tiny cystic lesions are\ndemonstrated in the pancreatic head with a superior cystic lesion seen\nadjacent to the hypoattenuating pancreatic mass measuring up to 7 mm (3:88).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is mild\nnodular thickening of the left adrenal gland without discrete mass.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.7 x 1.6 cm right kidney cyst is demonstrated (3:104). Additional\nbilateral hypoattenuating renal lesions are too small to characterize. There\nis no evidence of stones, focal renal lesions, or hydronephrosis. There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colonic diverticulosis without evidence of\ndiverticulitis.\n\nLYMPH NODES: There is a 1.0 cm irregular and hypodense common hepatic arterial\nlymph node (3:85). A portacaval lymph node measures up to 8 mm in short axis\n(3:85). No other enlarged retroperitoneal, mesenteric, pelvic, or inguinal\nlymph nodes are identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nBONES: There is mild bilateral hip osteoarthritis. Grade 1 anterolisthesis of\nL4 on L5 is likely degenerative in nature. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical and supraumbilical hernias are\nseen (8: 69 a 2.6 cm periumbilical scar is unchanged compared to ___.", "output": "1. 3.0 cm hypoattenuating mass-like lesion at the pancreatic neck/body\njunction is associated with upstream pancreatic ductal dilatation up to 1.3 cm\nand is concerning for underlying pancreatic adenocarcinoma. This lesion makes\nless than 180 degree contact with the superior aspect of the SMV and portal\nconfluence and contacts the GDA 7 mm beyond its origin.\n2. Stable dilatation of several side branch pancreatic ducts with a 1.4 cm\ncystic side branch dilatation in the pancreatic body unchanged compared to\nprior MR abdomen performed ___.\n3. Common hepatic artery lymph node measures up to 1.0 cm in maximum\ndimension.\n4. No evidence of solid organ metastases in the abdomen or pelvis.\n5. Please refer to separate report of CT chest performed concurrently for\ndescription of the intrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple subcentimeter hypodensities throughout the liver are\ntoo small to characterize, but likely represent cysts or biliary hamartomas. \nScattered calcified granulomas. Otherwise, the liver demonstrates homogenous\nattenuation throughout. There is no evidence of solid lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas is slightly atrophic. Otherwise, the pancreas has\nnormal attenuation throughout, without evidence of focal lesions or pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Accessory spleen inferiorly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter hypodensities within the kidneys bilaterally are too\nsmall to characterize, but likely represent cysts. Otherwise, the kidneys are\nof normal and symmetric size with normal nephrogram. There is no evidence of\nsolid renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate-sized hiatal hernia containing contrast.\nOtherwise, the stomach is unremarkable. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Diverticulosis of the\ndescending and sigmoid colon is noted, without evidence of wall thickening and\nfat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcification within the uterus likely represents\na small fibroid. No adnexal masses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. There is also\na shallow fat containing left inguinal hernia.", "output": "1. No specific evidence of malignancy within the abdomen or pelvis.\n2. Incidental findings include a moderate sized hiatal hernia, uterine\nfibroids, and diverticulosis.\n3. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nNo suspicious focal hepatic lesions are identified allowing for the lack of IV\ncontrast. There appears to be branching hypodense material, probably within\nthe portal veins. This measures approximately -60 Hounsfield units, although\nexact measurement is difficult given the thin nature of the abnormality. Is\nunchanged from previous. I suspect this represents branching fact within the\nportal venous system. Its exact significance is unclear.\n\nThe patient is status post cholecystectomy.\n\nThe spleen is not visualized, likely removed.\n\nThe left kidney is significantly atrophic. The right kidney is mildly\natrophic. There are multiple nonobstructing stones seen bilaterally. The\nadrenal glands are within normal limits.\n\nThe visualized pancreas is slightly atrophic but otherwise within normal\nlimits.\n\nThe patient is status post multiple bowel surgeries. There is significant\nedematous wall thickening noted at the level of the duodenum and proximal\njejunum up to a large anastomotic pocket. At this point, there is transition\nin the degree of bowel wall thickening.\n\nThere is significant edematous wall thickening of the entire colon, involving\nthe rectum. There is mild thickening of the terminal ileum as well. Given\nthe diffuse nature of these findings, this may be a result of significant\ncongestion/third-spacing, however underlying extensive colitis/enteritis is\nnot excluded.\n\nThe patient is status post surgical debridement around the left hip. The open\nskin wound extends all the way down to the iliac crest, and there is gas seen\nwithin the iliacus muscle as well as extending through the sciatic\nforamen/piriformis muscle and into the left hemi sacrum. There is significant\nedema seen within the overlying left-sided gluteus muscles. There is ill\ndefinition of the cortex of the left iliac bone medially, and there is\ncomplete erosion of the cortex near the site of the open defect. These\nfindings are compatible with focal osteomyelitis at this level. Similarly,\nthere is breech of the left sacral cortex also compatible with focal\nosteomyelitis. These findings are in keeping with the patient's history of\nnecrotizing fasciitis.\n\nThere is a fracture involving the right superior and inferior pubic ramus. At\nthe level of the right superior pubic ramus, there appears to be a lytic\nlesion involving the bone, implying underlying pathologic fracture. This,\ncombined with the chest findings raises the possibility of metastatic process,\nand further evaluation is recommended after the acute episode resolves.\n\nDiffuse subcutaneous edema, likely due to third spacing.\n\nModerate amount of free fluid is noted in the abdomen.", "output": "1. Open left hip skin wound in direct contact with the left iliac bone, in\naddition to gas tracking along the left iliacus and piriformis muscles, and\ninvolving the left hemi sacrum. These findings are compatible with the known\nhistory of necrotizing fasciitis, and the bony irregularities at the level of\nthe left hemi sacrum and left iliac wings are suggestive of underlying\nosteomyelitis at this level.\n2. Pan colonic significant wall thickening, as well as wall thickening of the\nproximal small bowel. Given the diffuse distribution, this is likely due to\nthird spacing, however underlying infectious process is not excluded. For\nclinical correlation.\n3. Suspected pathologic fracture of the right superior pubic ramus. This \ncombined with the chest findings raises the possibility of metastatic process." }, { "input": "LOWER CHEST: There is continued worsening of bibasilar ground-glass and\nnodular opacities since the recent chest CTA performed on ___. No\npleural or pericardial effusion. Heart is mildly enlarged. Multifocal\ncoronary calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Similar appearance of the gallbladder, with layering\nstones/sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A Dobhoff tube terminates in the proximal body of the\nstomach. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. Other than extensive diverticulosis, the colon and rectum are\notherwise unremarkable. Normal appendix.\n\nPELVIS: Bladder is unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There has been prior endovascular repair of an infrarenal abdominal\naortic aneurysm within aorto bi-iliac stent graft. Patency of this graft is\nnot assessed on the noncontrast study. The aneurysm sac measures up to 5.1 x\n4.6 cm (03:55).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L5 on S1 due to bilateral pars defects.\n\nSOFT TISSUES: Heterogeneous attenuation and slight stranding in the region of\nthe left inguinal canal is unchanged from prior CT.", "output": "1. No findings to explain patient's symptoms on this noncontrast CT. No bowel\nobstruction.\n2. Continued worsening of bibasilar nodular and ground-glass opacities since ___, for which the differential includes acute exacerbation of\nunderlying interstitial lung disease or superimposed infection. Additionally,\npulmonary hemorrhage could have a similar imaging appearance, and may be\nconsidered if there is a recent history of hemoptysis.\n3. Excluded infrarenal abdominal aortic aneurysm sac measures up to 5.1 x 4.6\ncm." }, { "input": "CT OF THE ABDOMEN: LUNG BASES DEMONSTRATE NO ABNORMALITIES. THE LIVER ALSO\nAPPEARS UNREMARKABLE. SINGLE FOCUS OF UNCOMPLICATED CHOLELITHIASIS IS SEEN.\nTHE ADRENAL GLANDS, KIDNEYS, SPLEEN AND PANCREAS ALL APPEAR NORMAL AS DO THE\nVISUALIZED LOOPS OF LARGE AND SMALL BOWEL. THERE IS NO FREE FLUID, NO\nADENOPATHY. THE AORTA AND ITS BRANCHES APPEAR UNREMARKABLE AS WELL WITH\nMINIMAL ATHEROSCLEROTIC DISEASE. SIMPLE RENAL CYST INVOLVING THE INFERIOR POLE\nOF THE LEFT KIDNEY IS UNCHANGED\n\nCT OF THE PELVIS: NO FREE FLUID, NO ADENOPATHY, VISUALIZED LOOPS OF LARGE\nSMALL BOWEL APPEAR NORMAL. NO MASS EFFECT ON THE IVC, NO EVIDENCE OF ___\n___ SYNDROME OR OTHER MASS EFFECT ON THE LEFT ILIAC VEINS. AGAIN\nAPPRECIATED DIVERTICULI INVOLVING MUCH OF THE LARGE BOWEL INCLUDING THE CECUM.\nNO SEQUELA SEEN OF THE PREVIOUSLY DIAGNOSED CECAL DIVERTICULITIS. PROSTATIC\nSIZE IS WITHIN NORMAL LIMITS, BLADDER APPEARS UNREMARKABLE. BONE WINDOWS\nDEMONSTRATE DEGENERATIVE CHANGES ONLY.", "output": "1. NO ACUTE ABNORMALITY IDENTIFIED, NO FINDINGS TO EXPLAIN THE PATIENT'S LEFT\nLOWER EXTREMITY EDEMA.\n2. SIMPLE AND UNCHANGED CHRONIC FINDINGS INCLUDING LEFT RENAL CYST, MINIMAL\nATHEROSCLEROTIC DISEASE, DIVERTICULAR DISEASE, DEGENERATIVE CHANGES OF THE\nBONY STRUCTURES.\n3. RESOLUTION WITHOUT SEQUELA OF THE PREVIOUSLY DIAGNOSED CECAL\nDIVERTICULITIS." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Incidental note is made of\nbilateral breast implants.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen. An IUD is noted, which appears to extend into the\nmyometrium.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes noted at L4-5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Malpositioned IUD is superiorly displaced by a large fibroid and may extend\ninto the myometrium." }, { "input": "LOWER CHEST: Partially visualized extensive pneumomediastinum and\nsubcutaneous chest wall emphysema appear to have mildly improved. Focal\nopacities within both lower lobes likely reflect atelectasis. There has been\ninterval placement of a left thoracostomy tube. Partially imaged bilateral\npneumothoraces appear to have improved since prior study, though their extent\ncannot be fully evaluated. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Small amount of gas along the periportal regions with trace\npneumobilia left (7b:27) has significantly improved. There is been interval\nplacement of a right PTBD, which terminates in the duodenum. Blush of\ncontrast in the right hepatic lobe (7b:33) is likely related to drain\nplacement. This is of higher attenuation than the blood pool. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: Mild peripancreatic stranding and edema about the pancreatic head\nis minimally improved. There is no evidence of pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube is seen terminating in the stomach. \nPreviously visualized extensive intraperitoneal and retroperitoneal free air\nhas significantly improved. Retained oral contrast is seen within the\nproximal small bowel. Visualized portions of the stomach and small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nVisualized colon and rectum are within normal limits. The appendix is normal. \nNo bowel obstruction. No pneumatosis. A moderate amount of fluid surrounding\nthe kidneys and liver tracking into the pelvis is new compared to the prior\nexamination.\n\nPELVIS: Previously visualized extensive retroperitoneal and extraperitoneal\nfree air extending into the bilateral inguinal canals is improving. The\nurinary bladder and distal ureters are unremarkable. Mild-to-moderate complex\npelvic free fluid has increased.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Mild-to-moderate degenerative changes of the thoracolumbar spine with\ndisc height loss, bulge, vacuum disc phenomena and endplate sclerosis, most\nnotable at L5-S1. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval placement of a right PTBD with a small blush of contrast in the\nright hepatic lobe, likely related to drain placement. Correlation with\nhematocrit is recommended.\n2. Interval decrease in intraperitoneal and retroperitoneal free air, with\npersistent small amount of gas tracks along the periportal region. No\nextravasation of oral contrast within the stomach, duodenum or proximal small\nbowel.\n3. Interval placement of a left thoracostomy tube with improved bilateral\npneumothoraces. Persistent mild bibasilar atelectasis.\n4. Interval decrease in size extensive pneumomediastinum and subcutaneous\nemphysema within the chest tracking into the abdomen and pelvis.\n5. Unchanged mild peripancreatic stranding and edema about the pancreatic\nhead, consistent with mild pancreatitis.\n6. Increased fluid about the right abdomen tracking into the pelvis which may\nbe from suspected biliary or duodenal leak.\n This preliminary report was reviewed with Dr. ___\nradiologist.\n\nNOTIFICATION: Change in the interpretation discussed with Dr. ___ on\n___ in the AM, in person." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are and a multiple enhancing lesions throughout the liver\nconsistent with metastases, including a 2.0 x 1.2 cm lesion in segment 8\n(11:72), a 1.1 x 1.0 cm lesion in segment 5 (11:104) and a 1.4 x 1.4 cm\nlesion in segment 8 (11:77). There is also a 2.5 x 2.2 cm nonenhancing lesion\nin the periphery of segment 6 suggestive of a cyst. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic. There is a 1.2 x 1.8 cm lesion in\nthe superior pole of the left kidney (11:100) with equivocal enhancement. \nAdditionally, there is a 2.1 x 2.0 cm mildly hyperdense lesion in the\ninterpolar region of the right kidney (07:54) with no significant enhancement \nafter contrast administration, likely representing a mildly complicated cyst. \nThere are also bilateral subcentimeter nonenhancing hypodense lesions\nsuggestive of cysts. There is a transplanted kidney within the left lower\nquadrant, which is normal in size, with multiple subcentimeter hypodense\nlesions that are too small to characterize. A transplanted kidney in the\nright lower quadrant is atrophic with nonenhancing lesions suggestive of\ncysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a large diverticulum\narising from the third portion of the duodenum. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is colonic\ndiverticulosis involving the sigmoid and descending colon.\n\nA peritoneal catheter dialysis has its tip terminating in the pelvis. There\nis small amount of free fluid, including in the perihepatic region which is\nlikely related to the the peritoneal dialysis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Sclerosis noted in the left sacral ala is likely related to chronic\ninsufficiency fracture. There is also a nonunited comminuted fracture \ninvolving the superior and inferior left pubic rami with callus formation\nnoted in some areas. There is also an old fracture with callus formation in\nthe left ischium. There is diffuse osteopenia.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple hepatic metastases in keeping with biopsy-proven metastatic\nneuroendocrine tumor. No additional site of disease is seen. Of note, the\nprimary tumor was not identified.\n2. Indeterminate lesion in the left native kidney that demonstrates equivocal\nenhancement. This should be reassessed on follow-up studies.\n3. Mildly complicated cyst in the right native kidney.\n4. Small ascites is likely related to peritoneal dialysis.\n\n5. Multiple old insufficiency fractures, including a comminuted nonunited\nfracture involving the left superior and inferior pubic rami.\n\nRECOMMENDATION(S): The impression and recommendation above was entered by Dr.\n___ on ___ at 17:25 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Suture seen along the greater curvature of the stomach. \nOtherwise, the stomach is unremarkable. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged compatible with recent postpartum\nstate. No free fluid in the pelvis.\n\nRETROPERITONEUM AND MESENTERY: There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy. There is no\nabdominal aortic aneurysm. No atherosclerotic disease is noted. The\nmesenteric vessels appear patent.\n\nBONES: Mild degenerative changes in the thoracolumbar spine. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple subcutaneous air locules and tissue stranding at the\nsurgical bed along the low anterior abdominal wall. Small fat containing\nhernia.", "output": "1. Multiple air locules associated tissue stranding at the surgical bed of in\nthe low abdominal wall likely from recent surgery. No drainable collection.\n2. No evidence of acute traumatic injuries in the abdomen or pelvis. No\nfracture." }, { "input": "LOWER CHEST: The lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: There is mild periportal edema with prominence of the inferior\nvena cava consistent with aggressive fluid resuscitation. Liver is otherwise\nunremarkable. Gallbladder is unremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis.\n\nGASTROINTESTINAL: There is no bowel obstruction.\n\nPELVIS: There is a small 2.2 cm pocket of loculated fluid anterior to the\nuterus, unchanged since ___. There is no free fluid in the pelvis. \nPostpartum uterus is noted with trace fluid within the low anterior cesarean\nsection scar, unchanged.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Re-demonstrated along the patient's ___ incision site\nis pockets of gas and loculated fluid with adjacent fat stranding, similar to\nprior. No new drainable collection is identified.", "output": "1. Pockets of gas and loculated fluid with adjacent fat stranding along\npatient's ___ incision, possibly a developing abscess, however\nwithout drainable fluid collection.\n2. Unchanged 2.2 cm pocket fluid anterior to the uterus, also unchanged.\n3. Mild diffuse soft tissue stranding in the anterior pelvic wall likely due\nto panniculitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 3:43 pm, 1 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Bibasilar opacities may reflect a combination of aspiration and\natelectasis. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral subcentimeter hypodensities are too small to characterize, but\nprobably reflect simple cysts. There is no evidence of suspicious renal\nlesions. Mild bilateral hydroureteronephrosis is demonstrated without an\nobstructing stone, and may be related to the markedly distended bladder. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: A percutaneous gastrostomy tube is in place. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. The appendix is normal. The\nventriculoperitoneal catheter terminates in the right abdomen adjacent to the\nascending colon. Trace nonhemorrhagic free fluid in the right lower quadrant\nis nonspecific.\n\nPELVIS: Assessment of the pelvis is limited due to streak artifact from\nbilateral total hip arthroplasties. The urinary bladder is markedly\ndistended, and there is a small diverticulum in the right superior posterior\nbladder (2:69). There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Limited assessment demonstrates an enlarged prostate\ngland.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nCompression deformity of the T12 vertebral body appears chronic. The patient\nis status post bilateral total hip arthroplasty without evidence of hardware\nrelated complication.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Bibasilar opacities are likely related to a combination of atelectasis and\naspiration.\n2. Bilateral mild hydroureteronephrosis without an obstructing stone and a\nmarkedly distended bladder may be related to outlet obstruction.\n3. Percutaneous gastrostomy tube in place. VP shunt catheter terminates in\nthe right side of the abdomen adjacent to the ascending colon." }, { "input": "LOWER CHEST: There is mild bronchiectasis ___ opacities at the right\nlung base, unchanged from ___. Ground-glass at the left lung base\nlikely represents atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities likely represent cysts. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: No evidence of complication with the patient's PEG tube. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is not visualized. A shunt\nterminates in the mid abdomen near the anterior abdominal.\n\nPELVIS: The evaluation of the urinary bladder is limited by beam hardening\nartifact from the patient's hip prostheses. The bladder wall thickening may\nbe secondary to under distention.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is a chronic mild compression deformity of the anterior T12\nvertebral body. There is extensive facet hypertrophy at L3-4 on the left.\n\nThe patient status post bilateral total hip arthroplasty.\n\nSOFT TISSUES: Surgical mesh is noted along the left lower quadrant anterior\nabdominal wall. There is a fat containing umbilical hernia. \nVentriculoperitoneal shunt catheter is noted. In the mid abdomen.", "output": "1. Bladder wall thickening may be secondary to bladder underdistention and/or\nchronic outlet obstruction, but correlation with urinalysis is recommended.\n2. No evidence of complication with the PEG tube.\n3. Mild bronchiectasis and subtle ___ opacity at the right lung base\nmay be infectious or inflammatory, unchanged from ___." }, { "input": "LOWER CHEST: Bilateral trace pleural effusions are nonhemorrhagic. Adjacent\nrelaxation atelectasis is minimal. Parenchymal opacity the lingula is likely\natelectasis. The heart is markedly enlarged. No evidence of a pericardial\neffusion. Calcified and noncalcified atherosclerotic disease in the partially\nimaged lower thoracic aorta is moderate. A paraesophageal hiatal hernia is\nsmall (series 2, image 21). No evidence of fracture in the partially imaged\nlower chest cage.\n\nABDOMEN:\n\nHEPATOBILIARY: Tiny liver are too small to accurately characterize CT, likely\ncysts or biliary hamartomas (series 6, image 66, 73). No intrahepatic or\nextrahepatic biliary ductal dilation. The gallbladder is unremarkable. No\nascites.\n\nPANCREAS: A 5 mm hypodensity in the pancreatic tail (series 2, image 40) and 7\nmm hypodensities in the pancreatic body are likely side-branch IPMNs (series\n2, image 47). No main pancreatic ductal dilation. No peripancreatic fat\nstranding or fluid collection. No pancreatic calcifications.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are numerous bilateral renal cortical and peripelvic cysts. \nPelvicaliectasis of right kidney is mild. The right ureter is normal caliber.\nThere is moderate to severe left hydronephrosis, likely from chronic UPJ\nobstruction. Left ureter is not dilated. No perinephric abnormality.\n\nGASTROINTESTINAL: A hiatal hernia is small. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. No bowel obstruction, free air, or\nintra-abdominal fluid collection. No evidence of mesenteric injury.\n\nNo retroperitoneal hematoma.\n\nPELVIS: The urinary bladder is moderately distended and unremarkable. The\ndistal ureters are unremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal masses.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Extensive calcified and noncalcified\natherosclerotic disease is noted. Calcified and noncalcified atherosclerosis\nat the origin of the celiac trunk and SMA is at least moderate to severe. The\nceliac axis demonstrates moderate to severe narrowing at the origin. The SMA\nis only mildly narrowed at the origin. The splenic vein is attenuated but\npatent (series 6, image 45). The main portal vein and SMV are patent. \nAtherosclerotic calcifications at the bilateral renal ostium is at least\nmild-to-moderate with only mild bilateral narrowing. Accessory left renal\nartery is also noted. There is an incidental retroaortic left renal vein\n(series 5, image 59). The origin of the ___ is attenuated but patent (series\n6, image 57).\n\nBONES: No evidence of acute fracture in the abdomen or pelvis. Multi-level\ndegenerative changes of lumbosacral spine are extensive. Degenerative changes\nin both hips are moderate.\n\nSOFT TISSUES: No soft tissue hematoma in the abdomen or pelvis.\n\n\nPROXIMAL LOWER EXTREMITIES:\n\nThere bilateral knee replacements. Streak artifact from the bilateral knee\nreplacements limits detailed evaluation of adjacent structures. Within\nlimitation:\n\nThere is a comminuted, angulated, and displaced closed fracture of the left\ndiaphysis extending into the metaphysis just proximal to the joint\nreplacement. No definite evidence of fracture of the hardware. There is a is\nmoderate to small left lipohemarthrosis with a layering hematocrit (series 2,\nimage 277; series 303, image 29). No soft tissue gas.\n\nEvaluation is limited by streak artifact but cortical irregularity of the left\npatella suggests a mildly displaced fracture versus streak artifact ___,\nimage 40). There is a left knee joint dislocation with internal rotation of\nthe distal left femur fracture fragment and left patella medially.\n\nNo evidence of active extravasation or pseudoaneurysm. Asymmetric enlargement\nof left proximal thigh extensor and flexor muscles is consistent with\nintramuscular edema and hematoma.\n\nThere is a 3 x 1.9 x 3.9 cm hematoma along the lateral left proximal femur\n(series 2, image 255; series 303, image 32). Additional discrete hematoma\nmeasures 3.9 x 1.9 x 3 cm.\n\nCalcified and noncalcified atherosclerosis of the bilateral femoral arteries\nare mild-to-moderate. Atherosclerotic calcified and noncalcified plaque in the\nbilateral popliteal arteries are moderate. These vessels are patent without\nvisualized vascular injury.\n\nThe right knee replacement appears intact.", "output": "1. Comminuted, displaced and angulated closed fracture of the left distal\nfemoral diaphysis and metaphysis extending to the knee prosthesis. No\ndefinite evidence of hardware fracture.\n2. Possible mildly displaced left patellar fracture, versus artifact.\n3. Moderate intramuscular hematoma and edema in the left thigh and 2 small\nsoft tissue hematomas in the distal left thigh measuring 3.2 x 3.2 cm and 3.9\nx 1.9 x 3 cm, respectively. No evidence of pseudoaneurysm or active\nextravasation.\n4. No evidence of traumatic injury in the partially imaged lower chest or\nabdomen and pelvis.\n5. Extensive diffuse atherosclerosis with probably moderate narrowing at the\norigins of the celiac trunk, SMA, and ___ as above.\n6. Moderate to severe left hydronephrosis, suggesting chronic UPJ obstruction.\nMild right pelvicaliectasis.\n7. Several pancreatic hypodensities measuring up to 7 mm, likely side-branch\nIPMNs." }, { "input": "LOWER CHEST: Mild centrilobular emphysema and basilar atelectasis. No pleural\nor pericardial effusion.\n\nABDOMEN: There are a few small stable hypodense hepatic lesions too small to\ncharacterize (series 6, image 26; series 8, image 44). The liver, pancreas,\nspleen, adrenal glands, and kidneys are otherwise unremarkable.\n\nGASTROINTESTINAL: Patient is status-post right hemicolectomy. No evidence of\nbowel obstruction, ascites, free air or inflammation in the peritoneal cavity.\n\nREPRODUCTIVE ORGANS: Status-post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions . There is a left\nhip arthroplasty.\n\nSOFT TISSUES: Rectus diastasis again noted.", "output": "No etiology identified for the patient's reported symptoms." }, { "input": "LOWER CHEST: Mild bibasilar atelectatic change, in addition to small bilateral\nincidental Bochdalek hernias. Lung bases are otherwise unremarkable.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.\n\nThere is wall thickening at the level of the gallbladder fundus, almost\ncertainly related to underlying adenomyomatosis. It was not definitely seen\non prior examinations, likely because of slice acquisition technique. If\nneeded, ultrasound follow-up can be arranged accordingly.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Patient is status post right hemicolectomy. A few\nuncomplicated diverticula are noted at the level of the sigmoid colon.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: Postoperative change noted at the level of the urinary bladder, with\nno suspicious urinary bladder lesion identified. There is no evidence of\npelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. The\nabdominal and pelvic wall is within normal limits.", "output": "1. No evidence of recurrent urothelial tumor or metastatic disease.\n2. Suspected gallbladder adenomyomatosis." }, { "input": "The study is mildly limited by motion. Within this limitation:\nLOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is apparent trace pericholecystic\nfluid and a gallstone (2; 19) but no gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a 0.8 cm bone island within the right femoral head (2; 81).\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Apparent trace pericholecystic fluid without gallbladder wall thickening. \nCholelithiasis.\n2. No evidence of pancreatitis. No evidence of intraperitoneal free air or\nfree fluid.\n3. Patient developed hives in reaction to IV contrast." }, { "input": "LOWER CHEST: Visualized lungs demonstrate minimal left basilar atelectasis.\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged tiny hypodense lesion at the dome of the liver,\npossibly cyst versus pseudo lipoma. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Small splenule is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nShunt tubing is noted course along the anterior abdominal wall with tip\nterminating at the inferior aspect of the liver.\n\nPELVIS: Small loculated fluid collection at the anterior aspect of the\nbladder (05:79), is decreased in size compared to prior may represent a small\nbladder diverticulum. The urinary bladder and distal ureters are\nunremarkable. There is trace free fluid in the pelvis, likely physiologic or\nfrom VP shunt.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Very small midline fat containing hernia is noted.", "output": "1. No evidence of gluteal abscess.\n2. No other acute findings seen in the abdomen or pelvis." }, { "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a heterogeneous, reticular enhancement pattern\npredominantly within the inferior right hepatic lobe. No evidence of focal\nlesions. The portal veins are patent. No evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of concerning renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops are unremarkable. No bowel obstruction. \nThe colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. Trace probably physiologic free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted. The uterus and adnexae are\nunremarkable for patient age.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease.\n\nBONES/SOFT TISSUES: There is no aggressive osseous lesion or acute fracture.", "output": "1. Heterogeneous, reticular enhancement pattern predominantly within the\ninferior right hepatic lobe. Recommend correlation with liver function tests.\nAnecdotally, this is a finding that has been seen with oral contraceptive use.\nAlternative differential considerations include congestive hepatopathy and\n___ disease. If further imaging assessment is warranted, recommend\nliver MRI.\n2. No acute abnormality otherwise identified to account for the patient's\nsymptoms.\n\nRECOMMENDATION(S): Recommend correlation with liver function tests and if\nfurther imaging assessment is warranted, consider liver MRI." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. Otherwise, the visualized lung\nfields are within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is small in size and demonstrates diffuse nodularity,\nconsistent with cirrhosis, similar in appearance to the most recent study. \nOtherwise, the liver demonstrates homogenous attenuation throughout. There is\nno evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains gallstones without\nwall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring up to 14 cm, and shows normal\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Cortical simple cysts are seen in the right kidney, the largest\nlocated in the upper pole and measuring up to 1.5 cm. Otherwise, the kidneys\nare of normal and symmetric size with normal nephrogram. There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal in appearance though\nthe tip is not clearly delineated as the distal appendix abuts the right\nadnexal tubular structure characterized as hydrosalpinx on previous\nultrasound.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fluid-filled tubular structure in the right adnexa,\ncharacterized as right hydrosalpinx on previous ultrasound is again noted,\nappears stable. The left ovary is not seen. The uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. Gastric and periaortic varices are again noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of acute process in the abdomen or pelvis.\n2. Cirrhosis with portal hypertension." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no evidence of pleural\nor pericardial effusion. There is extensive coronary calcification and\nmoderate aortic valve calcification.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status-post prostatectomy.\n\nLYMPH NODES: Multiple bilateral inguinal lymph nodes measure on the upper\nlimit of normal in size, but are atypical in morphology, demonstrating a\nslightly lobulated contour or (series 4, image 92, series 8, image 32, 59). \nThere is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or aortic dissection. \nExtensive atherosclerotic disease is noted. Incidental note is made of\nduplicated right renal arteries.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are extensive degenerative changes of the lumbar spine with lumbar\nscoliosis and grade 1 retrolisthesis of L2 on L3 and fusion of L2 and L3\nanteriorly.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple bilateral inguinal lymph nodes measure on the upper limit of\nnormal in size, but are atypical in morphology. Recommend either short-term\nfollowup or percutaneous sampling with ultrasound guidance.\n2. Extensive atherosclerotic disease.\n3. Severe degenerative changes of the lumbar spine.\n\nRECOMMENDATION(S): Short-term followup of inguinal lymph nodes, versus\npercutaneous sampling via ultrasound guidance.\n\nNOTIFICATION: The findings were entered into the InfoRadiology dashboard for\ncommunication to the ordering physician by Dr. ___ on ___\nat 3:54 ___, approximately 30 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral extrarenal pelvises there is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The bladder is distended. There is mild dilation of the proximal and\ndistal ureters. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is post prostatectomy. The penile urethra is\ndilated and fluid-filled, new from prior. There is apparent catheter located\nadjacent to the right penile tip.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is a sclerotic lesion in the T12 and T11 vertebral body. There\nis sclerosis of the right posterior elements of L2 and L4 lamina, unchanged\nfrom prior, but new since ___. The patient has undergone\nlaminectomy at L2-3.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple sclerotic lesions concerning for osseous metastatic disease. No\nadditional metastatic disease in the abdomen or pelvis.\n2. Dilated fluid-filled penile urethra, bladder distension, and mildly dilated\nureters. Apparent catheter located adjacent to the right penile tip, question\nif this is the source of urinary obstruction.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:40 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout,\nsuggestive of hepatic steatosis. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas is mildly atrophic, with normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter hypodensity in the lower pole of the right kidney is too small\nto characterize by CT. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "1. Hepatic steatosis.\n2. No acute intra-abdominal process." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (series 2, image 48).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is large amount of hemoperitoneum with more\norganized hematoma seen centered in the right-sided pelvis. The ovaries are\nnot visualized, likely obscured by the large amount of hematoma. Given the\nsame day pelvic ultrasound findings of normal left ovary, findings likely\nrepresent ruptured right hemorrhagic cyst with large amount of hemoperitoneum.\nContrast blushing within the right side of the hematoma in the pelvis is\nconcerning for active bleeding (series 2, image 57), although difficult to\nassess vascular origin of the bleed. Uterus is difficult to assess due to\nsurrounding hematoma. An IUD is noted, better evaluated on same day\nultrasound.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta and IVC are normal in course and caliber.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Large volume hemoperitoneum with more organized hematoma centered in the\nright-sided pelvis. Ovaries are not visualized, likely obscured by the\nhematoma. Given normal left ovary and nonvisualization of right ovary on same\nday ultrasound, findings likely represent a ruptured right hemorrhagic cyst.\n2. Contrast blush in within the hematoma in the pelvis is concerning for\nactive bleeding, difficult to assess vascular origin, but possibly a gonadal\nvessel.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:14 am, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A rounded soft tissue focus in the splenic hilum\n(2: 19) likely represents an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is enlargement of the left kidney with associated perinephric\nstranding and moderate left-sided hydroureteronephrosis secondary to a 4 mm\nstone in the midportion the left ureter (02:44). There is a 1.5 cm simple\ncyst in the lower pole of the right kidney (02:40).\n\nGASTROINTESTINAL: There is a large hiatal hernia. The stomach is otherwise\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There is a left-sided\nadnexal low-density rounded focus measuring 3.8 cm (2:71) which likely\nrepresents adnexal cyst.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Obstructive left-sided pyelonephritis and moderate left-sided\nhydronephrosis secondary to a 4 mm stone in the mid left ureter.\n2. 3.8 cm left-sided adnexal simple cyst. Given this patient is\npostmenopausal, pelvic ultrasound in ___ year is recommended." }, { "input": "CHEST: The lung bases are clear no pleural effusions, nodules, or masses. The\nvisualized portion of the heart and pericardium are no normal. There is no\npericardial effusion.\n\nABDOMEN: The liver is normal in size and homogeneous in enhancement no focal\nlesions. The portal and hepatic veins are patent and there is no intra or\nextrahepatic biliary ductal dilatation. The gallbladder is absent. The common\nbile duct is not dilated.\n\nThe spleen enhances homogeneously without focal lesions.\n\nThe previously visualized bilobed pseudocyst the region of the pancreatic head\nhas decreased in size, with the superior component measuring 1.3 x 1.4 cm,\npreviously 3.6 x 3.2 cm, and the inferior component measuring 1.7 x 1.2 cm,\npreviously 2.7 x 2.3 cm. The drainage catheter in the region of the pancreatic\ntail is present, and the previously noted pseudocyst in this region is no\nlonger present. Remainder of the pancreas enhances homogeneously without focal\nlesions. There is no pancreatic ductal dilatation or peripancreatic fat\nstranding.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and display symmetric nephrograms and contrast\nexcretion. In the interpolar region of the left kidney there is a 2.6 x 2.6 cm\nhypodensity, which likely represents a cyst, and is stable. There are no\nconcerning mass lesions seen within the kidneys. There are no perinephric\nabnormalities present. The ureters are normal in caliber along their\nvisualized course the bladder.\n\nThe distal esophagus is normal appearing with no hiatal hernia. The stomach is\nunder distended, but grossly normal. The visualized portion of the small bowel\nis partially opacified with contrast, and does not show abnormal dilatation or\nfocal wall thickening. The visualized portion of the large bowel contains\nfeces, and does not show obstructive mass lesions, or wall thickening. There\nis no intraperitoneal free air or free fluid.\n\nThere are no pathologically enlarged retroperitoneal or mesenteric lymph nodes\nby CT size criteria.\n\nThere is no aneurysmal dilatation of the abdominal aorta. The aorta and its\nmajor branches are patent.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: There are no concerning lytic or\nsclerotic lesions seen.", "output": "1. Interval decrease in size of the bilobed pseudocyst in the region of the\npancreatic head. Resolution of pseudocyst in the pancreatic tail, with\ndrainage catheter seen in that region. The remainder of the pancreas enhances\nhomogeneously without focal lesions.\n\n2. Stable left-sided kidney cyst." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical changes related to prior gastric bypass are\nnoted. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status hysterectomy and bilateral salpingo\noophorectomy. There is no evidence of postoperative seroma.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A tiny umbilical hernia containing fat is noted.", "output": "1. No evidence of recurrent or metastatic disease in the abdomen or pelvis.\n2. Status post hysterectomy and bilateral salpingo-oophorectomy. No evidence\nof postoperative seroma." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild grade 1 retrolisthesis of L4 on L5 vertebral level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute CT intra-abdominal or intrapelvic findings to account for patient\nsymptoms.\n2. Patient experienced a contrast related event during this exam. For details\nplease see note in the electronic medical record/OMR. The patient has received\ninstruction on how to manage this event at home." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nIncidental transient hepatic attenuation difference adjacent to the groove of\nthe falciform ligament. There is no evidence of focal lesions. The portal\nveins are patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits, noting an\nanatomic variant Phrygian cap.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa are better assessed on pelvic MRI\nobtained 3 days prior. No evidence of acute uterine or adnexal pathology.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Moderate, fat containing, midline pelvic wall ventral hernia.", "output": "No evidence of acute abdominopelvic pathology." }, { "input": "LOWER CHEST: Mild left pleural effusion. Visualized lung fields are within\nnormal limits. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic with relative, appropriate compensatory\ndilatation of the pancreatic duct. No focal lesion is identified. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a hypodensity in the interpolar region of the left kidney,\nmeasuring 2.4 x 2.4 x 2.1 cm, consistent with a simple renal cyst. In\naddition, there is a small, subcentimeter hypodensity in the upper pole of the\nright kidney, too small to further characterize, likely a simple renal cyst. \nOtherwise, the kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of concerning renal lesion or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Limited\nassessment of the sigmoid colon due to streak artifact from bilateral hip\narthroplasties. Significant sigmoid diverticulosis. Otherwise, the colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Limited assessment of the urinary bladder due to streak artifact from\nbilateral total hip arthroplasties. Within this limitation, the urinary\nbladder and distal ureters are unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Bilateral total hip arthroplasties with significant streak artifact. \nMultilevel degenerative change of the visualized thoracolumbar spine. Mild\nlevoscoliosis centered at the lower thoracolumbar spine. Grade 1\nretrolisthesis of L1 on L2. Grade 1 anterolisthesis of L5 on S1. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No liver abscess identified.\n2. Atrophic pancreas with appropriate compensatory ductal dilatation.\n3. Sigmoid diverticulosis." }, { "input": "LOWER CHEST:\n\nThe visualized lung bases are clear. There is no pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation, without focal lesion\nor intrahepatic biliary duct dilation. The portal vein is patent. The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\nPANCREAS: The pancreas is normal in attenuation, without focal lesion or\nperipancreatic stranding or fluid collection. There is no ductal dilation.\nSPLEEN: The spleen is homogeneous and normal in size.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are symmetric and normal in size, without mass or\nhydronephrosis..\nGASTROINTESTINAL: The small bowel is normal in caliber, without evidence of\nobstruction or wall thickening. There is extensive diverticulosis of the\ncolon, with focal inflammatory changes surrounding an inflamed diverticulum\narising from the proximal sigmoid colon. There is associated wall thickening\nof the adjacent colon. No drainable fluid collection. A normal, air-filled\nappendix is visualized.\nRETROPERITONEUM: Mesenteric lymph nodes are prominent, likely reactive, but\nnot pathologically enlarged by CT size criteria. There is no retroperitoneal\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES: There is no lytic or sclerotic lesion concerning for\nneoplasm or infection. The abdominal and pelvic walls are unremarkable.", "output": "Acute diverticulitis of the proximal sigmoid colon, without drainable fluid\ncollection or evidence of macro perforation. Given associated bowel wall\nthickening, a colonoscopy may be performed following resolution of the acute\nsymptoms to exclude underlying mass lesion." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The bladder wall demonstrates mild diffuse thickening, possibly\nsecondary to chronic outlet obstruction. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is not significantly changed in\nappearance, mildly enlarged, and with a small calcification centrally.\n\nLYMPH NODES: No change in shotty retroperitoneal lymph nodes, including left\nperiaortic 15 x 7 mm (04:69), and right aortocaval measuring 14 x 9 mm\n(04:73). There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild to moderate\natherosclerotic disease is noted, of note there is moderate plaque and\nstenosis in the right common femoral and SFA.\n\nBONES: Numerous osseous lesions throughout the axial skeleton, the majority of\nwhich demonstrate increased sclerosis and size. For reference L5 vertebral\nbody lesion measures 4.3 x 3.6 x 2.5 cm. No definite new lesions are\nidentified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Numerous osseous lesions throughout the axial skeleton, the majority of\nwhich demonstrate increased sclerosis and size, possibly secondary to\ntreatment effect. No definite new lesions are identified.\n2. No change in retroperitoneal lymph nodes which are not pathologically\nenlarged." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is circumferentially thickened, likely related to\nchronic outlet obstruction, unchanged. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unchanged in appearance and is mildly\nenlarged.\n\nLYMPH NODES: There is no size significant retroperitoneal or mesenteric\nlymphadenopathy. Stable 5 mm left para-aortic lymph node. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There has been significant progression in the extent of sclerotic\nmetastatic bone disease, involving the vertebral bodies, pelvis, proximal\nfemurs, ribs and sternum.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Significant progression in the extent of sclerotic metastatic bone disease.\n2. Otherwise, no other evidence of disease progression in the abdomen and\npelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Mild perinephric stranding is unchanged from ___. multiple\nrenal hypodensities are compatible with simple renal cysts. There is a left\ndouble-J ureteral stent which terminates in the urinary bladder. There is no\nhydronephrosis. Multiple nonobstructing renal stones on the left measure up\nto 9 mm. There is a single 3 mm renal stone (series 2, image 44) on the\nright.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Symmetric perinephric stranding, appears unchanged from ___.\nInterval placement of a left double-J stent which appears appropriately\npositioned. No hydronephrosis. Correlation with urinalysis for urinary\ninfection is recommended. Multiple nonobstructing bilateral renal stones\nmeasure up to 9 mm, as detailed above." }, { "input": "LOWER CHEST: Please refer to dedicated CT chest report on same day for\nintrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple irregular hypoattenuating lesions in the\nliver, many of which are larger as compared to CT abdomen and pelvis ___. A representative examples are as follows:\n- Segment VII lesion measuring 1.8 x 1.4 cm (series 5:58), previously\nmeasuring up to 1.0 cm across maximal diameter on ___.\n- Segment IV lesion measuring 1.9 x 2.0 cm (series 5:58), previously measuring\nup to 0.6 cm across maximal diameter.\n- Segment VIII measuring 1.4 cm across maximal diameter (series 5:55), new.\n- Segment II lesion measuring 1.7 cm across maximal diameter (series 5:53),\nnew.\n\nOther lesions appear unchanged from ___. For example a lesion in\nsegment IVb measuring 0.9 cm (series 5:63).\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are enlarged periuterine veins. The uterus is\notherwise unremarkable. There is no adnexal mass.\n\nLYMPH NODES: There is a prominent gastrohepatic lymph node measuring 0.7 cm\n(series 5:55), unchanged from prior. There is no other mesenteric,\nretroperitoneal, pelvic, or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Sclerotic lesions scattered throughout the thoracolumbar spine and\ninvolving the left sacroiliac joint, compatible with known osseous metastatic\ndisease, remain unchanged compared to ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval progression of metastatic disease in the liver compared to CT\nabdomen pelvis ___.\n2. Sclerotic lesions scattered throughout the thoracolumbar spine and\ninvolving the left sacroiliac joint, compatible with known osseous metastatic\ndisease, unchanged compared to ___. Please refer to same day bone\nscan for more details.\n3. Please refer to dedicated CT chest report on same day for intrathoracic\nfindings." }, { "input": "LUNG BASES: Please see dictation for separately reported CT Chest\nexamination.\n\nCT ABDOMEN:\nMore apparent on current examination is a hypodense region of liver parenchyma\nin segment V adjacent to the falciform ligament, appearing perfusional in\nnature or related to focal fat. The hemangioma within segment III is again\nseen, stable from ___. Otherwise, the liver enhances homogeneously\nwithout evidence of focal lesion. The portal vein is patent.\n\nThe gallbladder does not show stones or evidence of wall thickening.\n\nThere is no splenomegaly or focal splenic lesion.\n\nThe pancreas enhances homogenously. There is no peripancreatic stranding or\nductal dilatation.\n\nThe adrenal glands are within normal limits.\n\nThere are normal, symmetric nephrograms. There is no hydronephrosis. \nBilateral extrarenal pelvises are seen.\n\nOral contrast extends into the distal small bowel. Non-dilated loops of small\nbowel are normal in course and caliber. There is no wall-thickening or\nevidence of obstruction. There is colonic diverticulosis without evidence of\ndiverticulitis. Otherwise the colon is unremarkable. The appendix is normal.\n\nThere is no evidence of mesenteric or retroperitoneal lymphadenopathy by CT\nsize criteria.\n\nThe abdominal aorta is of normal caliber throughout, and major branches appear\npatent.\n\nThere is no intra-abdominal free air or fluid.\n\nCT PELVIS:\nThe imaged pelvic organs, including the bladder and terminal ureters, are\nnormal. Uterus is diminutive. There is no evidence of pelvic or inguinal\nlymphadenopathy by CT size criteria. Of note, the pelvic organs (bladder,\nuterus, anorectal junction) appear somewhat low-lying, possibly secondary to\npelvic floor laxity.\n\nBONE WINDOW:\nThere is an abnormal-appearing/absent right rectus abdominis muscle, possibly\nsecondary to breast reconstructive surgery, unchanged from prior.\n\nAgain seen is the sclerotic metastasis within the superior endplate of the T11\nvertebral body. This has increased in size in comparison to ___ study,\ncurrently measuring 1.4 cm in the sagittal plane (previously 1.1 cm in ___. There is no evidence of new suspicious osseous lesion. Inferior\nend-plate sclerosis of the L5 vertebral body is unchanged, probably\ndegenerative. There is minimal degenerative joint disease of the imaged\nthoracolumbar spine. Alignment is normal.", "output": "1. Increased size of known T11 sclerotic metastasis, from 1.1 to 1.4 cm in\nlargest sagittal dimension. No evidence of new bony metastasis.\n\n2. No evidence of metastasis elsewhere within the abdomen or pelvis.\n\n3. Unchanged segment III hepatic hemangioma.\n\n4. Colonic diverticulosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: A 2.8 x 2.1 cm hemangioma within the left lobe of the liver,\ncharacterized on MRI from ___, is not changed from multiple\nprior examinations. A 1 cm ill-defined hypodensity within segment VI is not\nsignificantly changed in size from ___. (05:57). Subcentimeter\nhypodensities seen at the liver dome are are less conspicuous on the current\nexamination and are too small to characterize on CT.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: A prominent gastric node which measures 6 mm is decreased in size\nfrom the prior examination when it measured 9 mm. (05:51) scattered\nretroperitoneal lymph nodes are demonstrated but overall decreased in size\nfrom the prior examination. For example a para aortic lymph node on the left\nmeasures 5 mm (previously 7 mm) (5:65). No new lymphadenopathy is identified.\nThere is no mesenteric, inguinal or pelvic lymphadenopathy by CT size\ncriteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Scattered sclerotic foci throughout the lower thoracic and lumbar\nvertebral bodies are stable from ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 1 cm ill-defined hypodensity within segment VI of the liver is not\nsignificantly changed from ___ and could represent a hemangioma. \nLarge left lobe hemangioma is unchanged.\n2. Numerous previously identified hypodensities in the liver are less\nconspicuous on the current examination. No new hepatic lesions.\n3. Retroperitoneal lymphadenopathy is minimally decreased from the prior\nexamination. No new lymphadenopathy.\n4. Thoracic and lumbar sclerotic metastases are unchanged. No new suspicious\nosseous lesions.\n5. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\n___ for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The largest hypodensity within the left lobe of the liver\ncurrently measures approximately 2.7 x 2.2 cm (series 5, image 56) and\ndemonstrates some peripheral puddling, probably a hemangioma. The smaller\nindeterminate hypodensity within the right lobe of the liver is also stable in\nsize, currently measuring 1.0 cm (series 5, image 53). The hypodensity\nadjacent to the falciform ligament (series 5, image 55) likely represents\nfocal fatty deposition or a perfusion abnormality. Otherwise, the liver\ndemonstrates homogenous attenuation throughout. There is no evidence of new\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral extrarenal pelvises. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple subcentimeter periaortic retroperitoneal lymph\nnodes measuring up to 8 mm (series 5, image 67), which are similar in\nappearance compared to ___. There is no new retroperitoneal or\nmesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is a common origin of the celiac and SMA.\n\nBONES: Scattered sclerotic foci throughout the lumbar vertebrae are stable in\nsize and distribution compared to ___, compatible with metastatic\ndisease. No evidence of new metastatic foci.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable 2.7 cm hypodensity within a left lobe of the liver, probably a\nhemangioma.\n2. Stable indeterminate 1.0 cm hypodensity within the right lobe of the liver.\n3. No new foci of metastatic disease.\n4. Stable scattered osseous metastatic disease within the lumbar spine." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 3.8 x 3.1 cm mixed density lesion in segment ___ (5:52). There is\na 2.4 x 1.9 cm ill-defined lesion in segment VIII (5:53). There is a\nsubcentimeter hypodense lesion in segment V (5:55). These three lesions are\nall new since ___.\n\nAgain seen is a hypodense lesion in segment III, now measuring 1.6 x 2.0 x 1.8\ncm (5:61), not significantly changed in appearance or size from prior study\nfrom ___, previously described as a hemangioma. A second\nheterogeneous lesion is again seen in segment VI, measuring 2.0 x 2.4 (5:59). \nAlso again seen is a 1.4 x 1.3 cm isodense lesion with a hypodense rim in\nsegment V (5:52), not significantly changed in size or appearance from prior\nstudy from ___, but appears to be new compared to study from ___.\n\nMultiple small subcentimeter hypodensities are still seen in the right liver,\ntoo small to fully characterize. Focal fat is again noted along the falciform\nligament in segment V (5:61).\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. No adnexal\nabnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multiple sclerotic osseous lesions are noted in the visualized thoracic\nspine, the lumbar spine and the right pelvis, compatible with known osseous\nmetastatic disease, not significantly changed from prior study from ___ or ___.\n\nSOFT TISSUES: Postsurgical changes are noted along the right anterior abdomen\nfrom prior breast reconstructive surgery.", "output": "1. Multiple hepatic lesions, as described above, some of which are new and/or\nenlarged compared to prior study from ___, concerning for\nprogression of metastatic disease. Recommend MRI for further evaluation and\ncharacterization.\n2. Similar-appearing spinal and right pelvic sclerotic osseous metastatic\ndisease compared to prior studies.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:39 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Mild bibasilar consolidations are likely reflective of\natelectasis. Left lower pneumonia is difficult to exclude. Some of this\nappears calcified, similar to ___. A 1.3 cm nodule in the right\nlower lobe is unchanged compared to ___ (2:2). No large pleural\neffusion. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nScattered hepatic hypodensities are not changed in size or configuration and\nare not well evaluated on current exam. These likely reflect simple hepatic\ncysts or biliary hamartomas (2:21, 22). There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A 1.0 x 0.8 cm\nhypoattenuating lesion in the left lower pole kidney is unchanged compared to\n___, likely a simple renal cyst (02:30). No hydronephrosis. No head\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal. Probable calcified lymph node in the right upper abdomen\nis unchanged compared to prior exam (02:32).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a small amount of air in the uterine fundal\nendometrial cavity. There are no other signs of fistualization. Bilateral\nadnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. An IVC filter is again demonstrated.\n\nBONES: Chronic compression deformity of the L1 vertebral body appears more\nsclerotic on current exam compared to ___ (602:39). There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Air seen in the fundal endometrial cavity of unclear etiology. No definite\nevidence of fistulization on this noncontrast enhanced exam. Recommend\ncorrelation with recent uterine instrumentation.\n2. Stable appearance of a 1.3 cm nodule in the right lower lobe compared to\n___.\n3. Mild bibasilar consolidations, left greater than right may be due to\natelectasis, but pneumonia is difficult to exclude in the left lower lobe.\n4. Extensive arterial calcifications." }, { "input": "LOWER CHEST: The lower lungs are partially imaged. No evidence of a pleural\neffusion or focal consolidation. No evidence of a pericardial effusion. \nAortic valve calcifications may be present.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits. There is a\nsmall amount of perihepatic fluid near the tip of the right lobe.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding or\nfluid collections.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cortical hypodensities are too small to accurately\ncharacterize on CT but statistically most likely cysts. No concerning focal\nrenal lesions, hydronephrosis, or or perinephric fluid collection.\n\nGASTROINTESTINAL: There is residual oral contrast in the esophagus. The\nstomach is unremarkable. The patient has had prior right ileocolectomy to\nresect a colon cancer. Anastomosis is seen in the right mid abdomen.\n\n\nNo frankly dilated loops of small bowel. There is nonspecific fluid and lies\nmaterial within small bowel. No bowel wall thickening or abnormal\nenhancement.\n\nThere is a short segment loop of small bowel that is contained within a right\nlower abdominal wall ventral hernia (series 2, image 54). There is collapse of\nthe distal limb of this loop of small bowel at the neck of the hernia. \n(Series 2, image 52). The proximal small bowel limb is not abnormally dilated\nbut there is some fecalized material which could suggest slow small bowel\ntransit as well as nonspecific fluid in nondilated loops of proximal small\nbowel. Given the provided clinical history an these findings, however, early\nor partial small-bowel obstruction is not completely excluded (series lumbar\n2, image 55, 60). Small amount of nonspecific free fluid in the right lower\nabdomen of low-attenuation could be related to this process. Alternatively,\nfluid-filled nondilated loops of small bowel could be seen with enteritis.\n\nThe small bowel within the hernia is not dilated and the wall is normal in\nthickness and enhances normally. No fat stranding or free fluid within the\nhernia sac. No free air, fluid collections, or pneumatosis.\n\nThere is diverticulosis of the remaining colon that is relatively decompressed\nwithout specific evidence of diverticulitis.\n\nThere is a 3.4 x 3-cm diverticulum with fecalized material arising from the\njejunum (series 2, image 34).\n\nPELVIS: The urinary bladder is relatively decompressed, limiting evaluation. \nThe distal ureters are unremarkable. There is trace free fluid/fat stranding\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The patient has had prior hysterectomy.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate, diffuse atherosclerotic\ndisease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Other\nlevel degenerative changes are noted in the lumbosacral spine including\nprominent Schmorl's nodes at the superior endplates the bones are relatively\ndemineralized. No fracture. The thoracolumbar spine is slightly curved to\nthe right.\n\nSOFT TISSUES: A small right lower abdominal wall ventral hernia containing a\nshort loop of small bowel is noted as described in the GI section of this\nreport. The neck of right lower quadrant ventral wall hernia measures up to\n3.3 cm (series 602b, image 35). There is diastases of the right lateral\nabdominal wall as well.", "output": "1. Status-post right ileocolectomy for colon cancer.\n2. Small right lower abdominal wall hernia with a 3.3-cm neck containing a\nshort segment loop of small bowel. The distal limb is relatively decompressed\nand the proximaly limb is not dilated but has fecalized material and there is\nfluid in the small bowel more proximally. There findings are non-specific but\ncould suggest early or partial small bowel obstruction and/or enteritis. \nClose monitoring is recommended.\n3. Non-specific small amount of free fluid in the right abdomen could be\nrelated to the process in the small bowel of the right lower quadrant as\nabove, either early/partial obstruction and/or enteritis.\n4. Colonic diverticulosis.\n5. 3.4 x 3-cm prominent small bowel jejunal diverticulum with fecalized\nmaterial.\n6. No organized fluid collections or free air.\n\nNOTIFICATION The addition of possibility of an early/partial bowel\nobstruction was discussed via telephone by ___ with Dr. ___\non ___ at 10:20 ___, 1 minutes after discovery of the findings." }, { "input": "LOWER CHEST: There is a 4 mm right lower lobe nodule (2:1) and a 3 mm\nsubpleural left lower lobe nodule (2:9). Mild bibasilar atelectasis is noted.\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of suspicious renal lesions or hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not definitely seen, however\nthere are no secondary inflammatory changes about the cecum to suggest acute\nappendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. The appendix is not definitely seen, however there is no secondary\ninflammatory change about the cecum to suggest acute appendicitis. No\ndiverticulosis.\n2. Otherwise, no specific findings in the abdomen or pelvis to explain the\npatient's symptoms.\n3. Bilateral pulmonary nodules measuring up to 4 mm. See below for\nrecommendations.\n\nRECOMMENDATION(S):\n For incidentally detected nodules smaller than 6 mm in the setting of an\nincomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensity in segment V of the liver is too small to\ncharacterize but potentially a cyst or hamartoma. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are two simple cysts in the left kidney, the larger measuring up to 2.1\ncm. There is no evidence of focal renal lesions or hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is wall thickening of\nthe terminal ileum extending approximately 15 cm. Diffuse colonic\ndiverticulosis is noted. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. A 3.8 cm left adnexal cyst\nis noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nClustered right lower quadrant lymph nodes are noted. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The wall of the distal terminal ileum is thickened concerning for an\ninfectious or inflammatory process.\n2. A 3.8 left adnexal cyst which may be physiologic. Clinical correlation\nregarding need for additional imaging based on patient's location of pain.\n\nNOTIFICATION: Addition of impression 2 was discussed by Dr. ___ with Dr.\n___." }, { "input": "LOWER CHEST: There is bilateral dependent atelectasis. Visualized lung fields\nare otherwise within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is unchanged pneumobilia. A\nmetallic biliary stent is in unchanged position. There is a small focus of\nair within gallbladder, likely related to the biliary stent. There is also\nhigh contrast material within the gallbladder, likely related to reflux of\noral contrast through the biliary stent. Additionally, there are some\nrounded, hypodense filling defects within the lumen of the gallbladder which\nlikely represent gallstones.\n\nPANCREAS: The known mass within the head/uncinate process of the pancreas\ncontinues to have ill-defined borders, but appears to make soft tissue contact\nwith the SMA and first jejunal artery and hazy contact with the SMV. Fiducial\nseeds are present. The pancreatic duct remains minimally dilated and\nunchanged in appearance since most recent examination. There is minimal\nperipancreatic stranding. Adjacent lymphadenopathy is unchanged as described\nbelow.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 2.8\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nabsent\nBiliary tree abrupt cutoff with or without upstream dilatation: Difficult to\nevaluate given presence of metallic biliary stent.\n\nArterial evaluation\n\nSMA involvement: Mass abuts the midportion of SMA\nSolid soft-tissue contact: ?180\u00b0\nIncreased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to first jejunal artery branch: present, encasing the branch\n\nCeliac Axis involvement: absent\n\nCommon hepatic artery involvement: absent\n\nVariant anatomy: none\nVariant vessel contact: absent\n\nVenous evaluation\n\nMPV involvement: absent\n\nSMV involvement: present\nDegree of solid soft-tissue contact: absent\nDegree of increased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein: absent\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: There are unchanged, enlarged portacaval and\nperipancreatic lymph nodes (6, 34; 6, 37; 6, 47 ; 6, 39), measuring 1.0-1.2 cm\nin short axis.\nOther extrapancreatic disease (invasion of adjacent structures): present, the\nwall of the third portion of the duodenum\n\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There are 3 left renal arteries and 2 right renal arteries. There\nis no abdominal aortic aneurysm. Extensive atherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: Degenerative changes are seen in the lumbar spine. \nThe abdominal and pelvic wall is within normal limits.", "output": "1. Known pancreatic head/uncinate process mass is grossly unchanged with less\nthan 180 degree soft tissue contact with the SMA, encasement of the first\njejunal branch artery from the SMA, and less than 180 degree of hazy contact\nwith the SMV.\n2. Likely involved peripancreatic lymph nodes appear stable.\n3. There is cholelithiasis without evidence of cholecystitis. Additionally\nthere appears to be air and reflux of oral contrast within the gallbladder\nlumen related to the metallic biliary stent which is unchanged in location." }, { "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 1.8 x 2.4 cm, previously 2.5 x 1.5 cm\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nabsent\nBiliary tree abrupt cutoff with or without upstream dilatation: absent\n\nArterial evaluation\n\nSMA involvement: present\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: absent\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: absent\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to celiac axis: absent\nExtension to bifurcation of right/left hepatic artery: Absent\n\nVariant anatomy: none\nVariant vessel contact: absent\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nVenous evaluation\n\nMPV involvement: present\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\n\nSMV involvement: absent\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein: absent\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: 1.1 cm portocaval lymph node 1.0 cm aortocaval lymph\nnode\nProminent but nonenlarged retroperitoneal lymph nodes are similar compared to\nthe prior study\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nLOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen are areas of patchy enhancement in the right hepatic\nlobe. There is no evidence of focal lesions. There is pneumobilia without\nevidence of intrahepatic or extrahepatic biliary dilatation. 2 common bile\nduct stents are in place. The gallbladder is within normal limits.\n\nPANCREAS: Again seen is mild pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a fibroid uterus. No adnexal abnormality is\nseen.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Slight decrease in infiltrative ill-defined mass with > 180 degree\ninvolvement of the SMA and < 180 degree involvement of the portal vein. There\nhas been near complete resolution of previously seen SMV involvement. \nEnlarged portocaval lymph nodes are again seen. No evidence of hepatic\nmetastatic disease.\n2. Two common bile duct stents are stable in position without biliary ductal\ndilatation." }, { "input": "LOWER CHEST: Please see separate dictation on the same day for detailed\nevaluation of the supradiaphragmatic structures.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Pneumobilia without intrahepatic or\nextrahepatic biliary dilatation is unchanged. Again seen is a biliary stent\nwith reflux of oral contrast in the stent and the gallbladder. The\ngallbladder is otherwise within normal limits.\n\nPANCREAS: The hypoattenuating mass in the uncinate process involving the SMA\nnow measuring approximately 2 x 1.3 cm is slightly smaller compared to prior.\nThere is no involvement of the celiac axis. The pancreatic duct is mildly\ndilated. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are small fibroids in the uterus. The visualized\nreproductive organs are otherwise unremarkable.\n\nLYMPH NODES: Enlarged GDA node (series 4, image 57), porta hepatis node\n(series 4, image 58), and para-aortic node (series 4, image 63) are unchanged\ncompared to prior. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes throughout the spine are unchanged.\n\nSOFT TISSUES: There is a new small ventral hernia (series 4, image 83) without\ninvolvement of the bowel.", "output": "1. Slightly smaller pancreatic mass in the uncinate process with unchanged\nenlarged GDA node, porta hepatis node, and para-aortic node.\n2. Biliary stent in unchanged position with pneumobilia and reflux of oral\ncontrast into the stent and the gallbladder." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in the bilateral right worse\nthan left lower lobes. There is a trace right pleural effusion. 3 mm nodule\nin the left lower lobe (602b:28) is unchanged from CT chest ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple ill-defined hypoattenuated lesions in the liver which\nappear grossly unchanged as compared to CT abdomen and pelvis ___, when accounting for technical differences between studies. The largest\nlesion is centered in segment 4a and measures approximately 3.5 x 2.3 cm\n(02:15), grossly unchanged. There is increased degree of intrahepatic biliary\ndilatation as compared with CT from ___. Pneumobilia is again\nnoted. The gallbladder is surgically absent. There is been interval\nplacement of a new and longer CBD stent since ___\n\nPANCREAS: The primary lesion at the pancreatic head/uncinate process is\nslightly less conspicuous which may reflect differences in technique. There\nis dilatation of the pancreatic duct which appears unchanged. Again noted is\nmore than 180 degrees of contact with the SMA grossly unchanged.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A splenule is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A calcified fibroid uterus is again noted.\n\nLYMPH NODES: There are multiple mesenteric lymph nodes which are grossly\nunchanged from ___. The largest mesenteric lymph node is a\nperiportal lymph node measuring 1.9 x 1.5 cm (02:21). There are multiple\nenlarged retroperitoneal lymph nodes the largest of which is a aortocaval\nlymph node measuring 2.1 x 1.2 cm (02:20), unchanged from ___.\nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes of the lumbar spine, sacro-iliac joints, and\nbilateral hip joints are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Moderate intrahepatic biliary dilatation, new from CT abdomen pelvis ___. Findings may reflect worsening malignant obstruction at the\nlevel of the bifurcating hepatic duct or obstructed stent.\n2. Decreased conspicuity of pancreatic head/uncinate process lesion likely\nreflecting differences in imaging technique. Multiple metastatic lesions in\nthe liver are grossly unchanged from ___. Lymphadenopathy is\nunchanged." }, { "input": "LOWER CHEST: Please refer to separately reported CT chest for details above\nthe diaphragm.\n\nABDOMEN:\n\nHEPATOBILIARY: Preciously detected hypodense liver lesions are less\nconspicuous on today's CT, likely in part due to phase of imaging and likely\nalso due to some degree of interval improvement. The most conspicuous lesion\nis located at the junction of segment 4a and 4b, measuring 2 x 2 cm (05:48). \nThere has been interval placement of a stent in the biliary tree traversing\nthe larger metallic stent. New Stent extends from the duodenum to the left\nintrahepatic biliary tree. This is mild persistent intrahepatic biliary\nductal dilation and small amount of pneumobilia. Gallbladder is decompressed.\n\nPANCREAS: The pancreatic uncinate lesion is poorly seen. However, there is\nabnormal soft tissue encasement of the SMA as on prior (5:58). There is\nunchanged pancreatic atrophy with moderate pancreatic ductal dilation,\nmeasuring up to 6.5 mm (05:54) in diameter. Periportal lymphadenopathy is\ngrossly unchanged.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is an adjacent splenule.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Small calcified fibroid noted. adnexa not well\nvisualized.\n\nLYMPH NODES: No change in enlarged portacaval, aortocaval and periportal\nenlarged lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm though there is ectasia of the\ndistal abdominal aorta measuring up to 2.2 cm in transverse dimention. \nExtensive atherosclerotic disease is noted.\n\nBONES: Stable multilevel degenerative changes in the lumbar spine, with\nendplate osteophytes and vacuum phenomenon seen from L2-S1. Also noted is\nmild retrolisthesis of L3 relative to L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval placement of biliary pigtail stent (through metallic stent) with\ndecreased intrahepatic biliary ductal dilations, now mild.\n2. Primary pancreatic uncinate process mass is poorly seen, liver metastatic\nlesions decreased in conspicuity may reflect favorable treatment response.\n3. Size stable nodes." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple regions of ill-defined hypoenhancement are slightly\nincreased in conspicuity throughout the liver, predominantly involving the\nleft hepatic lobe, which are similar to the prior study in ___,\naccounting for differences in imaging technique.\n\nThere is again expected central pneumobilia. A dual biliary stent is in\nunchanged position. Mild intrahepatic biliary dilatation is redemonstrated,\nunchanged. A small locule of gas is noted within the gallbladder lumen.\n\nPANCREAS: There is again ill-defined thickening along the uncinate process of\nthe pancreas, likely corresponding to the known pancreatic adenocarcinoma. \nThe lesion continues to abut the SMA, unchanged. Mild dilatation of the\npancreatic duct is unchanged, measuring up to 5 mm.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Incidental note is made of an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized on today's\nexam.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcified fibroids are redemonstrated in the uterus.\n\nLYMPH NODES: There is again enlarged retroperitoneal lymph nodes, which appear\nsimilar to the prior study. For example, there are enlarged peripancreatic\nlymph nodes measuring up to 1.1 cm (series 5: Image 52). No mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbosacral spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Overall, similar appearance of known ill-defined pancreatic mass as well as\nhepatic hypodense metastatic lesions, with increased conspicuity of hepatic\nlesions likely secondary to differences in imaging technique/contrast timing.\n2. Stable retroperitoneal lymphadenopathy.\n3. The dual biliary stents are in unchanged position.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThere is diffuse heterogeneous low attenuation of the liver parenchyma in\nkeeping with hepatic steatosis. Previously noted areas of ill-defined\nhypodensity in the left lobe are less clearly visualized.d 15 mm ill-defined\nhypodensity in segment 4A is similar to the prior study.\nBiliary stents remain in situ. Pneumobilia again noted, suggestive of stent\npatency. There is no intrahepatic duct dilatation.\nThe gallbladder contains intraluminal gas.\n\nPANCREAS: Overall unchanged appearance of the ill-defined soft tissue mass\naround the uncinate process of the pancreas measuring approximately 3 x 4.7\ncm, previously 2.8 x 4.5 cm. The mass encases the distal CBD and is\ninseparable from the third and fourth portion of the duodenum. Note is again\nmade of pancreatic duct dilatation and atrophy of the body and tail of the\npancreas.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable. Minimal nodularity of the\nleft adrenal gland is unchanged.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus again noted. There is no adnexal mass.\n\nLYMPH NODES: Stable retroperitoneal and mesenteric lymphadenopathy. Index\nnodes are as follows:\nPeriportal node (series 5, image 50) measures 15 mm, previously 15 mm\nPortacaval node (series 5, image 56) measures 13 mm, previously 12 mm\nRight periaortic node (series 5, image 57) measures 10 mm, previously 9 mm\n\nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:\nThere is no abdominal aortic aneurysm. Moderate atherosclerotic disease is\nnoted.\nNote is again made of partial soft tissue encasement of the SMA and first\njejunal branch.\nThe portal confluence abuts the pancreatic mass similar to prior study. There\nis no portal venous or SMV thrombus.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are noted in the lower lumbar spine and left hip joint. \nNote is again made of a healed left femoral neck fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable appearance of the ill-defined soft tissue mass centered in the\npancreatic uncinate process consistent with patient's known primary pancreatic\ncancer.\n2. Previously seen ill-defined hypodensities in the liver are less conspicuous\nlikely due to progression of background hepatic steatosis.\n3. Stable retroperitoneal and mesenteric lymphadenopathy." }, { "input": "LOWER CHEST: Please refer to dedicated CT chest report for same day for\nintrathoracic findings\n\n\nABDOMEN:\n\nHEPATOBILIARY: There is low attenuation the liver compatible with hepatic\nsteatosis. An ill-defined area of hypodensity in segment ___ (series 2:45) is\nunchanged in appearance from CT abdomen and pelvis ___. There is\nheterogeneous attenuation of the liver which is unchanged and likely secondary\nto perfusional abnormalities. A left internal biliary stent courses through a\npatent CBD stent and terminates in the third portion of duodenum, unchanged in\nposition. Pneumobilia is noted, within normal limits. There is no intra or\nextrahepatic biliary dilatation. The gallbladder contains intraluminal gas..\n\nPANCREAS: An ill-defined hypoattenuating mass centered in the uncinate process\nof the pancreas is difficult to measure but measures approximately 3.0 x 4.7\ncm (AP by TV, series 2:60), previously measuring 3.0 x 4.7 cm on CT abdomen\npelvis ___. The mass encases the distal common bile duct and is\ninseparable from the third and fourth portion of the duodenum. Degree of\nupstream pancreatic ductal dilatation and atrophy is unchanged.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A soft tissue nodule adjacent to the spleen\n(series 2:41) likely represents accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus is again noted.\n\nLYMPH NODES: There is mesenteric lymphadenopathy which is unchanged as\ncompared to ___. For example, the periportal lymph node measures\n1.5 cm (series 2:54), unchanged in the portal caval lymph node measures 1.0 cm\n(series 2:59), unchanged. Retroperitoneal lymphadenopathy measuring up to 1.1\ncm in the right para-aortic region (series 2:60) is unchanged. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Hepatic arterial anatomy is conventional.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Unremarkable.", "output": "1. Stable ill-defined mass centered in the pancreatic uncinate process\n2. Stable retroperitoneal and mesenteric lymphadenopathy.\n3. No evidence of new or worsening metastatic disease.\n4. Previously characterized ill-defined hypodensity in segment ___ of the\nliver is unchanged in appearance dating back to CT abdomen pelvis ___ and nonspecific in etiology and could be secondary to underlying\nperfusional abnormalities.\n5. Please refer to dedicated CT chest report on same day for intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffuse low attenuation, consistent with\nhepatic steatosis, with peripheral heterogeneous attenuation, suggestive of\nperfusional abnormalities. A 2.6 x 3.4 x 2.6 cm hypodensity in segment IV a\n(05:41) is increased in size and more conspicuous than on prior study, and is\nisodense to background liver parenchyma on 3 minutes delay. A left internal\nbiliary stent is unchanged in position, coursing through a patent CBD stent\nand terminating in the third portion of the duodenum. On delayed phase, there\nis hyper enhancement surrounding the biliary duct stent (12:19). Moderate\npneumobilia and air within the gallbladder are unchanged from prior.\n\nPANCREAS: An ill-defined, hypoattenuating mass in the head/uncinate process\nmeasures approximately 4.5 x 3.1 cm, previously 4.7 x 3.0 cm, surrounds the\ndistal common bile duct, with invasion of the third and fourth portions of the\nduodenum. Distal to the mass, the pancreas is atrophic, and the pancreatic\nduct is dilated, measuring up to 4 mm, similar to prior.. The pancreas has\nnormal attenuation throughout, without evidence of focal lesions or pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 1.2 cm splenule anterior to the spleen is again\nseen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Invasion of the third and\nfourth portions of the duodenum by the adjacent pancreatic head mass is again\nseen. The small bowel loops otherwise demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple enlarged periportal and peripancreatic lymph\nnodes measuring up to 1.5 cm (05:50) and 1.0 cm (05:55), unchanged. A 1.0 cm\nright para-aortic lymph node and a 1.0 cm left para-aortic lymph node are\nunchanged from prior (05:58, 53). There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute\nfracture.There is grade 1 retrolisthesis of L3 on L4, unchanged from prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Similar appearance of ill-defined mass in the pancreatic head/uncinate\nprocess, with unchanged retroperitoneal and mesenteric lymphadenopathy.\n2. A hypoenhancing lesion in segment IV a of the liver is larger and more\nconspicuous than prior, though becomes isodense to background liver parenchyma\non delayed phase imaging, which is nonspecific. Background hepatic steatosis\nand perfusional abnormalities makes characterisation difficult on CT. MR is\nrecommended for further evaluation.\n3. Delayed enhancement surrounding the internal biliary duct stent may\nrepresent cholangitis. Correlate clinically.\n4. Please refer to separate report of CT chest performed same day for\ndescription of intrathoracic findings.\n\nRECOMMENDATION(S): MR is recommended for further characterization of a\nhypoenhancing hepatic lesion and possible cholangitis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:17 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic biliary\nprominence in the left lobe which appears minimally unchanged as compared to\nCT abdomen pelvis ___. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are subcentimeter hypodensities measuring up to 9 mm in the lower pole\nthe right kidney (series 2:33) which are too small to characterize. There is\nno hydronephrosis or perinephric abnormality. There is no evidence of focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abdominopelvic process. No CT findings correlating to the reported\nhistory of diffuse abdominal pain." }, { "input": "LOWER CHEST: Multiple lung nodules are seen within the partially imaged lung\nbases, the largest of which is within the left lingula measuring 1.1 cm. \nThere is also a 0.7 cm nodule within the left lower lobe, in addition to\nmultiple millimetric nodules within the right middle and lower lobes.\n\nBulky soft tissue noted within the right lower lobe measuring approximately\n4.7 x 5.1 cm. In this partially imaged study without IV contrast, it is\nimpossible to exclude underlying mass lesion at this level.\n\nABDOMEN:\n\nHEPATOBILIARY: Comment evaluation of the liver parenchyma is difficult due to\nthe lack of IV contrast, however there are scattered innumerable areas of\nhypodensity seen throughout both the left and right lobes of the liver. The\nlargest is an area at the junction of segments ___ measuring 1.7 cm. The\nliver is also nodular in contour. Given these findings, these new multifocal\nliver hypodensities may either be related to metastatic disease or foci of\nHCC. It is impossible to differentiate based on this noncontrast scan.\n\nMultiple uncomplicated gallstones are seen. 1 of the gallstones just proximal\nto the gallbladder neck.\n\nIn addition, there are multiple size significant lymph nodes within the celiac\nregion, gastrohepatic ligament, and perigastric. Largest lymph node in the\ngastrohepatic region measures 1.2 cm in short axis diameter, largest lymph\nnode in the celiac region measures 1.5 cm in short axis diameter. Largest\nperigastric lymph node measures 1.5 cm and is adjacent to the gastric\nfundus/cardia. There also multiple retroperitoneal lymph nodes, the largest\nbeing a right para-aortic lymph node measuring 1.1 cm in short axis diameter.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 1.6 cm accessory splenule is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple renal vascular calcifications are noted, and the kidneys are\nmildly atrophic, right more than left. No definite suspicious renal\nabnormality is seen. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nVASCULAR: Patient is status post aortobifemoral graft. Evaluation of graft\npatency is impossible due the lack of IV contrast. There is some inflammatory\nchange surrounding the femoral insertion points at both groins, however no\ndefinite collection is identified. The soft tissue change is similar in size\nin appearance when compared to the prior dated ___.\n\nBONES AND SOFT TISSUES: A 1.0 cm sclerotic lesion is noted at the level of\nthe right acetabulum which is nonspecific, but was not definitely seen on the\nprior study. Given the remainder of the findings on the current study, it is\nsuspicious for metastatic disease. Recommend correlation with bone scan.\n\nMild compression fracture of the L5 vertebral body with approximately 20% loss\nof height, new from previous. There is sclerotic appearance of the vertebral\nbody at this level. It is unclear if this is due to compacted bone from the\nrecent fracture, or bony metastasis. Further evaluation with bone scan is\nrecommended.", "output": "1. Multiple new pulmonary nodules, largest measuring 1.1 cm in the left\nlingula.\n\nInterval appearance of multi station size significant lymphadenopathy, largest\nbeing a 1.5 cm lymph node in the celiac region. The abnormal lymph nodes also\ninvolve the gastrohepatic region, left retroperitoneal/periaortic region, and\nperigastric regions. Please refer to the body of the report for more detailed\ndescription.\n\nQuestionable sclerotic bone lesion with at the level of the right acetabulum,\nwhich is nonspecific but also concerning for new metastatic disease given the\nconstellation of findings.\n\nConsistent with metastatic disease.\n\nA strong candidate for the primary lesion would be the conglomerate of soft\ntissue in the at density noted within the right lower lobe/hilar region. This\narea was partially imaged, and full workup is recommended including CT scan of\nthe chest.\n\n\n2. Multiple new hypodense liver lesions identified, somewhat difficult to\ncharacterize given the lack of IV contrast but suspicious for metastatic\nneoplastic disease given the constellation of findings. Alternatively, the\nliver contours quite nodular sub, suggestive of underlying cirrhosis. These\nhepatic lesions may also represent foci of hepatocellular carcinoma. It is\nimpossible to the more specific in the context of a nonenhanced scan.\n\nThe largest lesion is in segment 8 measuring 1.7 cm.\n\n\n3. No collection seen to explain the discharge at the level of the groin. The\nsoft tissue changes are somewhat limited by lack of IV contrast, however they\nappear unchanged compared to prior study dated ___.\n\nRECOMMENDATION(S): Full metastatic workup, which should include CT scan of\nthe chest and bone scan. Ultrasound of the abdomen could also be performed to\nfurther evaluate the liver findings.\n\nNOTIFICATION: The findings and recommendations were communicated directly to\nDr. ___ telephone by Dr. ___ at 11:25." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings, including an opacity at the left\nlung base containing a surgical clip.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous background attenuation. \nCompared with CT abdomen pelvis on ___, multiple hypodense lesions\nare decreased in size. Two previously seen hypodense lesions in of 5 of the\nliver measure 0.7 and 0.4 cm, compared with 1.5 and 0.8 cm previously. A\nhypodense lesion in the caudate lobe measures 1.0 x 0.8 cm, compared with 1.2\nx 0.9 cm previously. The previously seen hypo attenuating lesion in the left\nhepatic lobe is not well visualized on this exam. There is no evidence of new\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post right nephrectomy, with unchanged 9 mm soft\ntissue nodule adjacent to the surgical clips, likely representing postsurgical\nchange, and no evidence of tumor recurrence in the nephrectomy bed (5:21). \nThe left kidney displays normal nephrogram. A 2.3 cm simple cyst arising from\nthe upper pole of the left kidney is unchanged. There is no evidence of solid\nfocal left renal lesion or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Pathologic fracture through the superior endplate of the S1 is\nunchanged in appearance (9:45). Sclerotic foci in the inferior left\nacetabulum and right iliac bone are similar to prior (8:37, 43). There is no\nevidence of new worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A previously seen subcutaneous nodule in the left anterior\nabdominal wall is decreased in size and density compared with ___\n(5:52). A 6.4 cm left-sided lipoma splaying the left lateral abdominal wall\nmuscles is unchanged (5:91).", "output": "1. Interval decrease in size of multiple hypodense hepatic lesions and a\nsubcutaneous left anterior abdominal lesion compared with ___.\n2. Stable pathologic fracture of the superior endplate of S1 and sclerotic\nfoci in the left acetabulum and right iliac bone. No new bony lesions.\n3. Status post right nephrectomy, with no evidence of local recurrence in the\nnephrectomy bed.\n4. No new foci of metastatic disease in the abdomen or pelvis.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout,\nsuggestive of steatosis. Two previously seen focal hepatic lesions are much\nless conspicuous compared with prior. No new hepatic lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post right nephrectomy, with no evidence of local\nrecurrence in the nephrectomy bed. The left kidney displays normal nephrogram.\nSimple cysts in the left kidney, the largest measuring 2.3 cm in the upper\npole, are not significantly changed. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: A lytic lesion in the superior endplate of S1 with surrounding\nsclerosis is not significantly changed. Sclerotic lesions in the right iliac\nwing , right proximal femur, and left acetabulum are not significantly\nchanged. There is no evidence of new worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: A left ventral hernia containing fat is noted.", "output": "-Two previously seen hepatic lesions are inconspicuous compared with prior,\nconsistent with treatment response. No new focal hepatic lesions.\n-Stable osseous metastatic disease.\n-Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Tiny hypodensity in segment 2 (series 5, image 43) is\nunchanged. No new concerning focal liver lesion. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Status post right nephrectomy. Simple cyst at the upper pole of the\nleft kidney measuring 2.4 cm.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Scant sigmoid\ndiverticulosis, no evidence of diverticulitis. Small area of rounded,\nring-like increased density in the pericolonic fat adjacent to the descending\ncolon (series 5, image 87) likely sequela of a prior episode of epiploic\nappendagitis. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland demonstrates somewhat asymmetric\nenhancement of the left compared with the right lobe, not a specific finding\non this modality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Sclerotic focus in the right proximal femoral shaft appears unchanged. \nThis is incompletely imaged. A large sclerotic lesion in S1 sacral segment\nwith peripheral sclerosis predominantly appears stable from prior. Small\nsclerotic lesion in the right iliac bone appears stable from prior.\n\nSOFT TISSUES: A paraumbilical hernia contains some of the anterior wall of the\ncecum. (Series 5, image 93). There are additional mid to upper abdominal\nright and left ventral abdominal wall hernias containing fat. 6.8 x 6.9 cm\nleft medial posterior abdominal wall muscle lipoma appears stable.", "output": "1. Stable sclerotic lesions largest of which is in the sacrum at S1.\n2. Ventral abdominal hernia partly contains cecum.\n3. Additional findings as above.\n4. Asymmetric enhancement of left prostate lobe. Recommend clinical\ncorrelation with physical exam and PSA.\n5. Nonaggressive appearing, stable deep left intramuscular abdominal wall\nlipomatous lesion.\n6. Small ovoid ring of increased density in the left colonic pericolonic fat\nmay reflect sequela of a prior episode of epiploic appendagitis." }, { "input": "LOWER CHEST: Please refer to the separately dictated CT of the chest for\ndetailed evaluation.\n\nHEPATOBILIARY: There is hepatic steatosis. There are no suspicious mass\nlesions. Portal vein and hepatic veins are patent. There is no biliary\nductal dilatation. Gallbladder is unremarkable.\n\nPANCREAS: Unremarkable pancreatic contours with no pancreatic ductal\ndilatation or suspicious mass lesions.\n\nSPLEEN: Stable splenomegaly measuring up to 15 cm.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY:Status post right nephrectomy with no suspicious mass lesions within\nthe nephrectomy bed. Unremarkable enhancement of the left kidney with a left\nupper pole renal cortical cyst that is stable in size. There is no\nhydronephrosis or nephrolithiasis of the left kidney.\n\nGASTROINTESTINAL: Stomach is unremarkable. There is no bowel obstruction. \nScattered colonic diverticulosis without diverticulitis. The focal fat\nstranding along the anterolateral aspect of the descending colon has improved,\nlikely reflective of epiploic appendagitis previously.\n\nPERITONEUM: There is no free air or free fluid. There is a stable non\naggressive appearing fatty lesion along the left paracolic gutter likely\nrepresenting a lipoma measuring 7 cm, stable.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches.\n\nPELVIS: Urinary bladder, prostate and seminal vesicles are unremarkable.\nRectum is unremarkable. There are no pelvic sidewall adenopathy.\n\nBONES:There are no new suspicious osseous lesions. There is a stable\nsclerotic lesion along the left aspect of S1. Sclerosis within the proximal\nright femoral shaft is unchanged as well. There are multilevel degenerative\nchanges of the lumbar spine.\n\nSOFT TISSUES: There is a midline surgical scar. There is diastasis of the\nabdominal wall muscles with a fat containing incisional hernia at the level of\nthe umbilicus.", "output": "1. Stable osseous sclerotic lesions within the sacrum and proximal femur.\n2. Otherwise, no new suspicious osseous lesions or distant metastatic disease.\n3. Anterior abdominal wall incisional hernia.\n4. Please refer to the separately dictated CT of the chest for detailed\nevaluation." }, { "input": "LOWER THORAX: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation.\nUnremarkable gallbladder.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: Status post right nephrectomy. The left kidney is unremarkable. 24\nmm cyst arising from the upper pole of the left kidney. 15 mm exophytic cyst\narising from the lower pole of the left kidney. No hydronephrosis. \nUnremarkable bladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are\nnormal in caliber. The cecum is medially positioned and partially contained\nwithin a paraumbilical hernia. Normal appendix.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric adenopathy. No pelvic or\ninguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Stable circumscribed 63 x 66 mm fat\ndensity lesion within the left posterior pararenal space consistent with a\nlipoma.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic calcification.\n\nBONES: Stable mixed lytic/sclerotic lesion within the imaged portions of the\nright proximal femur and left hemi sacrum. Densely sclerotic lesion within\nthe right iliac bone is also unchanged.\n\nSOFT TISSUES: Paraumbilical hernia containing mesenteric fat and a portion of\nnonobstructed cecum.", "output": "1. Stable appearance of osseous metastases involving the right proximal femur\nand left hemi sacrum.\n2. No new or progressive metastatic lesions are identified.\n3. Umbilical hernia containing mesenteric fat and a nonobstructed portion of\nthe cecum." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout\ncompatible with hepatic steatosis. A segment 2 subcentimeter hypodensities\nre-demonstrated and unchanged from prior. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient status post right nephrectomy with unchanged 1.1 cm cystic\nnodule in the resection bed, unchanged from prior (2:65). The left kidney is\nnormal in appearance with a normal nephrogram. A 2.8 cm left upper pole renal\ncyst is re-demonstrated and unchanged. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is re-demonstrated otherwise the\nstomach is unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Extensive colonic diverticulosis is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Mixed lytic and sclerotic lesions predominantly in the right proximal\nfemur and left sacrum remain unchanged (2:97 and 2:120). No pathologic\nfracture identified.\n\nSOFT TISSUES: An umbilical hernia containing nonobstructed small bowel is\nre-demonstrated and unchanged.", "output": "1. Stable osseous metastases with no new metastatic lesions or pathologic\nfractures identified.\n2. Status post right nephrectomy with stable 1.1 cystic nodule in the\nresection bed.\n3. Diverticulosis without findings of diverticulitis.\n4. Please refer to same-day CT chest for characterization of findings above\nthe diaphragm." }, { "input": "CT of the abdomen:\nPlease see chest findings on the chest CT report. Note of a left hilar mass,\nunchanged compared to the prior exam.\n\nLiver is homogeneous without focal masses, no dilated intrahepatic biliary\nradicles. The gallbladder is within normal limits. The pancreas, spleen, left\nkidney and visualized loops of large small bowel appear unremarkable. There is\nno free fluid, no pathologically enlarged adenopathy. Simple cyst involving\nthe superior pole of the left kidney, smaller lenticular hypodensity involving\nthe inferior pole of the left kidney is unchanged as well.\n\nThe left adrenal gland is unremarkable. The right adrenal gland as well. Small\nfocal new nodular density adjacent to the IVC (series 6, image 68) is\nunchanged and likely represents post- operative change. The abdominal aorta\nand its branches are widely patent.\n\nCT of the pelvis: Visualized loops of large small bowel appear unremarkable,\nno free fluid, no adenopathy. Some sigmoid diverticulosis only. Probable small\nleft flank fat containing, simple appearing hernia.\n\nBone windows demonstrate no suspicious areas.", "output": "1. No evidence of recurrence or metastatic disease within the abdomen or\npelvis in this patient with known RCC." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The adrenal glands are unremarkable bilaterally..\nURINARY: The patient is status post right nephrectomy. There is no evidence of\nrecurrence at the surgical bed. The contralateral kidney and collecting system\nare unremarkable.There is a simple cyst in the upper pole of the left kidney.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. There is interdigitation of fat\nbetween the left internal oblique and transverse abdominus muscles at the\nflank.", "output": "Status post right nephrectomy with no evidence of disease recurrence in the\nabdomen or pelvis." }, { "input": "LOWER CHEST: Left infrahilar soft tissue mass containing fiducial marker is\nre-identified with small amount of associated right lower lobe atelectasis. \nThere is no pleural or pericardial effusion. Heart size is within normal\nlimits.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is contracted without\nevidence of gallstones or pericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Right kidney is surgically absent. Left kidney contains an unchanged\n2.4 x 2.2 cm left upper pole cyst. There is no evidence of stones, focal\nrenal lesions, or hydronephrosis within the left kidney. There are no\nurothelial lesions in the left kidney or left ureter. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is a 2.2 x 2.8 cm lytic lesion in the left\naspect of the S1 vertebral body (2:67) with mild compression deformity of the\nS1 superior endplate (602b:44). No additional osseous lesion visualized. \nPlease note that the lower extremities are not imaged below the level the\nlesser trochanters. Abdominal and pelvic wall is within normal limits.", "output": "1. Lytic lesion of S1 measuring 2.2 x 2.8 cm with mild superior endplate\ndeformity correlating to finding on recent nuclear medicine bone scan and\nconcerning for metastatic disease. No additional osseous lesion visualized. \nPlease note that the lower extremities are not imaged below the level of the\nlesser trochanters.\n2. No additional focus of metastatic disease in the abdomen or pelvis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:50 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 2.4 x 1.7 cm lesion within segment I immediately\nanterior to the IVC which has a peripherally enhancing rim (4:59). This lesion\nwas not present on CT abdomen/pelvis dated ___ and appears to have\nminimally enlarged since the CT abdomen/pelvis dated ___. There is\nalso a hypodense lesion within segment II that is too small to completely\ncharacterize (08:23). The liver otherwise demonstrates homogenous attenuation\nthroughout. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is hypodense, interdigitating fat within the uncinate process\nof the pancreas. The pancreas otherwise has normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status-post total right nephrectomy. No\nabnormalities within the nephrectomy bed. There is a stable, 1.4 x 1.1 cm,\nexophytic lesion (-5.3 ___ arising from the inferior pole of the left kidney\n(4:84). There is also a stable, 2.0 x 2.1 cm simple cyst (4 ___ arising from\nthe superior pole of the left kidney (4:63). The left kidney is otherwise of\nnormal in size with normal nephrogram. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: The previously identified lytic lesion within the lateral aspect of S1\nhas enlarged and now measures 2.8 x 3.7 cm and is associated with a\ncompression deformity of the superior endplate. There are additional, new,\nlytic foci within the superior aspects of S2 and S3 and a stable appearing\nlytic focus within the T3 vertebral body (9:42, 9:44). There is a stable,\nsclerotic focus with in the right iliac bone.\n\nSOFT TISSUES: There are multiple nodules within subcutaneous tissues of the\nabdomen and back, which have enlarged since CT abdomen/pelvis dated ___ (4:72, 4:59, 4:47, 4:63). Again identified is an abdominal wall defect\nwith a fat containing hernia immediately left of midline (4:88).", "output": "1. Interval enlargement of previously identified lytic lesion of S1 with\ncompression deformity, new lytic lesions within S2 and S3, and a stable\nappearing lytic lesion within the vertebral body of T3. These findings are\nconcerning for disease progression\n2. New 2.4 x 1.7 cm peripherally enhancing hepatic lesion within segment I\nimmediately anterior to the IVC is concerning for metastasis.\n3. Interval enlargement of multiple subcutaneous nodules as described above. \nIn the setting of renal cell carcinoma, these are concerning for metastases. \nHowever, if the patient receives a subcutaneous injections in these areas,\nthese may also be consistent with subcutaneous granulomas.\n4. Stable sclerotic lesion within the right iliac bone is more likely a bone\nisland than a sclerotic metastasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. There\nmay be minimal skin thickening about the umbilicus, but no fluid collection or\nsignificant fat stranding.", "output": "1. Possible minimal soft tissue thickening about the umbilicus which may\nreflect cellulitis, but no fluid collections or significant fat stranding.\n2. No acute abdominal or pelvic pathology otherwise identified to explain the\npatient's symptoms. Normal appendix." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. Bilateral subcentimeter hypodensities are too\nsmall to characterize by CT. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nextensive diverticulosis of the colon. A segment of wall thickening in the\nproximal sigmoid colon is seen, with questionable surrounding fat stranding. \nNo definite inflamed diverticulum. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is notable for fibroids. No adnexal\nabnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes are noted, with loss intervertebral disc\nspace and vacuum disc phenomenon at L2-3, grade 1 anterolisthesis of L4 on L5,\nand grade 1 retrolisthesis of L5 on S1.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "A segment of wall thickening in the proximal sigmoid colon with diverticula\nand questionable surrounding fat stranding which may represent early/mild\ndiverticulitis. No focal fluid collections or free air." }, { "input": "LOWER CHEST: There is mild smooth septal thickening at the lung bases likely\nsecondary to mild fluid overload. There is mild bibasilar atelectasis. There\nis no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates increased attenuation in the region of\nthe gallbladder fossa which may reflect reactive hyperemia. There is no\nevidence of focal lesions. There is mild intra and extrahepatic biliary\ndilatation, similar to ___ in ___ when the patient demonstrated\ncholedocholithiasis, but increased compared to the previous CT from ___. The common bile duct measures up to 11 mm. Within the distal common\nbile duct, at the level of the ampulla, there appears to be approximately 13\nmm soft tissue density lesion which may represent choledocholithiasis (02:37).\n\nThe gallbladder is distended and contains multiple stones near the neck of the\ngallbladder. Pericholecystic fluid is also noted between the gallbladder and\nliver, not seen on the prior ultrasound, without gallbladder wall thickening\nor stranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding. The pancreatic cyst seen within the uncinate process on ___ is\nnot visualized on the current CT.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. The left\nadrenal gland is thickened without discrete nodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is mild cortical scarring along the interpolar region of the right\nkidney. There is no evidence of focal renal lesions or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild-to-moderate degenerative changes of the thoracolumbar spine are noted. \nChronic grade 1 anterolisthesis of L4 on L5 is again noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild intra and extrahepatic biliary dilation, similar to the prior ___\nfrom ___ when the patient exhibited choledocholithiasis, and new from\nthe CT from ___. Additionally, there appears to be an approximately 13\nmm soft tissue density lesion within the distal common bile duct at the level\nof the ampulla which may represent an obstructing stone. Recommend ___\nand/or ERCP for further assessment. If ___ is obtained, recommend\nperformance of the examination with a hepatobiliary contrast agent.\n2. Distended gallbladder with gallstones, pericholecystic fluid, and adjacent\nperihepatic hyperemia. Findings are suspicious for cholecystitis, likely\nsecondary to distal common bile duct obstruction from choledocholithiasis.\n3. Previously demonstrated uncinate process subcentimeter cystic lesion within\nthe pancreas on ___ is not well visualized on the current CT examination.\n4. Mild fluid overload.\n\nRECOMMENDATION(S): ___. If ___ is obtained, recommend administration\nof hepatobiliary contrast agent.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:29 pm, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Lower lung atelectasis noted. The heart appears mildly enlarged.\nNo pleural or pericardial effusions seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Left biliary drain terminates within\nthe common bile duct. Pneumobilia is noted. The gallbladder surgically\nabsent. Skin staples are seen spanning the right upper quadrant abdominal\nwall. Surgical drain enters the right anterolateral body wall and terminates\nin the gallbladder fossa. No residual fluid collection is seen within the\ngallbladder fossa. A tiny focus of gas within the gallbladder fossa likely\nreflects indwelling drainage catheter.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is bulky hypertrophy of the left adrenal gland, unchanged from\n___. The right adrenal gland is normal.\n\nURINARY: There is no excretion of renal contrast. the kidneys are of normal\nand symmetric size with normal nephrogram. There is no evidence of focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is colonic\ndiverticulosis without evidence of diverticulitis. The appendix not\nvisualized but there is no secondary signs of acute appendicitis.\n\nPELVIS: There is a Foley catheter within the bladder. Air within the anti\ndependent portion of the bladder is likely due to Foley insertion. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcified uterus is normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute\nfracture.There is severe facet arthropathy of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nSubcutaneous stranding in the tract of the drainage catheter in the right\nlower quadrant and in the supraumbilical region is likely postoperative", "output": "1. Status post recent cholecystectomy with surgical drain extending to the\ngallbladder fossa without residual fluid collection.\n2. No acute findings to account for pain.\n3. Lack of contrast excretion from the kidneys, requiring correlation with\nserum creatinine as contrast nephropathy is of concern." }, { "input": "LOWER CHEST: Mild dependent atelectasis is noted. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodensity at the hepatic dome (2:7) is incompletely\ncharacterized, but likely represents a hepatic cyst or biliary hamartoma. A\ncalcified granuloma is seen in the inferior right lobe (2:38). There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cysts measuring simple fluid density, up to 5.3 cm in size in\nthe right upper pole (2:23) are noted. A 2.2 cm right lower pole cyst (2:36)\nmeasures soft tissue density, and is incompletely characterized on this study.\nAdditional bilateral subcentimeter hypodensities are too small to\ncharacterize, but likely represent cysts. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal (2:58).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 on L5 is likely degenerative in etiology.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted, does not contain\nany loops of bowel.", "output": "1. Small left inguinal hernia containing fat, and no loops of bowel. No acute\nabdominopelvic process.\n2. Multiple bilateral renal cysts. A 2.2 cm right lower pole cyst measures\nsoft tissue density and is incompletely characterized on this study. \nRecommend outpatient followup renal ultrasound further characterization.\n3. Grade 1 anterolisthesis of L4 on L5 is likely degenerative in etiology.\n\nRECOMMENDATION(S): Outpatient renal US followup." }, { "input": "LOWER CHEST: There is a tiny right pleural effusion which is new from recent\nprior chest CT exam. Subpleural fibrotic changes in the lower lungs\nconsistent with known interstitial lung disease. No evidence of a\nsuperimposed pneumonia. The imaged portion of the heart is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally without concerning focal lesion. \nTiny hypodensity within left hepatic lobe on series 2, image 17 is too small\nto characterize as well as a second tiny lesion on series 2, image 13 in\nsegment 2. The main portal vein is patent. No biliary ductal dilation. The\ngallbladder appears normal without radiopaque stones or signs of acute\ncholecystitis.\n\nPANCREAS: The pancreas appears normal without concerning lesion or signs of\ninflammation.\n\nSPLEEN: The spleen is normal in size without focal abnormality.\n\nADRENALS: Both adrenal glands appear normal.\n\nURINARY: The kidneys enhance symmetrically and excretion of contrast is prompt\nand equal. There are renal cortical hypodensities, the larger which appears\nto represent a simple cyst in the left midpole measuring 2.3 x 2.0 cm. No\nhydronephrosis, pyelonephritis or worrisome renal lesion. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is decompressed. The duodenum appears normal. \nLoops of small bowel demonstrate no signs of ileus or obstruction. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. Not visualized\nthough no secondary signs of appendicitis seen. There is a small bowel\ncontaining right inguinal hernia without associated signs of obstruction or\nincarceration. Bowel The colon contains a moderate fecal load and is without\nwall thickening or signs of acute inflammation or obstruction. The sigmoid\ncolon partially herniates into the left inguinal hernia though is without\nsecondary obstruction. No signs of incarceration.\n\nPELVIS: Brachytherapy seeds within the prostate noted. The urinary bladder\nappears unremarkable. The ureters opacified normally. No pelvic sidewall or\ninguinal adenopathy is detected.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes in the lumbar spine appear most pronounced at L3-4 and\nL5-S1 with loss of disc space.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New tiny right pleural effusion. Fibrosis re- demonstrated at the lung\nbases.\n2. No acute findings in the abdomen pelvis.\n3. Bowel containing inguinal hernias appear uncomplicated." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple subcentimeter hypodensities within both hepatic lobes\nare too small to characterize by CT but are unchanged from CT abdomen and\npelvis from ___. There is no biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable\n\nADRENALS: Unremarkable.\n\nURINARY: Multiple cortical hypodensities within both kidneys are too small to\ncharacterize by CT but unchanged from ___. A 2.4 cm simple renal\ncyst is again demonstrated in the left kidney. No hydronephrosis.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Loops of ileum are\ndemonstrated within the right inguinal hernia. The left inguinal hernia\ncontains sigmoid colon. No evidence of bowel obstruction. No ascites.\n\nPELVIS: Brachytherapy seeds are again seen within the prostate. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: No lymphadenopathy in the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Bilateral inguinal hernias containing bowel, as on prior.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Bilateral bowel containing inguinal hernias without bowel obstruction, as\non prior.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Few scattered subcentimeter hypodensities are too small to\ncharacterize, however remain unchanged in appearance since prior study from ___. There is no biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: There is a 2.4 cm simple cyst in the left mid to lower pole,\nunchanged. Additional subcentimeter hypodensities are too small to\ncharacterize, though stable in appearance and likely compatible with simple\ncysts. No hydronephrosis.\n\nGASTROINTESTINAL: Small hiatal hernia is unchanged. Right inguinal hernia\ncontains nonobstructed loops of ileum. Left inguinal hernia contains\nnonobstructed loops of sigmoid colon. No evidence of bowel obstruction or\nascites.\n\nPELVIS: There is no free fluid in the pelvis.Numerous brachytherapy seeds are\nagain seen within the prostate.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Right inguinal hernia contains nonobstructed loops of ileum. \nLeft inguinal hernia contains nonobstructed loops of sigmoid colon.", "output": "1. Stable examination with no evidence of metastatic disease within the\nabdomen or pelvis.\n2. Bilateral inguinal hernias containing nonobstructed bowel, unchanged.\n3. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nFatty atrophy of the right latissimus dorsi muscles noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple sub cm hypodensities in the liver are unchanged from prior\nexaminations likely represent cysts or biliary hamartomas. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Region of calcification within\nthe pancreatic tail likely represents a thrombosed splenic artery is\npseudoaneurysm and appears not significantly changed compared to prior\nexamination ___. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple hypodensities in the kidneys bilaterally statistically likely\nrepresent simple cysts though many too small for accurate characterization. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of metastatic disease within the abdomen or pelvis. Chronic\nfindings as above." }, { "input": "LOWER CHEST: There is moderate traction bronchiectasis at the right lung base.\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensities in segment 4A (9:21) and 5 (9:8) are too small to\nfurther characterize, though are unchanged since prior exam from ___ and most consistent with simple hepatic cysts or biliary hamartomas. No\nconcerning hepatic lesions identified. There is no evidence of intrahepatic\nor extrahepatic biliary ductal dilatation. The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral renal hypodensities, the largest in the interpolar aspect\nof the right kidney measuring 4.2 x 3.4 cm, are unchanged since at least\n___ and most likely represent simple renal cysts. No focal\nconcerning renal lesions identified. No hydronephrosis or obstructing stone\nin either kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. Prostatic\ncalcifications are noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Diffuse atherosclerotic\ndisease is noted. Rounded calcification within the pancreatic tail is most\nconsistent with a thrombosed splenic artery pseudoaneurysm, similar to prior\nexam.\n\nBONES: Left total hip arthroplasty in situ. Mild-to-moderate degenerative\nchanges of the visualized lumbosacral spine. No lytic or blastic osseous\nlesions suspicious for malignancy or infection are identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Subcentimeter hypodensities in segments 4A and 5 of the liver, too small\nfurther characterize, likely represent hepatic cysts.\n3. Bilateral renal hypodensities, the majority of which are too small to\nfurther characterize, most consistent with simple renal cysts.\n4. Please refer to separate, same-day CT chest report for further description\nof intrathoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: No new focal liver lesion. There are stable hepatic\nhypodensities which are too small to characterize possibly cysts or\nhamartomas. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder surgically absent\n\nPANCREAS: There is a stable area of coarse calcification at the pancreatic\ntail. Coarse calcification is also demonstrated anterior to pancreatic head. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are stable bilateral renal hypodensities including the\npreviously described indeterminate interpolar 1 cm lesion on the left. There\nis no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a focal area of mucosal thickening along the\ngastric fundus, measuring 3.5 by 4.6 cm with possible ulceration (series 4,\nimage 62, series 17, image 34). Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. There is sigmoid colon\ndiverticulosis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: No concerning bone lesion. There is moderate right hip osteoarthritis.\nThere is a left total hip arthroplasty in satisfactory appearance without\nevidence of hardware related complication. Incidental note is made of L5\nspondylolysis. Minimal anterolisthesis of L5 with respect to S1. Multilevel\ndegenerative changes in the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is a focal area of mucosal thickening along the gastric fundus,\nmeasuring 3.5 by 4.6 cm with possible ulceration (series 4, image 62, series\n17, image 34). Recommend evaluation with gastroscopy.\n2. Otherwise stable appearance. No evidence of metastatic disease in the\nabdomen.\n\nRECOMMENDATION(S): Gastroscopy.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 10:28 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: There is mild atelectasis at the bilateral lung bases. A tiny\ncalcified nodule in the right lower lobe is consistent with a calcified\ngranuloma. Please see the separate report of the CT chest performed on the\nsame date.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: A 4 mm hypodensity in the pancreatic head (02:58) appears to be due\nto interdigitation of fat and is unchanged compared to the prior study. No\nother focal pancreatic lesions are seen. No pancreatic duct dilatation. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nTiny subcentimeter hypoenhancing lesion in the upper pole the left kidney is\ntoo small to characterize but statistically likely represents a cyst. No new\nrenal lesions seen. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The cecum is\nlocated in the right upper quadrants, the appendix is visualized in the right\nflank region is unremarkable in appearance (601:30). There is moderate\nsigmoid diverticulosis without evidence acute diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is moderately enlarged, unchanged from\nthe prior study.\n\nRETROPERITONEUM AND MESENTERY: There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy. There is no\nabdominal aortic aneurysm. Mild atherosclerotic disease is noted. The\nmesenteric vessels appear patent.\n\nBONES: Degenerative disease noted at in L1-L 2. No fracture seen. A small\nsclerotic focus in the proximal right femur is unchanged compared to multiple\nprior studies, nonspecific in appearance and likely representing a bone\nisland.\n\nSOFT TISSUES: Fat containing left inguinal hernia.", "output": "1. No abdominopelvic metastases or lymphadenopathy.\n2. Please see the separate report for the CT chest performed on the same date." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThe portal vein is patent.\n\nPANCREAS: 4 mm focal hypodensity within the pancreatic head is unchanged\ncompared to prior examinations, and demonstrates fat attenuation, likely\nrepresenting interdigitation of fat (5:68). The pancreas otherwise has normal\nattenuation throughout, without evidence of suspicious focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. There a 9 mm hypodense lesion of the left lower\npole kidney (05:39) slightly increased compared the prior study, incompletely\ncharacterized, though most likely to represent a cyst. A punctate cortical\ndefect of the right lower pole kidney is unchanged, suggestive of prior\ninsult. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a focal segment of\njejunum which demonstrates concentric hypoattenuating prominence of the wall\n(05:41), which is somewhat not well characterized. The remainder of the small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is sigmoid predominant diverticulosis without associated\ninflammatory change. The large bowel is otherwise thin-walled and\nunremarkable without pericolonic fat stranding or fluid collection.\n\nPELVIS: The bladder is only mildly distended, though there is concentric\nprominence of the bladder wall in the setting of an enlarged prostate. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged, particularly with prominent\nhyperplasia of the median lobe indenting into the bladder. The seminal\nvesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel lumbar degenerative changes with up to severe disc space\nnarrowing at L1-L2 with grade 1 retrolisthesis at this level. There is also\nmoderate disc space narrowing at L4-L5.\n\nSOFT TISSUES: There are small to moderate left and small right fat containing\ninguinal hernias. The abdominopelvic soft tissues are otherwise grossly\nunremarkable. A subtle 7 mm sclerotic focus in the right proximal femur is\nunchanged since at least ___, probably a bone island.", "output": "1. Focal hypoattenuating mural prominence of a short segment of the jejunal\nwall is not fully characterized and could represent mixing of contrast, though\nsmall bowel metastasis, particularly given the history of melanoma is not\nexcluded. Short-term interval follow-up examination in 3 months or\nGI/surgical consultation is advised.\n2. Interval increase in size of a 9 mm hypoattenuating left lower pole renal\nlesion, which still most likely represents a cyst. Confirmation with renal\nultrasound is recommended.\n3. Otherwise no other evidence of abdominopelvic metastasis.\n4. For thoracic findings, please refer to the separately dictated report.\n\nRECOMMENDATION(S):\n1. Short-term three-month follow-up CT examination or GI/surgical\nconsultation.\n2. Renal ultrasound.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:36 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. A 5 mm hypoattenuating focus\nwithin the pancreatic head (2:69) favors focal fat. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter hypodensity in the lower pole of the left kidney is unchanged,\nlikely a simple cyst. There is no evidence of suspicious renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a near\ncircumferential mass in the jejunum, increased in size compared to CT of the\nabdomen/pelvis from ___ and now demonstrating ulceration and a new\nextramural nodular component (601:34, 2:86), overall measuring up to 2.1 cm in\nthickness, previously 1.0 cm. Adjacent to the mass, there are two new,\nenlarged mesenteric lymph nodes measuring 1.1 cm and 1.5 cm in short axis\n___, 2:79-82). Findings could represent primary jejunal adenocarcinoma\nversus melanoma metastasis to bowel. The remainder of the small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis no bowel obstruction. Descending sigmoid colonic diverticulosis is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and projects into the bladder\nbase. The seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is moderate loss of disc height at L1-2 and L4-5. There is\nminimal retrolisthesis of L1 on L2. There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: Unchanged fat-containing left inguinal hernia.", "output": "1. Near circumferential mass in the jejunum, increased in size compared to CT\nof the abdomen/pelvis from ___ and now demonstrating ulceration\nand a new extramural nodular component. Two new, enlarged mesenteric lymph\nnodes adjacent to the mass. Findings could represent primary jejunal\nadenocarcinoma versus melanoma metastasis to bowel.\n2. Prostatomegaly.\n3. Diverticulosis.\n4. Moderate size fat-containing left inguinal hernia.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:19 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size. A 7 mm hypoenhancing lesion in the\nspleen appears new (series 5, image 67). Enhancing, round structure at the\nsplenic hilum is consistent with an accessory spleen (series 5, image 65).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nTiny renal cortical hypodensities are too small to accurately characterize on\nCT. No hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: Ingested enteric contrast reaches the distal small bowel. \nThe stomach is unremarkable.\n\nFocal thickening of a short segment of proximal jejunum in the left upper\nabdomen is again demonstrated and consistent with metastasis, smaller from\nprior (series 5, image 79; series 9, image 21 common 20, 18). There is mild\nfocal narrowing of the lumen but oral contrast is seen distally. Surrounding\nfat stranding is moderate. Multiple adjacent mesenteric lymph nodes remain\nenlarged, now measuring up to 12 mm in short axis, smaller from prior X (e.g. \nSeries 5, image 76; series 9, image 20, 22, 19).\n\nColonic diverticulosis is most pronounced in the sigmoid colon where it is\nsevere. The rectum is within normal limits. The appendix is normal. No\nbowel obstruction.\n\nPELVIS: The urinary bladder is underdistended, limiting evaluation. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is markedly enlarged.\n\nLYMPH NODES: Mesenteric lymphadenopathy is detailed in the GI section of this\nreport. No evidence of retroperitoneal, pelvic, or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Multilevel\ndegenerative changes in the lumbosacral spine are moderate. Mild\nretrolisthesis of L1 on L2 with severe loss intervertebral disc height is\nunchanged.\n\nSOFT TISSUES: A fat containing left inguinal hernia is small (series 5, image\n112).", "output": "New 7-mm hypoenhancing splenic lesion. Otherwise, interval metastatic disease\nimprovement with decrease in size of the proximal jejunal mass and adjacent\nenlarged mesenteric lymph nodes.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:27 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please refer to the separately dictated CT of the chest from\nearlier on the same date for full description of the intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of concerning focal hepatic lesions. There is a small\namount of pneumobilia predominantly affecting the left hepatic lobe which is\nnot unexpected in the setting of a common bile duct stent. There is no\nsignificant intra or extrahepatic biliary dilatation. The common bile duct\nstent appears well positioned. The patient is status post cholecystectomy.\n\nPANCREAS: The pancreas demonstrates main duct dilatation measuring up to 6 mm\nin the pancreatic head and body (6:68). This dilated duct is seen up to the\nlevel of the pancreatic head before it disappears from view. In the posterior\naspect of the pancreatic head there is a 2.2 x 1.9 hypodense poorly defined\nmass (13:38). There is extensive stranding extending from this mass and\ninvolving the surrounding vascular structures. There is more than 180 degree\ninvolvement of the superior mesenteric vein (13:36). In addition, numerous\njejunal branches of the SMV are also involved. While the proximal portion of\nthe SMA demonstrates a fat plane separating the stranding from the vessel,\nmore distally there is almost circumferential involvement of the SMA and at\nleast one arterial jejunal branch is also involved (13:39). Stranding is seen\nmore inferiorly surrounding a collection of superior mesenteric vein\ntributaries (6:83).\n\nSPLEEN: The spleen demonstrates normal size and attenuation. There is no\nevidence of concerning focal lesion.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys are of normal symmetric size within normal nephrogram. \nThere is no evidence of concerning focal renal lesion or hydronephrosis. No\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach appears grossly\nunremarkable, not well evaluated on CT. There is no evidence of small-bowel\nobstruction. There is a ventral abdominal wall hernia containing fat and\nloops of small bowel without evidence of soft tissue stranding or other signs\nof incarceration. There is sigmoid diverticulosis without evidence of\ndiverticulitis. The rectum is unremarkable. The appendix is not visualized.\n\nPELVIS AND REPRODUCTIVE ORGANS: Please note that evaluation of the distal\npelvis is limited somewhat secondary to beam hardening artifact associated\nwith bilateral hip arthroplasties. Within limitation of the study the urinary\nbladder appears within normal limits. The reproductive organs appear\nunremarkable.\n\nLYMPH NODES: There is a 1.6 x 1.0 cm gastroduodenal lymph node (13:28). No\nother lymphadenopathy within the abdomen pelvis is appreciated, however\nevaluation is somewhat limited due to the extent of the peripancreatic\nstranding.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild to moderate calcified\natherosclerotic plaque is noted.\n\nBONES: As above, there are bilateral hip arthroplasties. Sternotomy wires are\npartially visualized. There is no worrisome osseous lesion or acute fracture.\n\nSOFT TISSUES: As above there is a large ventral wall hernia. Otherwise, soft\ntissues of the abdominopelvic walls are within normal limits.", "output": "1. Poorly defined, hypodense pancreatic head mass with associated main duct\ndilatation and significant vascular involvement as outlined above.\n2. Expected pneumobilia in the setting of a CBD stent. The CBD stent appears\nappropriately positioned.\n3. Please refer to the separately dictated CT of the chest from earlier on the\nsame date for full description of the intrathoracic findings." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. Pneumobilia most notably involving the left\nhepatic lobe is again noted, not significantly increased when compared to the\nstudy from ___. There has been interval exchange and upsizing of the\ncommon bile duct stent. The stent terminates in the second duodenal segment. \nThe gallbladder is is resected.\n\nPANCREAS: The previously characterized hypodense mass in the head of the\npancreas is not clearly defined in today's study. At the same location there\nis an ill-defined hypodensity measuring approximately 1.5 x 1.4 cm (3:153). \nThere has been interval resolution of the extensive stranding seen in the\nprevious study involving primarily the SMV and jejunal branches, although this\nregion continues to abut the posterior aspect of the primary jejunal branch\n(3:159).\nA prominent gastroduodenal lymph node now measures 1.3 x 0.9 cm, previously\n1.6 x 1.0 cm (3:134). A porta hepatis lymph node previously measuring 1.0 cm\nnow measures 0.8 cm (3:127). No new pancreatic lesions are demonstrated. The\npancreatic ductal dilatation is largely unchanged.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Several small cortical hypodensities are seen bilaterally, too small\nto characterize. Otherwise, the kidneys are of normal and symmetric size with\nnormal nephrogram. There is no evidence of stones, focal renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: A common bile duct stent terminates in the second duodenal\nsegment as noted above. Otherwise, the small bowel loops demonstrate normal\ncaliber, wall thickness and enhancement throughout. There is no evidence of\nobstruction. Colon and rectum are within normal limits.\n\nRETROPERITONEUM: Excluding the prominent gastroduodenal and porta hepatis\nlymph nodes described above, there is no evidence of abnormally enlarged lymph\nnodes elsewhere concerning for lymphadenopathy.\n\nPELVIS: Evaluation of the pelvis is limited by metallic streak artifact from\nthe prostheses of the bilateral total hip arthroplasties. Within this\nlimitation, the urinary bladder and distal ureters appear grossly\nunremarkable.\nIn comparison with the prior study, a left iliopsoas rim enhancing lesion has\nincreased in size, now measuring 4.2 x 1.8 x 1.3 cm previously 1.2 x 1.0 x 1.9\ncm (3:220).\nThere is no evidence of pelvic or inguinal lymphadenopathy. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Limited visualization of the reproductive organs by\nartifact caused by the total hip arthroplasty bilaterally demonstrate no gross\nabnormalities.\n\nBONES: Bilateral total hip arthroplasties are again demonstrated. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing a loop of small bowel and partial\nintrusion of the transverse colon are present (3:180, 193). Otherwise, the\nabdominal and pelvic wall is within normal limits.", "output": "1. Less conspicuous appearance of ill-defined hypodense mass in the head of\nthe pancreas now measuring approximately 1.5 x 1.4 cm, previously 2.2 x 1.9\ncm.\n2. Interval resolution of peripancreatic stranding associated with the mass\npreviously involving the SMV.\n3. Interval increase in size of left iliopsoas rim enhancing lesion now\nmeasuring approximately 4.2 x 1.8 x 1.3 cm, previously 1.2 x 1.0 x 1.9 cm.\nThis could reflect a progressing psoas abscess, evolving hematoma, or\nmalignancy." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. Redemonstration of stable pneumobilia,\ninvolving the left hepatic lobe (series 4, image 29). Patient is status post\ncholecystectomy. Redemonstration of a common bile duct stent terminating in\nthe second portion of the duodenum.\n\nPANCREAS:\n PANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 1.6 x 1.3 cm\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nDilatation of the 5 mm\nBiliary tree abrupt cutoff with or without upstream dilatation: Biliary stent\nin place\n\nArterial evaluation\n\n___ involvement: absent\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to first ___ branch: Absent\n\nCeliac Axis involvement: absent\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: absent\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to celiac axis: absent\nExtension to bifurcation of right/left hepatic artery: Absent\n\nVariant anatomy: none\nVariant vessel contact: absent\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\n\nVenous evaluation\n\nMPV involvement: absent\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\n\nSMV involvement: present\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein: present\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: Stable prominent gastric duodenal lymph node,\nmeasuring 1.2 x 1 cm (previously 1.3 x 0.9 cm) (series 4, image 39). Stable\nprominent porta hepatic lymph node, measuring 1.4 x 1 cm (previously 1 x 0.8\ncm) (series 4, image 34).\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a stable small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Again\nvisualized are sigmoid diverticulosis without evidence for diverticulitis. \nThere is no evidence of mesenteric lymphadenopathy.\n\nPELVIS: The evaluation of the distal pelvis is limited secondary to beam\nhardening artifacts from bilateral hip arthroplasties. Within limits of the\nstudy, the urinary bladder air without organ appears unremarkable.\n\nBONES: Patient is status post bilateral hip arthroplasties.\n\nSOFT TISSUES: Redemonstration of an ventral abdominal wall hernia, containing\nfat as well as small bowel with no evidence of stranding or incarceration\n(series 4, image 90). Redemonstration of a 2 x 1.5 x 1.5 cm left psoas\nheterogeneous partially rim enhancing lesion (series 6, image 55; series 4,\nimage 110), which previously measured 4.2 x 1.8 x 1.3 cm in ___ and\nwas much more conspicuous.", "output": "1. Stable pancreatic head mass, measuring 1.6 x 1.3 cm, contacts the SMV and\nits first draining vein. Grossly unchanged main pancreatic duct dilation. \nFurther staging as detailed above.\n2. Stable prominent gastric duodenal and porta hepatic lymph nodes.\n3. Interval decrease in size and conspicuity of left psoas lesion.\n4. Chronic findings include small hiatal hernia, sigmoid diverticulosis,\nventral abdominal wall hernia, bilateral hip arthroplasties.\n5. Stable common bile duct stent." }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver has diffusely low attenuation consistent with fatty\ndeposition. No focal hepatic lesion. There is mild central left intrahepatic\nbile duct dilation that is similar to the preoperative appearance. Central\nintrahepatic duct walls show mild thin enhancement, as expected. There is a\nhepaticojejunostomy along the anterior aspect of the porta which has the\nexpected appearance. The gallbladder is surgically absent.\n\nPANCREAS: Since the prior CT, the patient has undergone a Whipple procedure\nwith resection of the pancreatic head, neck, uncinate process, and first and\nsecond portions of the duodenum. The pancreas is markedly atrophic in the\nbody and the proximal tail with the most parenchyma remaining in the distal\ntail, unchanged from prior. The pancreatic duct is currently tiny with the\nprior dilation resolved. Pancreaticojejunal anastomosis has the expected\nappearance. No evidence of tumor.\n\nVASCULAR:\nThere is no abdominal aortic aneurysm with mild-moderate atherosclerotic\ncalcifications but no definite flow-limiting stenosis in the major arteries of\nthe abdomen or pelvis. SMV, portal vein, and splenic vein are all patent\nwithout thrombus. Renal vasculature appears widely patent.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance, with contrast symmetrically. No hydronephrosis\nor stones. No concerning focal lesion with a few scattered subcentimeter\nlesions that are too small to characterize definitively.\n\nGASTROINTESTINAL: The gastrojejunal anastomosis status post duodenectomy with\nRoux-en-Y gastrojejunostomy and pancreatico- and hepaticojejunostomy have the\nexpected appearance. No evidence of obstruction. Surgical sutures are seen\nwithin the root of the mesentery caudal to the pancreatic and biliary\nanastomoses with a small amount of surrounding soft tissue that is\npredominantly linear with the fibrotic appearance as expected. As before, the\nappendix is in the right upper quadrant at the upper limits of normal in size\nat some portions measuring 7 mm in diameter..\n\nRETROPERITONEUM: No retroperitoneal adenopathy or fluid collection. No\nintra-abdominal adenopathy either.\n\nPELVIS: Portions of the pelvis are obscured by streak artifact from bilateral\nhip arthroplasties including the majority of the prostate and urinary bladder\nand portions of the deep pelvis and pelvic side walls. Within these\nlimitations, no definite abnormality is seen. No pelvic adenopathy evident. \nNo free fluid evident.\n\nBONES: No concerning bone findings with mild-moderate multilevel lumbar disc\ndegeneration. Bilateral bipolar hip arthroplasties are unchanged in\nappearance with persistent lucency in the right acetabulum about the\nanterior-most screw.\n\nSOFT TISSUES: Surgical changes are seen within the anterior abdominal wall in\nthe midline without evidence of hernia or fluid collection.", "output": "Expected appearance of the pancreas and anastomoses post Whipple procedure. \nSmall amounts of scarring about suture lines in the mesentery related to the\npancreaticojejunostomy and hepaticojejunostomy is expected. No findings\nconcerning for tumoral recurrence.\n\nFatty liver." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nfocal renal lesions or hydronephrosis. There are two unchanged tiny\nnonobstructing left renal stones measuring 3 and 4 mm respectively (03:41,\n03:43). There is no perinephric abnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Colon and rectum are within normal limits. Appendix\ncontains air, has normal caliber without evidence of fat stranding. There is\nno evidence of mesenteric lymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears bulky, similar to the ___\nexamination, but incompletely characterized on this noncontrast study (series\n6, image 39).\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions.\nSurgical clips overlie the midline abdominal wall (series 5, image 15). There\nis no hernia.", "output": "1. Two nonobstructing left renal calculi measuring 3 and 4 mm.\n2. Bulky uterus likely related to uterine fibroids as seen on the prior CT\nexamination from ___." }, { "input": "LOWER CHEST: There is bilateral dependent atelectasis. Otherwise the lung\nbases are clear. No pleural or pericardial effusion. The heart is mildly\nenlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is a 2.2 cm gallstone with rim\ncalcification in the gallbladder neck. Apparent discontinuity of the\ngallbladder wall near the gallbladder fundus is secondary to motion artifact\n___, image 19). There is pericholecystic fluid. There is soft tissue\nstranding and fluid tracking along the right abdomen. Findings are suspicious\nfor acute cholecystitis.\n\nPANCREAS: The pancreas is atrophic without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is delayed nephrogram of the right kidney. There is mild right\nhydroureteronephrosis. Air is seen within the right collecting system and\nbladder most likely due to recent instrumentation per clinical team and\nconsistent with reflux to the right kidney. Multiple subcentimeter\nhypoattenuating lesions throughout the bilateral kidneys are too small to\ncharacterize but most likely representing cysts. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel\ndemonstrate no obstruction. The colon and rectum are within normal limits. \nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There is a calcified right\novarian cyst measuring 2.3 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is an old healed right inferior pubic ramus fracture. There are\nmultilevel degenerative changes of the lumbar spine. There is grade 1\nanterolisthesis of L4 on L5. There is scoliosis of the lumbar ___\non the right.\n\nSOFT TISSUES: There is a 3.3 x 2.0 cm lipoma in the left transverse abdominal\nmuscle series 2, image 52). There is a small fat containing umbilical hernia.", "output": "1. Cholelithiasis with cholecystic fluid and stranding and fluid along the\nright-sided abdomen concerning for acute cholecystitis. Ultrasound is\nrecommended for further evaluation.\n2. Delayed nephrogram of the right kidney which could be due to\nreflux/obstruction. Correlation with laboratory findings for evaluation of\nurinary tract infection is recommended.\n3. Mild right hydroureteronephrosis with air seen in the right collecting\nsystem and bladder suggesting recent instrumentation and reflux.\n4. Calcified right ovarian cyst, for which follow-up with pelvic ultrasound in\n___ year is recommended.\n5. No additional acute process within the abdomen or pelvis.\n\nRECOMMENDATION(S): Urinalysis. Pelvic ultrasound in ___ year.\n\nNOTIFICATION: The findings were discussed with SICU resident by ___\n___, M.D. on the telephone on ___ at 9:04 am, 5 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple bilateral subcentimeter cortical hypodensities, too small\nto characterize by CT. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nextensive colonic diverticulosis without evidence of diverticulitis. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "There is extensive colonic diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodense lesions in the liver are too small to characterize and\nlikely represents biliary hamartomas or cysts (2; 20). There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis. There are left parapelvic cysts. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.", "output": "No acute intra-abdominal process to explain patient's symptoms." }, { "input": "LOWER CHEST: Ground-glass opacities within the dependent portion of the lungs\nbilaterally likely reflects atelectasis. No focal consolidations. Coronary\nand aortic valvular calcifications are demonstrated. No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hypodensities throughout the liver likely represent\ncysts or biliary hamartomas. There is heterogeneous enhancement throughout\nthe liver, which may be due to phase of contrast, but raises suspicion for\nunderlying liver disease. There is a peripherally calcified lesion within the\nleft lobe, likely benign (series 2, image 20). The main portal vein is\npatent. There is no evidence of focal enhancing lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There appears to be distal splenic vein thrombosis. The spleen is\natrophic, likely representing chronic infarction.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Scarring is seen at the upper pole of the kidneys bilaterally, right\ngreater than left. Multiple hypodensities within the kidneys bilaterally,\nsome of which are consistent with simple cysts, others which are too small to\ncharacterize, but also likely represent simple cysts. Otherwise, kidneys are\nof normal and symmetric size with normal nephrogram. There is no evidence of\nenhancing renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. There is fluid throughout the small bowel loops and within the\nproximal colon, likely representing gastroenteritis. Otherwise, small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Although this examination is limited due to lack of\narterial phase, the celiac artery is not visualized, raising concern for\ncomplete occlusion. There is also complete occlusion of the proximal SMA,\nhowever there appears to be distal reconstitution. Dense atherosclerotic\nplaque at the origin of the renal arteries bilaterally, however they appear\npatent. The ___ also appears patent.\n\nBONES: Moderate scoliosis of the lumbar spine with grade 1 retrolisthesis of\nL2 on L3. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Fluid-filled small and large bowel loops, likely representing\ngastroenteritis. No bowel wall thickening.\n2. Extensive atherosclerotic disease. Although this examination is limited\ndue to lack of arterial phase, the celiac artery and its branches are not\nvisualized, raising concern for occlusion. There is also complete occlusion\nof the proximal SMA with distal reconstitution. These are likely chronic.\n3. Heterogeneous appearance of the liver, which may be due to phase of\ncontrast, however should be correlated with LFTs.\n4. Diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: The lower lungs are only partially imaged. Diffuse\nperibronchovascular nodules in the right lower and middle lobes are new from\nthe prior exam and compatible with small airways disease, possibly due to\naspiration or infection. The partially imaged left lung is clear. No\npericardial or pleural effusion. The distal esophageal wall is slightly\nedematous which could suggest sequelae of reflux and/or esophagitis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent with clips in the\ngallbladder fossa.\n\nPANCREAS: The pancreas is very atrophic. The pancreas has normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nNo peripancreatic fat stranding or fluid collections.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral extrarenal pelvises. No concerning focal renal lesions,\nhydronephrosis, or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized, but no\nsecondary signs of acute appendicitis are noted. No bowel obstruction, free\nair, or intra-abdominal fluid collection.\n\nPELVIS: The urinary bladder is markedly distended are unremarkable. The\ndistal ureters are unremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient appears to be post hysterectomy. No adnexal\nmasses.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy by CT size criteria. A few small right external\niliac chain lymph nodes measure up to 4 mm, unchanged (series 2, image 74,\n76).\n\nVASCULAR: No abdominal aortic aneurysm. Moderate diffuse atherosclerotic\ndisease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Multilevel\ndegenerative changes are moderate to severe, most pronounced at L4 through S1\nand in the lower thoracic spine. Posterior fixation hardware with left\npedicle screws at L5 and L4 are unchanged appear appropriate in position. \nSclerotic focus in the left proximal femur likely reflects a bone island.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia with moderate\nfat stranding, unchanged (series 2, image 60; series 602b, image 43). There\nis a small ventral fat containing right upper abdominal wall hernia (series 2,\nimage 35; series 602b, image 43). There is a small fat containing midline\npelvic wall hernia (series 2, image 73; series 602b, image 44).", "output": "1. No acute abnormality identified within the abdomen or pelvis to account for\nthe patient's abdominal pain. No CT evidence for colitis or bowel\nobstruction.\n2. New right middle lobe and left lower lobe peribronchovascular nodules\nsuggesting small airways disease, either due to aspiration or infection.\n3. Slightly edematous distal esophagus could suggest reflux and/or sequelae of\nchronic esophagitis.\n4. Multiple fat containing umbilical and ventral hernias as above. Perhaps\nmild-to-moderate fat stranding in the umbilical hernia, however, similar to\nthe prior exam." }, { "input": "There are bilateral pleural effusions, right more than\nleft with associated atelectasis/consolidation. Below the diaphragm, the\nliver is visualized and the patient is status post segment IV resection with\nsome fluid in the resection bed as well as some locules of air, which may be\npost-surgical.\n\nA surgical drain is seen at the site of the resection. Some bubbles of air\nare seen just over the liver surface and again may be postoperative. No focal\nenhancing lesions within the liver. The spleen is visualized and is normal.\nThe portal vein is patent. The upper abdominal aorta is dilated at 4.1 cm in\ntransverse x 3.8 cm in AP diameter. The celiac artery is patent and gives\nrise to the splenic artery. The SMA is patent and gives rise to the common\nhepatic artery. The ___ is patent. The aorta is calcified throughout its\nlength. Calcification is seen at the origin of the right renal artery.\n\nThe adrenals and kidneys are normal apart from a simple cyst in the lower pole\nof the right kidney which measures 2.7 cm in maximum diameter. The pancreas\nis normal. The bowel where visualized is normal. No significant\nlymphadenopathy. No significant free fluid.\n\nCT OF PELVIS FINDINGS: Some air is seen in the bladder, which may be\nsecondary to previous catheterization. The prostate is normal. Some fat\ncontaining inguinal hernias are noted bilaterally. Some minimal free fluid is\nalso identified in the pelvis.\n\nBony windows reveal no suspicious sclerotic or lytic lesions. Multiplanar\nreconstructions were essential in depicting the anatomy and identifying the\npathology.", "output": "1. Fluid with some locules of air at the site of the previous hepatic\nresection in segment IV which is postoperative change. Surgical drain in\nsitu.\n2. Some perihepatic free fluid and some small locules of air which are\nconsistent with postoperative change.\n3. Bilateral pleural effusions and associated atelectasis/consolidation. \n4. Right lower pole renal cyst.\n5. Minimal free fluid in the pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is smaller in diameter compared\nto prior measuring 6 mm with decreased surrounding inflammation, consistent\nwith resolving appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Normal appearance of the appendix. No acute findings in the abdomen pelvis to\naccount for pain." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is perisplenic subcapsular intermediate\ndensity material measuring 7 mm in thickness. Some minimal associated\ncalcification is demonstrated (series 2, image 23). This is new compared to\n___ exam.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. There is focal thickening\nof the distal esophagus which is nonspecific. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Postsurgical\nchanges and suture material are visualized in the distal sigmoid suggestive of\npartial resection. Diverticulosis is visualized throughout the colon, without\nevidence of wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nUnchanged prominence of bilateral distal external iliac lymph nodes (series 2,\nimage 79).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen in the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of colitis.\n2. Focal thickening of the distal esophagus for which follow-up\ncharacterization with endoscopy is recommended.\n3. New focal perisplenic material could represent subacute perisplenic\nhematoma or less likely infiltrative process. Recommend correlation with any\nrecent prior imaging if available for further characterization or if not\navailable follow-up short-term CT in ___ months to document stability and/or\nresolution.\n4. Diverticulosis without evidence of diverticulitis." }, { "input": "Heart size appears top-normal. There is a small complex right-sided pleural\neffusion with compressive atelectasis, the density of which has decreased\nsince prior indicative of evolving hemothorax. There is trace dependent\natelectasis in the left lung base.\n\nCT abdomen with contrast: There is re- demonstration of a geographic\nhypodensity surrounding 2 fiducial markers in hepatic segments VII and VIII\nwith internal hyperdensity, unchanged compared to the ___ examination\nagain representative of coagulative necrosis post radiofrequency ablation. \nTiny locules of gas are seen within the area of ablation, not seen on the\nprior CT exam. Two other sites of hypodensity reflecting previous sites of\nradiofrequency ablation are unchanged. Small subcapsular and perihepatic\nhematoma is smaller compared to the prior exam along with decrease in density\ncompatible with evolution. There is no evidence of active extravasation on\nthis single phase examination. The gallbladder is again distended with\nmultiple gallstones. The portal vein appears patent.\n\nThe spleen and adrenal glands are unremarkable. The pancreas appears atrophied\nbut is otherwise unremarkable. There is re- demonstration of a millimetric\nhypodensity in the right interpolar kidney, not completely characterized but\nlikely a cyst. The kidneys otherwise present symmetric nephrograms and\nexcretion of contrast without focal solid mass, hydronephrosis or perinephric\nabnormality.\n\nThe stomach, duodenum and remainder of the small bowel is unremarkable without\nobstruction. The large bowel is thin-walled and unremarkable. There is mild\nfecal loading.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment.\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThere is no ascites, pneumoperitoneum or abdominal wall hernia.\n\nCT pelvis with contrast: Small locules of gas are seen within otherwise\nunremarkable bladder. The prostate is mildly enlarged. The rectum is\nunremarkable. There is no free pelvic fluid or air. There is no inguinal or\npelvic sidewall lymphadenopathy by CT size retained.\n\nOsseous structures: There is no suspicious focal osseous lesion. Mild\ndegenerative changes are noted throughout the visualized thoracolumbar spine.\nThere is grade 1 anterolisthesis of L3 on L4, unchanged.", "output": "1. Re- demonstration of geographic hypodensity in hepatic segments VII/VIII in\narea of recent radiofrequency ablation appearing unchanged compared to the\n___ examination. Unchanged area of internal hyperdensity in the\nablation zone is compatible with coagulative necrosis. Interval development of\nsmall locules of gas within the ablation site, most likely reflective of\nnecrosis in the absence of any signs of infection.\n2. Interval decrease in size and complexity of a small subcapsular and\nperihepatic hematoma. No new focus of hemorrhage.\n3. Re-demonstration of complex right-sided pleural effusion compatible with\nevolving hemothorax, similar in size but with interval decrease in density. \nAssociated partial collapse of the right lower lobe.\n4. Air in the bladder lumen; correlate with recent instrumentation.\n5. Cholelithiasis." }, { "input": "LOWER CHEST: The evaluation of the lung bases is slightly limited due to\nmotion. Within these limitations, visualized lung fields are within normal\nlimits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is markedly distended. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. There is a\nradiopaque substance within some loops of small bowel, consistent with\npatient's previous consumption of Pepto-Bismol. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: Bladder is decompressed with Foley catheter in place. Distal ureters\nare unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Marked gastric distension. Otherwise unremarkable exam." }, { "input": "LOWER CHEST: Atherosclerotic calcifications are seen in the lung bases. There\nis no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates nodular contour and appears shrunken,\ncompatible with known cirrhosis. There is a focus of hyperenhancement in the\nliver dome (series 3: Image 12) without definite washout on the delayed\nimages. A small amount of perihepatic ascites is noted. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is\ndistended and contains gallstones without wall thickening or surrounding\ninflammation. There is mild pericholecystic fluid, likely related to the\nunderlying hepatic disease. The main portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is calcified and atrophic.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a millimetric hypodensity in the right kidney, too small to fully\ncharacterize. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is mildly\ndiffuse thickening of the colon, which can be seen in portal colopathy. \nColonic diverticulosis is noted without evidence of acute diverticulitis. The\nrectum is unremarkable. There is mild mesenteric edema.\n\nPELVIS: The urinary bladder is decompressed. There is a small amount of\nfree-fluid seen in the deep pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There are multiple prominent portal hepatis and para-aortic lymph\nnodes, the largest measuring up to 1.1 cm (series 3: Image 162). There is no\npelvic or inguinal lymphadenopathy. There is no mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cirrhotic appearing liver with perihepatic ascites. A focus of enhancement\nis seen in the liver dome without definite washout on the delayed scans and\nmay represent a perfusion abnormality, for which close attention on follow up\nexams is recommended.\n2. A few prominent portal hepatis and retrocaval lymph nodes are noted, likely\nreactive.\n3. Cholelithiasis.\n\nRECOMMENDATION(S): Close attention on a follow up study in 6 months is\nrecommended for the focus of enhancement along the liver dome." }, { "input": "LOWER CHEST: Atelectasis or scarring within the lung bases bilaterally. No\nfocal consolidations. No suspicious lung nodules. No pleural or pericardial\neffusion.\n\nABDOMEN:\nSmall volume nonhemorrhagic ascites throughout the abdomen and pelvis.\n\nHEPATOBILIARY: The liver is cirrhotic in appearance. No focal liver lesions,\nalthough this examination is limited due to a single-phase the contrast. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. A\nsingle punctate gallstone is seen layering dependently in the region of the\ngallbladder neck (series 3, image 27). The gallbladder is collapsed, and\nthere is no evidence of acute cholecystitis. The portal vein appears patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is extremely atrophic and calcified, likely due to\ninfarction.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter hypodensities within the kidneys bilaterally are too\nsmall to characterize, but likely represent simple cysts. Otherwise, the\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nnephrolithiasis or ureterolithiasis. There is no hydronephrosis. There is no\nperinephric abnormality. There is no evidence of urothelial lesions. The\ndistal ureters and bladder are unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Prominent portacaval lymph nodes are visualized measuring up to\n1.1 cm in short axis (series 3, image 27), which are unchanged compared to\nprior, and likely related to underlying chronic liver disease. There is no\nnew retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse body wall edema. Small bilateral fat\ncontaining inguinal hernias are noted.", "output": "1. No CT findings correlating with the reported history of hematuria. \nPreviously visualized bladder wall thickening has nearly resolved.\n2. Cirrhotic appearing liver without focal liver lesions. Small volume\nascites throughout the abdomen and pelvis.\n3. Stable prominent portacaval lymph nodes measuring up to 1.1 cm, likely\nrelating to underlying chronic liver disease.\n4. Cholelithiasis." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable.\n\nABDOMEN: The liver enhances normally without concerning focal lesion. The\nmain portal vein is patent. The gallbladder is surgically absent. Mild\nintrahepatic biliary ductal prominence likely reflect prior cholecystectomy. \nThe spleen appears normal in size. The adrenal glands appear normal\nbilaterally. The pancreas is unremarkable. Several renal cortical\nhypodensities are seen along the left kidney which appear relatively unchanged\nfrom the prior exam. There is similar prominence of the right renal pelvis\nwithout evidence of hydroureter or ureteral obstruction, possibly representing\ncongenital UPJ obstruction. The abdominal aorta is normal in course and\ncaliber without significant atherosclerotic calcification. No retroperitoneal\nlymphadenopathy. The stomach and duodenum appear normal.\n\nPELVIS: Patient has undergone a prior proctocolitis a may with right lower\nquadrant ileostomy. The small bowel appears normal in caliber with contrast\nseen through the level of the distal small bowel loops. However, there is\nmild thickening and fluid distension of small bowel just proximal to the stoma\nwhich may reflect a segmental enteritis. There are adjacent mildly prominent\nmesenteric lymph nodes which are likely reactive. There is also relative\nthickening of the exiting bowel loop at the stoma and a catheter is noted\ntraversing the stoma. No free air. Small volume free fluid is unchanged. \nUterus and ovaries appear unremarkable. The urinary bladder is normal in\nappearance. No pelvic sidewall or inguinal adenopathy.\n\nBONES: No worrisome lytic or blastic osseous lesion is seen. Sclerosis at the\nright SI joint could reflect sacroiliitis and appears unchanged.", "output": "1. Status post proctocolectomy with right lower quadrant ileostomy. Small\nbowel is thickened at the stoma and for a short segment proximal to the stoma\nconcerning for enteritis. Reactive mesenteric lymph nodes, small volume free\nfluid.\n2. Prominent right renal pelvis could reflect congenital UPJ obstruction,\nunchanged.\n3. Sclerosis at the right SI joint unchanged likely reflect sacroiliitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. 10\nmm cyst within segment 6, unchanged. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreatic body appears unremarkable. There is relative atrophy\nof the pancreatic tail. There is a cysto gastrostomy tube extending between\nthe gastric lumen and the pancreatic tail. There is no residual collection\nidentified at the distal end of the tube. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter hypodensity in the interpolar region of the left\nkidney, too small to characterize but likely a small cyst. No\nhydroureteronephrosis.\n\nGASTROINTESTINAL: Cysto gastrostomy tube in situ. The stomach is otherwise\nunremarkable. Visualized small bowel loops demonstrate normal caliber and\nwall thickness. The visualized colon is unremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Linear filling defect\nwithin the distal abdominal aorta (axial series 5, image 42) may represent a\nfocal dissection but appears unchanged in comparison to the prior study from\n___. No atherosclerotic disease is noted. Chronic occlusion of the splenic\nvein with multiple collateral vessels, most prominently coursing antecolic.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Unremarkable.", "output": "1. Essentially complete resolution of walled off necrosis involving the\npancreatic tail post cysto gastrostomy.\n2. Chronic splenic vein occlusion with multiple collateral vessels." }, { "input": "LOWER CHEST: There is minimal consolidation involving the bilateral lower\nlobes, right greater than left. Small right pleural effusion is seen. The\nvisualized heart failure dose aortic and mitral valve calcifications. There\nis no pericardial abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHepatic hypodensities are stable from prior CTs and appear benign. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. subcentimeter renal hypodensities are too small\nto characterize. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a percutaneous gastrostomy. New from the prior\nexamination on ___ is minimal fat stranding of the fat surrounding the\ngastrostomy just subjacent to the anterior abdominal wall on the left. Of\nnote, as compared to the prior examination, the gastrostomy tube is not\nclearly within the lumen of the stomach on this study. Numerous loops of\nsmall bowel within the left upper quadrant show minimal dilatation, which may\nbe related to a focal ileus due date inflammation. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Retroperitoneal and mesenteric lymphadenopathy is overall stable\nfrom the prior examination. There is no pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are small bilateral inguinal hernias which contain fat.", "output": "1. Gastrostomy tube is not clearly within the lumen of the stomach however the\nstomach appears to be at least partially tacked to the anterior abdominal\nwall. Recommend interrogation with fluoroscopy for further evaluation of\nG-tube placement.\n2. Stranding involving the fat adjacent to the gastrostomy tube just subjacent\nto the anterior abdominal wall on the left suggests mild inflammation, new\nfrom the prior examination on ___. Few prominent but not pathologically dilated loops of small bowel in the\nleft upper quadrant may reflect peristalsis or a focal ileus due to adjacent\ninflammation. No free air in the abdomen.\n4. Mesenteric and retroperitoneal lymphadenopathy is overall stable.\n5. Minimal consolidation at the base of the right lobe may reflect atelectasis\nhowever infection should be considered in the appropriate setting.\n\nNOTIFICATION: These findings were discussed with Dr. ___ via telephone at\n22:41 on ___ by Dr. ___.\nFindings also discussed with Dr. ___ telephone at 22:45 on ___ by Dr. ___." }, { "input": "LOWER CHEST: 4 mm left lower lobe posterior basal segment granuloma (series 5,\nimage 11). The partially imaged lung bases are otherwise unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are not\ndilated or thickened. There is a sigmoid volvulus with twisting of the\nmesentery, significant mesenteric edema, and marked sigmoid colon dilation. \nNo pneumatosis or pneumoperitoneum. Small volume free fluid in the right\nlower quadrant and pelvis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small volume\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Sigmoid volvulus. Associated mesenteric edema. Small volume free fluid. No\npneumatosis or pneumoperitoneum.\n\nNOTIFICATION: The findings were discussed with ___, Medical Student\nby ___, M.D. on the telephone on ___ at 10:02 pm, less than\n10 minutes after discovery of the findings." }, { "input": "LOWER CHEST: There are trace bilateral pleural effusions. There is mild\nsubsegmental atelectasis in the bilateral lower lobes. There is a small\npericardial effusion, partially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions. There is moderate right\nhydronephrosis with a nephroureteral stent in place. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: Trace air in the bladder is presumably from recent Foley catheter. \nThe bladder is otherwise unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Four fiducial markers are seen in the cervix. There is\nan approximately 2.6 x 2.1 cm mass in the right lateral aspect of the cervix,\nbetter seen on MRI of the pelvis from ___.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta and IVC are normal in course and caliber. \nPortal vasculature is patent. The celiac artery, SMA, bilateral renal\narteries and ___ are normal in caliber and patent.\n\nBONES: There is no suspicious osseous lesion or acute fracture. There is a\nposterior lead coursing into the right aspect of the spinal canal at the L3\nlevel.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of bowel perforation or abdominopelvic fluid collection.\n2. Moderate right hydronephrosis with a nephroureteral stent in place.\n3. Four fiducial markers seen in the cervix. Approximately 2.6 x 2.1 cm mass\nin the right lateral aspect of the cervix, better assessed on MRI of the\npelvis from ___.\n4. Trace bilateral pleural effusions.\n5. Small pericardial effusion, partially imaged." }, { "input": "LOWER CHEST: Bibasilar atelectasis is demonstrated. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is top-normal in size measuring 12.8 cm with normal\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Extensive colonic\ndiverticulosis is visualized with focal wall thickening and inflammatory\nchanges visualized in the distal descending and proximal sigmoid colon with\nadjacent fatty stranding compatible with acute diverticulitis. No adjacent\nfluid collections or macro perforation is identified. The appendix is\nsurgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes are visualized throughout the\nthoracolumbar spine without evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: A lower anterior abdominal wall fluid collection is visualized\nmeasuring up to 14 x 7 x 2.6 cm (2:65) without adjacent fatty stranding to\nsuggest acute inflammatory changes and may reflect a seroma, related to\nhistory of abdominoplasty. The abdominal and pelvic wall is within normal\nlimits.", "output": "1. Acute diverticulitis. No associated drainable fluid collection or\nextraluminal gas.\n2. Probable lower anterior abdominal wall seroma, as described above, given\nclinical history of abdominal plasty." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a 6 mm hypodensity in segment ___, which is incompletely\ncharacterized but may represent a hepatic cyst or biliary hamartoma. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There are innumerable punctate calcified\ngranulomas throughout the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. Punctate calcifications in the left upper and interpolar\nkidney represent nonobstructing renal stones. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: There is a punctate, 2 mm calcification lying dependently within the\nbladder, compatible with a calculus. The urinary bladder and distal ureters\nare otherwise unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerosis in the bilateral sacroiliac joints is likely degenerative. There is\nmild grade 1 retrolisthesis of L5 on S1. Multilevel degenerative changes are\nmild, most pronounced at L2-3.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "1. Punctate 2 mm bladder calculus may represent a recently passed renal stone.\nNo hydroureteronephrosis.\n2. Additional punctate, nonobstructing left renal calculi.\n3. Colonic diverticulosis without diverticulitis." }, { "input": "Lungs: The visualized lung bases are within normal limits.\n\nLiver: The liver is homogeneous with a smooth contour. No suspicious liver\nlesion.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder is unremarkable.\n\nSpleen: The spleen is not enlarged and is homogeneous. Revisualization of the\n5 mm nodule in the left upper quadrant anterior to the spleen, series 2, image\n10, stable since ___, likely a splenule.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Cortical scarring seen in both kidneys. Bilateral extrarenal pelvises\nare seen. There is no hydronephrosis.\n\nGastrointestinal: The partially visualized bowel is within normal limits,\nexcept for colonic diverticula. A small duodenal diverticulum is seen. There\nis no evidence of bowel dilatation or obstruction.\n\nVascular: There are mild atherosclerotic calcifications of the abdominal\naorta.\n\nThe portal vein and hepatic veins are patent.\n\nLymph nodes: There are no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion. Mild degenerative\ndisc disease is seen.", "output": "1. No explanation for the patient's upper abdominal pain on this examination.\nColonic diverticulosis, with no evidence of diverticulitis.\n\n2. No evidence of metastasis to the abdomen." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse decreased attenuation of the liver parenchyma\nin keeping with hepatic steatosis. there is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nirregular eccentric thickening of the lateral aspect of the cecal apex\nmeasuring up to 2 cm in thickness (series 5, image 78). Mild stranding is\nnoted in the adjacent pericecal fat. The remainder of the large bowel is\nunremarkable. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: 2.7 cm calcified lesion along the posterior lower uterine\nsegment is unchanged since ___ and likely represents a calcified fibroid.\n\nLYMPH NODES: The previously noted retroperitoneal lymphadenopathy has\nresolved. For example left periaortic node (series 5, image 60) measures 5\nmm, previously 11 mm. Previously enlarged lower periaortic nodes are\nimperceptible. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Previously seen retroperitoneal lymphadenopathy has resolved. No new\nevidence of metastatic disease in the abdomen and pelvis.\n2. Eccentric thickening in the cecal apex and mild pericecal stranding may be\nsecondary to post treatment typhlitis. However, a primary cecal neoplasm can\nhave this appearance and cannot be excluded. Correlation with colonoscopy is\nrecommended.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 5\nmm enhancing lesion near the dome (series 5, 45) likely represents a small\nhemangioma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are diminutive and mildly scarred, bilaterally. \nSubcentimeter hypodensities are too small to characterize, but likely\nrepresent cysts. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a small duodenal\ndiverticulum, otherwise visualized loops of small bowel are unremarkable. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. No definite cecal lesion identified as\npreviously questioned.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. A 2.7 x 1.6 cm mobile, soft\ntissue density lesion with rim calcification likely represents a calcified\nlymph node possibly from prior granulomatous disease. The adnexae are\notherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen and pelvis.\n2. Diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Atrophic changes of the bilateral kidneys. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Incidental\nduodenal diverticulum at D3-D4 measuring 2.1 cm. Diverticulosis of the\nsigmoid and descending colon is noted, without surrounding inflammatory\nchanges. Underdistention of the sigmoid colon limits full assessment.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. 2.8\ncm peripherally calcified mobile structure is again noted in the pelvis,\npossibly representing either a calcified lymph node related to granulomatous\ndisease, or sequelae of previous epiploic appendagitis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen and pelvis.\n2. Diverticulosis of the descending and sigmoid colon, without evidence of\ndiverticulitis." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis normal in size though there is slight hypoattenuation of the intracardiac\nblood pool suggesting mild anemia. No pleural or pericardial effusion is\nseen. A small hiatal hernia is noted which appears slightly inflamed.\n\nABDOMEN: Evaluation limited in the absence of IV and p.o. contrast. Allowing\nfor this, the liver appears normal. The gallbladder is unremarkable. The\npancreas appears normal. The spleen is normal in size. The adrenals are\nnormal bilaterally. The kidneys appear normal without hydronephrosis, or\nstone. The abdominal aorta is minimally calcified and normal in course and\ncaliber. No retroperitoneal lymphadenopathy. The stomach is decompressed. \nThe duodenum is unremarkable aside from the presence of a segment 3\ndiverticulum. No adenopathy, free air or free fluid.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix is normal. The colon appears mostly decompressed with a few\nscattered diverticula and no signs of active inflammation. An unchanged\ncalcified structure is again seen abutting the lower right uterus, of doubtful\nclinical significance. No adnexal mass. Uterus is unremarkable. No free\npelvic fluid. No pelvic sidewall or inguinal adenopathy. The urinary bladder\nappears partially distended and normal.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A tiny fat containing umbilical hernia noted.", "output": "1. Small hiatal hernia which appears slightly inflamed, please correlate\nclinically.\n2. Diverticulosis without diverticulitis.\n3. Normal appendix." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is moderate intrahepatic biliary\ndilatation and dilatation of extrahepatic common hepatic duct measuring 1.1 cm\n(series 2: Image 29). There is layering hyperattenuating material in the\ngallbladder likely representing stones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a intermediate density rounded focus measuring 1.0 cm in the midpole\nof the right kidney (series 2:40). There is a subcentimeter punctate\nhypoattenuated focus in the lower pole the right kidney (series 2:43) which is\ntoo small to characterize. There is no hydronephrosis. Bilateral mild\nperinephric stranding is nonspecific and is likely within normal limits given\nthe patient's age.\n\nGASTROINTESTINAL:\nAbutting one of the suture sites in the small bowel, there is an extraluminal\ncollection containing enteric contents and air which measures 2.6 x 3.2 cm\n(series 2:48). More inferiorly, there is another smaller area of extraluminal\nfoci of air (series 2:58). Of note, oral contrast makes its way past this\nanastomosis without extravasation into the collection. Anastomotic sutures\nare also noted in the ileum (series 2:64). There is no evidence of\nobstruction. There is colonic diverticulosis without evidence of\ndiverticulitis. The appendix is normal.\n\nPELVIS: There is a small amount air in the anti dependent portion of the\nbladder, potentially related to recent instrumentation. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The calcified prostate is not enlarged.\n\nLYMPH NODES: There is haziness of the mesentery which is most prominent\nadjacent to the anastomotic sutures in the ileum. There is no retroperitoneal\nor mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is significant\natherosclerotic disease with severe calcification at the origin of the celiac\naccess and moderate to severe calcification at the SMA origin.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is subcutaneous stranding and sutures along anterior\nmidline incision. There are foci of subcutaneous emphysema in the right\nlateral abdominal wall.", "output": "1. Abutting a suture site in the small bowel, there is an extraluminal\ncollection containing enteric contents and air which measures 2.6 x 3.2 cm\n(series 2:48). More inferiorly, there are smaller extraluminal foci of air\n(series 2:58). Of note, oral contrast makes its way past this anastomosis\nwithout extravasation. Given the provided clinical history of surgery one\nmonth ago, these findings are suspicious for perforation.\n2. There is haziness of the mesentery which is most prominent adjacent to\nanastomotic sutures in the ileum. There is also subcutaneous stranding and\nsutures along the anterior midline incision. This is nonspecific.\n3. Small amount of air in the anti-dependent portion of the bladder is likely\nsecondary to recent instrumentation.\n4. Colonic diverticulosis without evidence of diverticulitis.\n5. Severe atherosclerotic disease with severe calcification at the origin of\nthe celiac axis and moderate to severe calcification at the SMA origin.\n6. Moderate intrahepatic and extrahepatic biliary dilatation. This may be\nsecondary to sphincter of Oddi dysfunction or biliary dyskinesia or\nnonvisualized choledocholithiasis. MRCP can be considered for further\ncharacterization. Cholelithiasis.\n\nNOTIFICATION: The updated findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 11:30 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Appendix is not seen, and there is a suture\nline at the base of the cecum indicating that it may be surgically absent. \nThere are no secondary inflammatory signs.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. No\npelvic lymphadenopathy. Prominent but not pathologically enlarged right\ninguinal lymph nodes are likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is skin thickening and subcutaneous stranding overlying\nthe right flank and lower back spanning a region of approximately 13 x 8 cm\n(TV by CC). No subcutaneous gas. No fluid collection.", "output": "1. Skin thickening and subcutaneous stranding overlying the right flank and\nlower back is consistent with the clinical history of cellulitis. No\nsubcutaneous gas or fluid collection.\n2. No acute intra-abdominal pathology." }, { "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. The portal vein is patent. The gallbladder is well\ndistended and has a relatively thin wall.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion or peripancreatic stranding or\nfluid collection.\n\nADRENALS: There is a small homogeneous lesion of fat density arising from the\nmedial limb of the right adrenal gland, consistent with a myelolipoma. (Image\n___:52). The left adrenal gland is normal appearing.\n\nKIDNEYS: There is a lesion in the left upper kidney pole of water density,\nmeasuring 1.3 cm TV x 1.6 cm AP x 1.4 cm CC, which is likely a simple renal\ncyst. A small subcentimeter exophytic lesion is seen arising from the right\nupper renal pole, which is too small to characterize but is likely a simple\ncyst. There is no hydronephrosis or evidence of pyelonephritis.\n\nGI: There is a small hiatal hernia. Postsurgical changes are seen from\nRoux-en-Y gastric bypass. The small and the imaged portion of the large bowel\nare within normal limits, without wall thickening or evidence of obstruction.\n\nRETROPERITONEUM: There is no abdominal aortic aneurysm.There is no\nretroperitoneal or mesenteric lymph node enlargement by CT size criteria.\n\nOSSEOUS STRUCTURES: Multilevel degenerative changes are seen within the spine.", "output": "1. No evidence of pathologic intra-abdominal mass.\n2. Expected postoperative appearance of Roux-en-Y gastric bypass.\n3. Small fat-density lesion arising from the medial limb of the right adrenal\ngland, likely a myelolipoma." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nThere is a right corpus luteum cyst.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits, including\nmild rectus diastasis.", "output": "No CT evidence of metastasis in the abdomen or pelvis." }, { "input": "LOWER CHEST:\n\nSmall bilateral pleural effusions and bibasilar atelectasis. Status post TAVR.\nHeart is enlarged.\n\nABDOMEN:\nLack of IV contrast limits evaluation of the solid abdominal organs.\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions on this noncontrast study. . There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening. High density material in the gallbladder is vicarious excretion\nof IV contrast used for TAVR.\nPANCREAS: Pancreas shows mild atrophy. Minimal prominence of the pancreatic\nduct. There is no peripancreatic stranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: 1.5 cm left adrenal nodule..\nURINARY: Kidneys show excretion of contrast used during cardiac\ncatheterization. Persistence of the nephrogram is consistent with poor renal\nfunction. There is a small subcentimeter cyst at the lower pole of the left\nkidney. No hydronephrosis..\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Herniated loops of small bowel and\nmesenteric fat through anterior ventral abdominal wall/umbilical region;\nwithout evidence of obstruction. Sigmoid diverticulosis without evidence for\nacute diverticulitis.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy. There is stranding and high-density material seen within the\nregion of the left groin, with this stranding and high-density material seen\ntracking into the left lower quadrant, adjacent to the left transversus\nabdominus muscle. This is concerning for hematoma in the setting of recent\nleft femoral vascular access for aortic valve replacement.\nVASCULAR: There is no abdominal aortic aneurysm. There is marked calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nRight hip arthroplasty. There is no evidence of worrisome lesions. Abdominal\nand pelvic wall is within normal limits.", "output": "1. There is stranding and high-density material seen within the region of the\nleft groin, with this stranding and high-density material seen tracking into\nthe left lower quadrant, adjacent to the left transversus abdominus muscle.\nThis is concerning for hematoma in the setting of recent left femoral vascular\naxis for aortic valve replacement.\n2. Umbilical hernia containing loops of small bowel without evidence for\nobstruction.\n3. Left adrenal nodule" }, { "input": "LOWER CHEST: There is a 2.2 x 1.3 cm peripheral bilobed low density left\nlower lobe nodule which measures low ___ ___ on postcontrast imaging,\nconsistent with either low grade or no enhancement, highly suggestive of\nbenignity. This nodule may represent a hamartoma or be sequela of mucous\nplugging (8:13). More superiorly there is a 7 mm low-density nodule with mild\nsurrounding inflammation (8:3). There is a punctate calcified granuloma in\nthe right lower lobe. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Two\nsubcentimeter hepatic hypodensities are too small to characterize, however\nlikely represent hepatic cysts or biliary hamartomas (8:27. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. There are\ncalcifications along the gallbladder wall, and tiny gallstones (9:40). There\nis no evidence of gallbladder mass. Thickening at the gallbladder fundus\noutside the calcifications is suggestive of adenomyomatosis (9:44). The\nportal vein, SMV and splenic vein are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter cortical hypodensities bilaterally are too small to\ncharacterize, however likely represent cysts. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are multilevel degenerative changes in the lower thoracic and\nlumbar spine. Bilateral L5 pars defects are noted (14:54). There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A soft tissue nodule in the left anterior abdominal wall likely\nrepresents an injection granuloma (8:100). The abdominal and pelvic wall is\nwithin normal limits.", "output": "1. Calcifications within the gallbladder wall and cholelithiasis, without\nevidence of concerning gallbladder mass. Gallbladder wall thickening at the\nfundus outside of the calcifications is suggestive of adenomyomatosis.\n2. 2.2 cm left lower lobe bilobed low density nodule with low grade or no\nenhancement, highly suggestive of benignity, may represent a hamartoma, or be\nsequela of prior mucous plugging, however PET-CT is recommended for further\nevaluation.\n\nRECOMMENDATION(S): Recommend PET-CT for further evaluation of left lower lobe\nnodule.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:46 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Lungs: The visualized lung bases are within normal limits, except for\nbibasilar subsegmental atelectasis.\n\nLiver: The liver is homogeneous with a smooth contour. No suspicious liver\nlesion.\n\nBiliary: The gallbladder has been surgically removed. The common bile duct\nmeasures up to 1.0 cm. There is mild intrahepatic bile duct dilatation.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: The kidneys are unremarkable. There is no hydronephrosis.\n\nGastrointestinal: The bowel is within normal limits. There is no evidence of\nbowel dilatation or obstruction. There is no contrast extravasation. The oral\ncontrast reaches the mid jejunum in the left upper quadrant.\n\nVascular: There are no atherosclerotic calcifications of the abdominal aorta.\n\nThe portal vein and hepatic veins are patent.\n\nLymph nodes: There are no size significant lymph nodes. Small para-aortic\nlymph nodes are seen, not meeting criteria for pathologic enlargement.\n\nBone and soft tissues: There is no suspicious bone lesion. There is partially\nvisualized orthopedic hardware in the lower lumbar spine. Small foci of air\nin the anterior abdominal wall likely relates to recent laparoscopic\nprocedure.", "output": "1. The oral contrast reaches the mid jejunum in the left upper quadrant. There\nis no contrast extravasation.\n\n2. The common bile duct measures up to 1.0 cm, with mild intrahepatic bile\nduct dilatation. Recommend correlation with liver enzymes.\n\n3. Nonspecific mild prominence of retroperitoneal lymph nodes.\n\nRECOMMENDATION(S): Recommend correlation with liver enzymes to assess the\nsignificance of the mild intrahepatic bile duct dilatation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The slight heterogeneity of the liver parenchyma with minimal\nopacification of the hepatic veins, likely due to phase contrast. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis, likely physiologic.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute findings to account for pain. Normal appendix." }, { "input": "LOWER CHEST: The chest will be reported separately.\n\nABDOMEN:\n\nHEPATOBILIARY: Stable hepatic hemangiomas, the largest measuring 7.3 cm in\nsegment 7 of the liver. Stable hypoenhancing lesion in the porta hepatis\nmeasuring 3 x 2 cm, corresponding to the previously biopsy proven IgG 4\ninfiltrate. The patient has had an interval cholecystectomy. There is an\nadjacent a 5.2 x 2.1 cm subcapsular collection, compatible with postoperative\nchanges. The biliary drain has been removed. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes are seen along the right anterior abdominal\nwall.", "output": "1. Stable hypoenhancing lesion in the porta hepatis, at the site of biopsy\nproven IgG 4 disease.\n2. No new lesions.\n3. Post cholecystectomy, with small subcapsular hepatic collection, sequelae\nof recent surgery.\n4. The chest will be reported separately." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions. Eccentric thrombus is seen in the main\nportal vein extending into the origin of the left portal vein. This appears\nsimilar to the prior MRI. There are multiple varices seen adjacent to the\ndistal esophagus and in the upper abdomen.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder demonstrates pericholecystic inflammatory changes, as seen on\nprior MRI.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The patient is status post splenectomy.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. No evidence of focal\nlesion. There is no hydronephrosis. There is no nephrolithiasis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nunremarkable.\n\nLYMPH NODES: Again seen is lymphadenopathy in the region of the gastrohepatic\nligament, adjacent to the porta hepatis, in the mesentery and in the\nretroperitoneum. Enlarged lymph nodes are also noted in the epicardial fat. \nThe lymphadenopathy appears mildly increased compared to the previous MRI. \nFor example a mesenteric lymph node in the left mid abdomen measures 1.7 cm in\nshort axis, previously 1.3 cm. It periaortic retroperitoneal lymph node\nmeasures 1.8 cm in short axis, previously 1.3 cm. New lymph node adjacent to\nthe porta hepatis measures 1.7 cm in short axis, previously 1.3 cm.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. No atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Eccentric thrombus in the main portal vein extending into the origin of the\nleft portal vein appears similar to the prior MRI. Prominent esophageal\nvarices are noted.\n2. No focal hepatic lesion.\n3. Upper abdominal and retroperitoneal lymphadenopathy, mildly increased from\nprior MRI.\n4. Pericholecystic inflammatory changes, as seen on prior MRI." }, { "input": "LOWER CHEST: The lung bases are clear. Heart size is normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.7 cm simple cyst in the upper pole of the left kidney. No\nsuspicious renal lesions. There is no perinephric abnormality.\n\nGASTROINTESTINAL: No hiatal hernia. Small bowel is fluid-filled without wall\nthickening. No evidence of obstruction. Large bowel is unremarkable. \nAppendix is normal. There is a 2.5 x 1.7 cm fat containing lesion in the\nomentum of the right lower quadrant adjacent to the sigmoid colon with\nsurrounding fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable. There is calcification of\nthe seminal vesicles.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted with potential moderate narrowing of the right renal artery,\nalthough no differential flow is seen in the kidneys.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is\nmild stranding around the right common femoral artery without hematoma.", "output": "1. Right lower quadrant epiploic appendagitis.\n2. Fluid-filled small bowel, nonspecific, but can be seen in the setting of\nenteritis.\n3. Normal appendix.\n4. Extensive atherosclerosis." }, { "input": "LOWER CHEST: Moderate bilateral pleural effusions, right greater than left,\nnew from prior. There is mild relaxation atelectasis within bilateral lower\nlobes.\n\nCoronary artery calcific atherosclerosis is seen. There is no pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Innumerable hypoattenuating foci throughout the liver are\nsimilar prior CT and MRI, consistent with biliary hamartomas. No suspicious\nfocal lesion is identified. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains layering sludge,\nmore conspicuous from prior. No gallbladder wall thickening is definitively\nseen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions. There has been interval\nresolution of right hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Within the lower pelvis\nthere is extensive mesenteric stranding with multiple loops of small and large\nbowel identified adjacent to a new 5.1 cm x 3.8 cm x 4.8 cm rim-enhancing\ncollection along the right anterior perirectal space, likely representing a\nnew intrapelvic abscess related to known ruptured appendicitis (series 2,\nimage 64). There is small fluid track along the right superior pelvic\nsidewall (series 2, image 60) which apparently connects the periappendiceal\nfat stranding with the lower pelvic collection. There is probable secondary\ninflammatory tethering of bowel loops, resulting in obstruction-like\ndilatation of several small bowel loops, which may alternatively represent\nileus.The rectum appears decompressed. The ruptured appendix, demonstrating\nthick enhancing wall, is again seen overlying the right psoas.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: A right iliopsoas percutaneous pigtail catheter is seen with\ninterval near complete resolution of right iliopsoas intramuscular abscess.", "output": "1. Interval development of a 5.1 cm right anterior perirectal abscess\nsecondary to known ruptured appendicitis.\n2. Likely inflammatory tethering of multiple bowel loops centered along the\nnew abscess, resulting in small bowel ileus versus functional obstruction.\n3. Interval near complete resolution of right iliopsoas intramuscular abscess\nfollowing percutaneous drainage catheter placement.\n4. New moderate bilateral pleural effusions with bilateral lower lobe\nrelaxation atelectasis.\n5. Interval resolution of right hydronephrosis." }, { "input": "Heart size is normal without significant pericardial fluid. Trace right base\natelectasis. Imaged lung bases are otherwise clear.\n\nCT abdomen without contrast: Gallbladder is surgically absent. Liver,\nspleen, pancreas and adrenal glands are grossly unremarkable in the context of\na noncontrast examination. 59 mm intermediate density right interpolar renal\nlesion has increased in size compared to ___ where it measured to 27 mm\n(02:37) and there is some surrounding stranding. No nephrolithiasis or\nhydronephrosis.\n\nNo bowel obstruction is seen. Small bowel loops are normal caliber without\nevidence of obstruction. Large bowel is thin-walled and unremarkable without\npericolonic fat stranding or fluid collection. Normal appendix in the right\nlower quadrant.\n\nAbdominal aorta is normal caliber. No mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria. No ascites or pneumoperitoneum. Please\nnote a portion of the right anterior abdominal wall is not imaged and contact\nwith the gantry causes streak artifact, mildly limiting examination.\n\nCT pelvis without contrast: Bladder, uterus, adnexa and rectum are\nunremarkable. No free pelvic fluid or air. No inguinal or pelvic sidewall\nlymphadenopathy by CT size criteria.\n\nBones and soft tissues: No suspicious focal bone lesion. Moderate degenerate\nchanges of the spine.", "output": "1. Interval increase in size of an intermediate density right interpolar renal\nlesion measuring 59 mm, previously 27 mm and with adjacent stranding. This\nlesion is incompletely characterized and further evaluation with ultrasound or\ngadolinium enhanced MR ___ no clinical contraindication) is recommended. No\nnephrolithiasis or hydronephrosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post right radical nephrectomy. The left\nkidney is of normal size. There is no evidence of focal renal lesions within\nthe limitations of an unenhanced scan. There is no hydronephrosis. There is\nno nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the lthoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post right radical nephrectomy, with no evidence of local or\nmetastatic disease recurrence." }, { "input": "LOWER CHEST: There is a stable partially imaged right lower lobe pulmonary\nnodule (2:1), stable since ___. The remaining visualized lung fields\nare within normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas appears grossly unremarkable allowing for noncontrast\ntechnique. There is no peripancreatic stranding.\n\nSPLEEN: Normal size, normal appearance.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient status post right nephrectomy. The nephrectomy bed appears\nunremarkable. The left kidney is of normal and symmetric size. There is no\nevidence of focal renal lesions within the limitations of an unenhanced scan. \nThere is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: A prominent portacaval lymph node measuring 1.5 cm in short axis\ndiameter is stable dating back to ___. Otherwise, no lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nStable multilevel degenerative changes of the visualized thoracolumbar spine\nare noted.\n\nSOFT TISSUES: There is nonspecific stranding of the lower pelvic anterior soft\ntissues along with skin thickening. No soft tissue gas or evidence of\ndrainable collection. There is a small fat containing umbilical hernia. The\nabdominal wall is within normal limits.", "output": "1. Mild fat stranding and skin thickening along the lower pannus, partially\nimaged, no soft tissue gas or definite drainable collection. These may\nreflect cellulitis.\n2. Enlarged porta hepatis lymph nodes stable compared to ___.\n\n3. Status post right nephrectomy." }, { "input": "LOWER CHEST: There are multiple millimetric pulmonary nodules bilaterally. \nThese measure up to 6 mm in the right lower lobe (4:5) and are unchanged since\nat least ___. There is mild bibasilar dependent atelectasis. There\nis no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post right nephrectomy. The nephrectomy bed\nappears unremarkable. The left kidney is normal in size. There is no\nevidence of focal renal lesions within the limitations of an unenhanced scan. \nThere is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable.\n\nLYMPH NODES: A prominent portacaval lymph node measuring up to 1.5 cm in short\naxis is unchanged over multiple prior studies. Otherwise, there is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRe-demonstration of mild-to-moderate multilevel degenerative disease in the\nvisualized thoracolumbar spine, most pronounced at the lumbosacral junction.\n\nSOFT TISSUES: Similar to prior, there is nonspecific stranding of the lower\npelvic anterior soft tissues with persistent skin thickening. A small fat\ncontaining umbilical hernia is unchanged.", "output": "1. Re-demonstration of mild fat stranding and skin thickening along the lower\npannus without evidence of soft tissue gas or a drainable fluid collection,\nunchanged. As before, this may reflect cellulitis.\n2. Stable enlarged porta hepatis lymph nodes.\n3. Status post right nephrectomy." }, { "input": "Lungs: Please see the report of the CT chest performed on the same day for\nmore details.\n\nLiver: The liver is homogeneous with a smooth contour. There is decreased\nattenuation consistent with hepatic steatosis. No suspicious liver lesion.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\nhas been removed surgically.\n\nSpleen: The spleen is not enlarged. It is dense calcified.\n\nPancreas: Unremarkable. No pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Bilateral cortical hypodensities are seen, statistically likely\ncysts. No hydronephrosis.\n\nPelvis: The bladder is underdistended, and contains a Foley catheter, and is\nfilled with air. The distal ureters are unremarkable. Small amount of free\nfluid within the pelvis.\n\nReproductive organs: The visualized reproductive organs are unremarkable.\n\nGastrointestinal: The patient is status post sigmoid colectomy and left lower\nquadrant end colostomy. Midline skin staples are seen.\n\nA persistent 4.1 cm x 2.5 cm fluid collection with septations is seen at the\nright aspect of the rectouterine pouch, smaller in size, previously measuring\n5.2 cm x 3.8 cm. There is associated surrounding fat stranding. The drain\npasses through the collection, with the distal tip in the left aspect of the\nrectouterine pouch.\n\nThe distal tip of the enteric tube is in the gastric body.\n\nMildly fluid-filled small bowel loops with increased mucosal enhancement and\ndilation up to 3.6 cm, likely post-operative ileus vs enteritis.\n\nVascular: Moderate atherosclerotic calcifications of the abdominal aorta.\n\nLymph nodes: No size significant lymph nodes.\n\nBone and soft tissues: No suspicious bone lesion. Moderate degenerative\nchanges of the lumbar spine. Severe compression deformity of the T12\nvertebral body with mild retropulsion into the central spinal canal. \nAnasarca. Surgical staples along the ventral midline in keeping with recent\nsurgery.", "output": "1. The patient is status post sigmoid colectomy and left lower quadrant end\ncolostomy for sigmoid diverticulitis complicated by perforation and abscess\nformation. A persistent 4.1 cm x 2.5 cm fluid collection with septations is\nseen at the right aspect of the rectouterine pouch, smaller in size compared\nto the CT performed on ___. The drain passes through the\ncollection, with the distal tip in the left aspect of the rectouterine pouch\n\n2. Mildly fluid-filled small bowel loops with increased mucosal enhancement\nand dilation up to 3.6 cm, likely post-operative ileus vs enteritis.\n\n3. Severe compression deformity of the T12 vertebral body. If there is point\ntenderness or neurologic symptoms MRI of the thoracic spine can be considered.\n\n4. Hepatic steatosis." }, { "input": "LOWER CHEST: Left lower lobe consolidative opacity appears improved compared\nto ___, either reflecting resolving pneumonia or atelectasis. No\npleural effusion. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Small volume pneumobilia is unchanged,\nconsistent with CBD stent and recent ERCP. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreatic head demonstrates normal attenuation without evidence\nof focal lesions. The body and tail of the pancreas is slightly more\nhypoattenuating and edematous in appearance compared to ___. \nPeripancreatic and upper abdominal edema appears progressed, most of which is\nlikely postoperative in etiology.\n\nFluid and air-filled collection along the lesser curvature of the stomach\nmeasuring approximately 3.9 x 2.3 cm in largest axial dimension (02:30), is\nincreased in size, previously measuring 3.3 x 2.2 cm. Superior to this\ncollection is a tract extending into the left subphrenic space where there is\na 7.3 x 3.7 cm collection, now more organized in appearance with increased\ninternal fluid density and persistent punctate foci of air. This is unchanged\nin size, previously measuring 7.4 x 3.8 cm. Prominence of the main pancreatic\nduct in the pancreatic tail is increased, currently measuring 7 mm, previously\n4 mm (02:35).\n\nSPLEEN: The spleen is top-normal in size measuring 12.9 cm. Hypodensity along\nthe posterior aspect of the spleen is unchanged compared to prior exam and\nmeasures 1.0 cm (02:25).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cortical hypodensities, some which are too small fully\ncharacterize, are most consistent with simple renal cysts. No evidence of\nhydronephrosis. No suspicious renal lesions are identified. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Status post hepaticojejunostomy, with post surgical\nanastomotic suture material demonstrated in the midline abdomen and right\nupper quadrant. Mild soft tissue stranding adjacent to the anterior small and\nlarge bowel loops is likely related to recent surgery.\n\nLYMPH NODES: Scattered retroperitoneal lymph nodes measure up to 8 mm in short\naxis in the left periaortic station, likely reactive (02:44).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is continued focal narrowing of the main portal vein, similar\nto prior (02:30). Multiple adjacent collateral vessels are unchanged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Fluid and air-filled collection along the lesser curvature of the stomach\nis slightly increased in size compared to prior exam, currently measuring up\nto 3.9 cm.\n2. 7.3 cm left subphrenic collection is more organized in appearance and\nunchanged in size compared to ___.\n3. Increased pancreatic body edema with slightly worse peripancreatic and\nupper abdominal fat stranding, the majority which is likely postoperative in\netiology, although a component of superimposed pancreatitis is likely present.\n4. Status post hepaticojejunostomy and cholecystectomy.\n5. Continued focal narrowing of the main portal vein, similar to prior exam.\n6. Interval improvement of a left lower lobe consolidated opacity, either\nreflecting resolving pneumonia or atelectasis." }, { "input": "LOWER CHEST: 1 cm right lobe nodule partly imaged today (series 2, image 3),\nalready described on ___, a follow-up chest CT in ___ was\nrecommended.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. The gallbladder contains layering hyperdense material, likely a\ncombination of stones and sludge.\n\nPANCREAS: Again visualized is a large 15.3 x 11.7 by 14.4 cm encapsulated\ncystic fluid collection involving the body and tail of the pancreas; unchanged\ncompared to ___. There is a small tongue like projection arising\nfrom the inferior margin of the dominant cystic collection extending to the\nright (03:46).\nA second collection arising from the tail extends inferiorly and measures\napproximately 3.1 x 6.3 by 11 cm in size (___).\nA third loculated fluid collection in the left hemiabdomen measures 3.7 x 2.7\nx 4.3 cm in size (03:50 ___ 01:31).\n\nThere is very minimal remnant pancreatic parenchyma in the region of the head\nand uncinate process as well as the tail that demonstrates normal enhancement.\n\nThe large pancreatic fluid collection is seen compressing the CBD, and causing\nintrahepatic biliary ductal dilation as before.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.\nThere is a punctate nonobstructing calculus in the inferior pole of the right\nkidney (02:37).\n1.2 cm hyperdense (02:49) nonenhancing hemorrhagic cyst noted arising from the\nlower pole of the left kidney.\nSmaller scattered simple cortical cysts are also noted on both sides.\nThere are no solid enhancing renal masses or hydronephrosis on either side.\n\nGASTROINTESTINAL: There is no bowel obstruction. Significant stool burden is\npresent throughout the colon. Normal appendix.\n\nLYMPH NODES: Small lymph nodes involving the retroperitoneum have increased in\nsize when compared previous exams, but largest of these nodes measures only\n8.5 mm of thickness in the left para-aortic location, most likely these are\nreactive in nature.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Mild atherosclerotic\ndisease is noted. There is persistent narrowing of the main portal vein at\nthe porta hepatis (series 3, image 29) without complete occlusion. The\nsplenic vein is compressed but patent. There are numerous varices within the\nmesentery and surrounding the stomach.\n\nBONES: Bilateral L4 pars interarticularis lysis with grade 1 anterolisthesis\nof L4 over L5 noted. No worrisome osseous lesions identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nOf note, the pelvic region was not imaged.", "output": "1. Stable size of the large pseudocyst within the central retroperitoneum\ncentered around the body and tail of the pancreas; measuring up to 15.3 cm in\nsize. 2 additional loculated fluid collections arising from the tail and\nextending inferiorly into the left hemipelvis are smaller in size compared to\nthe prior exam.\n2. There is near complete necrosis of the pancreatic parenchyma with focal\nareas of sparing in the tail, head and uncinate process.\n3. Severe unchanged compression of the main portal vein with varices in the\nmesentery and surrounding the stomach.\n4. Intrahepatic biliary ductal dilation is unchanged compared to prior. \nLayering sludge and stones seen within the distended gallbladder.\n5. 1.2 cm hemorrhagic cyst arising from the lower pole of the left kidney.\n6. 1 cm right lower lobe pulmonary nodule, unchanged compared to the prior\nexam, for which a follow-up chest CT has been recommended previously, ___ (in 3 months).\n\nRECOMMENDATION(S): Please see impression 6." }, { "input": "LOWER CHEST: Mild ground-glass opacity in the right lower lobe most likely\nrepresents atelectasis. There is no pleural effusion or pericardial effusion.\nPatient is status post cardiac pacer with lead terminating in the right\nventricle. Surgical clips are seen in the epiphrenic space. The left atrium\nis mildly dilated with calcific density at the mitral annulus.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 1.1\ncm hypodensity in the left lobe of the liver is nonspecific, however likely\nrepresenting biliary hamartoma or cysts. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nTrace nonhemorrhagic ascites is seen around the liver. VP shunt catheter\ncourses along the right side of the abdomen with tip terminating in the right\nlower quadrant.\n\nPANCREAS: The pancreas is mildly atrophic. As previously noted, there is a\n2.8 x 2.8 cm hypodensity in the body of the pancreas. However, there is no\nsignificant main pancreatic ductal dilation. The overall size and\nconfiguration of the pancreatic hypodensity is similar compared to ___. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n3.9 x 3.6 cm hypodensity in the interpolar region of the right kidney\ndemonstrates mild rim enhancement and is decreased compared to the prior\nexamination and may reflect an involuting cyst. Other subcentimeter\nhypodensities scattered throughout the kidneys are too small to characterize\nby CT, though likely representing cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal (02:56).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n2.8 x 2.8 cm.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. No adnexal\nabnormality is seen.\n\nLYMPH NODES: Again seen are innumerable prominent lymph nodes throughout the\nretroperitoneum, measuring up to 1.0 cm (02:41), unchanged from prior exam. \nIn addition, innumerable mesenteric lymph nodes measuring up to 11 mm are\npersistent. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Again seen is mild ectasia of the abdominal aorta, measuring up to\n2.6 cm. Bilateral common iliac artery aneurysm is also unchanged, measuring\nup to 2.1 cm. However, there is no evidence of dissection. Extensive\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post median sternotomy. Linear horizontal sclerosis at S1\nis unchange2d from prior exam on ___.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted. Surgical clip\nis partially imaged in the left groin.", "output": "1. No acute intra-abdominal or intrapelvic abnormalities.\n2. Persistent cystic mass in the pancreatic body, currently measuring 2.8 cm. \nThis lesion has been previously biopsied on ___, yielding\nnondiagnostic results.\n3. Unchanged prominent mesenteric and retroperitoneal lymph nodes. A\nlymphoproliferative process cannot be excluded.\n4. VP drain terminating in the right lower quadrant. Small volume perihepatic\nascites.\n5. Mildly ectatic aorta and bilateral common iliac artery aneurysms,\nunchanged." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is a cystic mass within the pancreatic body, measuring 2.3 x\n3.3 x 2.5 cm (series 2: Image 18 and series 601b: Image 36), which is a\nknown finding and has been recently biopsied. There is no peripancreatic\nstranding. Multiple prominent lymph nodes are noted surrounding the pancreas,\nthe largest measuring up to 1.0 cm.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple hypodense cystic lesions are seen scattered throughout the kidneys,\nwith the largest measuring up to 4.2 x 4.5 cm in the right lower renal pole. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. A VP drain is seen extending anteriorly from the\ninferior aspect of the liver down to the right lower quadrant, to terminate in\nthe right pericolic gutter\n\nREPRODUCTIVE ORGANS: The prostate is enlarged, measuring up to 3.5 x 5.8 cm\n\nLYMPH NODES: Multiple prominent peripancreatic and mesenteric lymph nodes are\nnoted. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. The aorta is mildly ectatic measuring up to 2.9 cm, at the\nlevel of the kidneys (series 2: Image 38). There is dilatation of the right\nand left common iliac arteries, measuring up to 2.3 cm and 1.6 cm respectively\n(series 2: Image 53).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are noted along the visualized spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is a cystic mass in the pancreatic body, measured at 2.5 cm, with\nsurrounding prominent mesenteric and retroperitoneal lymph nodes. This is a\nknown finding and has been recently biopsied.\n2. A VP drain is seen extending anteriorly from the inferior aspect the liver\nextending to the right lower quadrant, however, without sizable fluid\ncollection in the abdomen or pelvis.\n3. Mildly ectatic aorta, measuring up to 2.9 cm\n4. Aneurysmal dilatation of the right and left common iliac arteries,\nmeasuring up to 2.3 cm and 1.6 cm respectively.\n5. Renal cysts." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nABDOMEN: The liver, gallbladder, spleen, pancreas, adrenal glands and kidneys\nare unremarkable except for a small hemangioma in the caudate. No biliary\nductal dilatation.\n\nGASTROINTESTINAL: No intestinal obstruction, free air or ascites.\n\nPELVIS: There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions. Grade 1\nretrolisthesis of L5 on S1 is unchanged compared to prior. There is diffuse\nosteopenia.\n\nSOFT TISSUES: Re-demonstration of calcifications of the right iliopsoas muscle\nsimilar to prior (2; 61).", "output": "No acute findings. No abscess or imaging findings for pyelonephritis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout with\nmild diffuse fatty infiltration there is no evidence of focal lesions. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is surgically absent. There is stool throughout the\ncolon consistent with constipation. No perienteric inflammatory process is\nidentified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal, mesenteric, or pelvic sidewall\nadenopathy. There are prominent right inguinal lymph nodes measuring up to\n1.8 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nThere is mild retrolithesis of L5-S1. Bones are mildly demineralized. \nProminent bridging marginal osteophytes are seen on the left at L4-L5 and\nL5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or pelvic process.\n2. Prominent right inguinal lymphadenopathy, likely reactive. Clinical\nfollow-up recommended to ensure regression. Follow-up imaging with ultrasound\nmay be performed based on clinical evaluation of the patient.\n3. Constipation" }, { "input": "LOWER CHEST: There is mild scattered subsegmental atelectasis in the bilateral\nlung bases. In the right lower lobe, there is a small calcified granuloma. \nSmall ground-glass subpleural nodule in the right middle lobe measures 6 mm\n(series 2; image 5). There is no pleural effusion. There is no pericardial\neffusion. Cardiac size is mildly enlarged. There are mild coronary\ncalcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. In\nsegment III of liver, there is a 2.3 x 0.9 cm lobulated hyperdense focus\nrepresenting known hepatic varix. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent. There\nis a small volume of perihepatic and perisplenic simple ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout. Multiple cystic\nlesions in the pancreas are better visualized on MRCP from ___. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Punctate\ncalcification within the splenic parenchyma likely represent sequela of prior\ngranulomatous disease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Stomach is otherwise\nunremarkable. There is diffuse dilatation of small bowel measuring up to 3.5\ncm in caliber, with gradual transition in the distal ileum, likely reactive\nileus. There are multiple areas of simple ascites within the mesentery (for\nexample, series 2; image 55, image 62), largest in the left lower quadrant,\nmeasuring 3.2 x 5.1 x 11.1 cm (series 2; image 68, series 601; image 26).\n\nPELVIS: There are contiguous, non-organized hyperdense fluid collections\nwithin the deep pelvis. The inferior and posterior component is adjacent to\nthe anterior wall of the sigmoid colon and measures 5.7 x 4.2 x 7.4 (series 2;\nimage 78, series 601; image 46). The larger anterior component with multiple\nlocules of gas is seen posterior to the bladder and above the vaginal cuff. \nThis collection measures approximately 10.5 x 6.6 x 11.2 cm (series 2; image\n77, series 602; image 45). The patient is status post\nhysterectomy/oophorectomy.\n\nLYMPH NODES: There is no mesenteric or retroperitoneal lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Right femoral central venous line terminates in the distal right\ncommon iliac vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple injection granulomas are seen in the soft tissues, some\nwith small foci of air. Multiple additional foci of air seen in the right\nupper quadrant. These findings are likely consistent with injection\ngranulomas as well as postoperative changes.", "output": "1. Two contiguous, non-organized, hyperdense intrapelvic collections measuring\n5.7 x 4.2 x 7.4 and 10.5 x 6.6 x 11.2 cm. The larger component is located\nposterior to the bladder and above the vaginal cuff, and has multiple locules\nof air within it. The additional, more inferior and posterior, collection is\nadjacent to the anterior wall of the sigmoid colon. These are most compatible\nwith pelvic hematoma given the history of recent surgery, though superimposed\ninfection is unable to be excluded.\n2. Small volume simple ascites in the abdomen.\n3. Diffuse dilatation of small bowel measuring up to 3.5 cm in caliber, with\ngradual transition in the distal ileum, likely reactive ileus.\n4. Trace bilateral pleural effusions with mild to moderate bibasilar\natelectasis.\n5. Small ground-glass nodule in the right lobe measures 5 mm. No specific\nfollow-up is recommended for this. See full set of recommendations below.\n\nRECOMMENDATION(S): For an incidentally detected single ground-glass nodule\nsmaller than 6 mm, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: There has been interval increase in small bilateral\nnonhemorrhagic pleural effusions with associated atelectasis. There is no\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n2.6 x 1.3 cm hyperintensity in segment III is unchanged and consistent with\nknown hepatic varix (05:17). There is otherwise no suspicious liver lesion. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation. Multiple cystic pancreatic lesions are again\nidentified, likely side-branch IPMNs, better evaluated by ___ of ___. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A punctate calcification is unchanged, likely a\nsequelae of prior granulomatous disease. A small accessory spleen is\nincidentally noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Persistent fluid-filled\ndistention of multiple loops of small bowel has increased slightly when\ncompared with the prior study with maximal diameter measuring up to 4.6 cm,\npreviously 3.5 cm (05:35). Again, there is a gradual transition to\ndecompressed loops in the distal ileum, likely representing a reactive ileus.\nThere is colonic diverticulosis without evidence of diverticulitis.\n\n\nABDOMINAL CAVITY AND PELVIS: Patient is status post interval placement of a\npigtail drainage catheter in the large hyperdense collection within the\npelvis, which is substantially decreased in size. This collection previously\nmeasured up to 10.5 x 6.6 x 9.8 cm in greatest axial ___, the now\nmeasuring up to 7.4 x 6.9 x 5.7 cm (5:75; 07:42). Multiple additional\ncommunicating hyperdense collections appear more organized compared with the\nprior study, now less hyperdense centrally with increasing peripheral\nenhancement. A lobulated collection inferior to the third portion of the\nduodenum measures up to 3.5 x 2.4 cm (05:45), previously 3.1 x 2.1 cm. A\ncollection anterior to the right common iliac artery measures up to 5.4 x 5.0\ncm, previously 3.7 x 4.2 cm (05:57). A collection in the left lower quadrant\nsuperior to the entry site of the pigtail catheter measures up to 3.3 x 2.5\ncm, previously 5.1 x 3.2 cm (5:65).\nThere is persistent mild to moderate ascites and diffuse fat stranding,\nparticular within the left pericolic gutter.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and bilateral\noophorectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are mild.\n\nSOFT TISSUES: Diastasis recti and multiple injection granulomas are\nincidentally noted, unchanged. The abdominal and pelvic wall is otherwise\nwithin normal limits.", "output": "1. Interval pigtail catheter drainage of a large infected pelvic hematoma with\nmarked interval decrease in size of the pelvic fluid collection.\n2. Numerous additional fluid collections more superiorly within the abdomen\nhave slightly increased in size and appear more organized compared with the\nprior study, as described above.\n3. Increased persistent fluid-filled distension of loops of small bowel\nwithout an acute transition point, likely representing reactive ileus.\n4. Interval increase in nonhemorrhagic pleural effusions bilaterally, now\nsmall to moderate." }, { "input": "LOWER CHEST: Extensive bronchiectasis and scarring/atelectasis within the\nlower lobes bilaterally is unchanged compared to the recent chest CT. A\nnodular opacity within the left lower lobe measures 13 x 10 mm (series 3,\nimage 14), increased in size compared to prior, likely relating to underlying\ninterstitial disease. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. The common bile duct is dilated measuring up to 1.9 cm, unchanged\ncompared to prior. The gallbladder is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 10 mm splenule is seen inferiorly.\n\nADRENALS: Right adrenal gland is normal in size and shape. Stable left\nadrenal adenoma.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There are multiple dilated fluid-filled loops of small bowel\nwith air-fluid levels. A transition point is seen within the mid abdomen\n(series 4, image 32), likely distal ileum, representing small bowel\nobstruction. There is no small bowel wall thickening. There is no mesenteric\nstranding. No pneumatosis or pneumoperitoneum. There is a large hiatal\nhernia containing fluid. Otherwise, the stomach is unremarkable. The colon\nis filled with a mixture of stool and contrast. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy. No adnexal\nmasses visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted, particularly at the origin of the celiac and SMA.\n\nBONES: Moderate levoconvex scoliosis of the lumbar spine. Grade 1\nretrolisthesis of L1 on L2. There is no evidence of worrisome osseous lesions\nor acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. There is also\na fat containing right inguinal.", "output": "1. Small bowel obstruction with transition point at the distal ileum, detailed\nabove.\n2. Extensive bronchiectasis and scarring/atelectasis within the lower lobes\nbilaterally. Nodular opacity within left lower lobe has increased in size,\nlikely relating to underlying interstitial disease.\n3. Dilated common bile duct up to 1.9 cm, unchanged compared to prior.\n4. Other incidental findings include severe atherosclerosis, a stable left\nadrenal adenoma, a large hiatal hernia, and diverticulosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low, homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2:67).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small volume\nfree fluid is noted within the pelvis. Bilateral adnexal cysts are seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence for acute intra-abdominal process. Normal appendix.\n2. Bilateral adnexal cysts and small volume free pelvic fluid.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The hyperenhancing focus within segment VIII is unchanged in\nappearance, likely representing a transient hepatic attenuation difference. \nOtherwise, the liver demonstrates homogenous attenuation throughout. There is\nno evidence of new focal lesions. There is stable prominence of the common\nbile duct, likely related to cholecystectomy. There is no new evidence of\nintrahepatic or extrahepatic biliary dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is an NG tube which terminates in the stomach. The\npatient is status post total colectomy with a right lower quadrant ileostomy\nand a peristomal hernia that is unchanged compared to prior. The stomach is\nunremarkable. Multiple diverticula are seen arising from the second and third\nportions of the duodenum. Otherwise, small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The appendix is\nsurgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is heterogenous in appearance, likely due to\nsmall fibroids. Otherwise, the visualized reproductive organs are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: The sclerotic lesions within multiple lumbar vertebral bodies likely\nrepresent bone islands, unchanged since ___. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a parastomal hernia at the right lower quadrant\nileostomy, which is unchanged in appearance.", "output": "1. Status post total colectomy with a right lower quadrant ileostomy and a\nparastomal hernia, but no evidence of obstruction.\n2. No other acute intra-abdominal process to explain abdominal pain." }, { "input": "LOWER CHEST: Visualized lung fields are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. Status post cholecystectomy, with\nunchanged prominence of the common bile duct.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: Kidneys are unremarkable.\n\nGASTROINTESTINAL: The patient is again noted to be status post total colectomy\nwith right lower quadrant and ileostomy. Unchanged parastomal hernia without\nevidence of bowel obstruction. Multiple duodenal diverticula are again seen\nin the second and third portions of the duodenum.\n\nPELVIS: The urinary bladder is decompressed. Fibroid uterus is\nredemonstrated. The adnexa are unremarkable for age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are unchanged.\n\nSOFT TISSUES: Right lower quadrant parastomal hernia as described above.", "output": "Postoperative changes status post total proctocolectomy, with stable\nappearance of right lower quadrant parastomal hernia. No evidence of bowel\nobstruction or findings to suggest active disease. The etiology of pain is\notherwise not elucidated." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRedemonstration of a stable local vascular malformation within the right\nhepatic lobe (2:20). There is no suspicious focal lesion. There is mild\nright intrahepatic biliary ductal dilatation. The CBD is dilated, measuring\nup to 1 cm, although this may represent a sequelae of cholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions. There is no perinephric\nabnormality. There is no hydronephrosis or hydroureter.\n\nGASTROINTESTINAL: The stomach is unremarkable. Duodenal diverticula are again\nseen. The small bowel loops otherwise demonstrate normal caliber and wall\nthickness where visualized. Patient is status post total colectomy with a\ndiverting loop ileostomy in the right lower quadrant.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: Mild calcific atherosclerotic disease is present. Incidental note\nis made of a large noncalcified atherosclerotic plaque in the distal SMA\n(2:69). There is no abdominal aortic aneurysm.\n\nBONES: Moderate to severe degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: Redemonstration of a wide neck parastomal hernia containing\nloops of nonobstructed small bowel.", "output": "Status post total colectomy with a diverting loop ileostomy in the right lower\nquadrant. Stable parastomal hernia containing loops of nonobstructed small\nbowel." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. A 5 mm nodule is noted in the\nleft lower lobe (02:18). There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Mild perinephric\nstranding is nonspecific but likely represents sequelae of prior injury. A\nlikely right extrarenal pelvis is noted. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The bladder is distended but otherwise normal. There is no free fluid\nin the pelvis. 2 radiopaque foci in the pelvis (2:76, 71) likely represent\nphleboliths .\n\nREPRODUCTIVE ORGANS: The uterus is normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild perinephric stranding is nonspecific but likely represent sequela of\nprior injury.\n2. No evidence of nephrolithiasis, ureterolithiasis, or hydronephrosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Mild stranding is\nnoted in the Gerota's fascia, which could be correlated with renal\ninsufficiency. There is no evidence of nephrolithiasis or hydronephrosis\nbilaterally. There is no evidence of focal renal lesions within the\nlimitations of an unenhanced scan.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small foci of edema are seen in the lower anterior abdominal\nwall, likely injection sites. Otherwise, the abdominal and pelvic wall is\nwithin normal limits.", "output": "1. No evidence of renal stone or hydronephrosis.\n2. Mild bladder wall thickening is noted.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:40 AM, 1 minutes after discussion\nof findings with attending with changes to earlier wet read." }, { "input": "LUNG BASES: Bilateral small pleural effusions are noted, slightly larger on\nthe left than right, with mild compressive lower lung atelectasis. The imaged\nportion of the heart is top-normal with dense mitral annular calcification and\naortic valvular calcification. A catheter is seen within the right atrium.\n\nABDOMEN: The unenhanced appearance of the liver is normal. The gallbladder is\nmoderately distended. Mild atrophy of the pancreas noted. The spleen is\nnormal in size. The right and left adrenal glands appear normal. No renal\nstone or hydronephrosis. There is relative atrophy of the right kidney\nunchanged. The abdominal aorta is aneurysmal along the infrarenal segment\nmeasuring up to 4.2 x 3.3 cm, previously 4.0 x 3.3 cm. There is no\nretroperitoneal adenopathy. The stomach is decompressed. The duodenum\nappears normal. No free air or free fluid.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix is normal. The colon contains a mild fecal load. There is no\nevidence of colitis or pericolonic inflammation. Diverticulosis is noted\nwithout evidence of diverticulitis. Uterus is surgically absent. There is no\nadnexal mass. Trace free fluid is noted tracking into the deep pelvis. Foley\ncatheter noted within the urinary bladder which is minimally distended. No\npelvic sidewall or inguinal adenopathy.\n\nBONES: There is no worrisome lytic or blastic osseous lesion. No fracture. \nFacet arthropathy is noted in the lower lumbar spine.\n\nBODY WALL: Body wall edema is moderate.", "output": "1. Small pleural effusions with compressive lower lung atelectasis.\n2. Infrarenal abdominal aortic aneurysm measuring up to 4.2 x 3.3 cm.\n3. Top-normal heart size with mitral annular and aortic valvular\ncalcification.\n4. Diverticulosis without evidence of diverticulitis. No definite findings to\naccount for left lower quadrant pain.\n5. Trace ascites." }, { "input": "Chest: Please refer to CT chest obtained on ___ for complete\nintra thoracic findings.\n\nAbdomen: Evaluation is limited in the absence of intravenous contrast.\nAllowing for this, the unenhanced liver appears homogeneous in attenuation\nwith no focal lesion identified. There is no intrahepatic biliary dilatation.\nThere is no radiopaque cholelithiasis. The pancreas is without ductal\ndilatation. The spleen is unremarkable, within normal limits in size. \nBilateral adrenal glands and unenhanced kidneys are unremarkable in\nappearance. There is no hydronephrosis. No nephrolithiasis is identified.\n\nThe stomach, duodenum, and loops of small bowel are unremarkable. The appendix\nis visualized and normal in appearance. Scattered diverticula are identified\nthroughout the descending colon and sigmoid colon without evidence of\ndiverticulitis. The abdominal aorta demonstrates moderate atherosclerotic\ncalcifications. The infrarenal aorta measures up to 3.3 and 3.3 cm,\npreviously 3.2 cm on prior examination dated ___, compatible with an\naneurysm.\n\nAgain seen is misty mesentery with prominent mesenteric nodes (2:75),\nunchanged since the prior examination. Prominent pre- and para-aortic\nlymphadenopathy remain stable (2: 66, 73 and 68). The largest node,\npreviously 3.2 x 2.3 cm, now measures 2.9 x 1.8 cm on current examination. In\nthe absence of intravenous contrast, assessment for aortic wall extension is\nlimited.\n\nPelvis: The bladder is moderately well distended, unremarkable in appearance.\nThe uterus and adnexa are not visualized. There is no inguinal or pelvic\nsidewall adenopathy. No free fluid is identified.\n\nOsseous structures: No suspicious lytic or blastic lesion is identified.", "output": "1. Stable para-aortic adenopathy with no new lesions identified.\n2. Infrarenal abdominal aortic aneurysm measuring 3.3 x 3.3 cm, stable since\n___.\n3. Please refer to CT Chest clip # ___ for intrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. The\nlack of appreciable hepatic vasculature suggests hepatic steatosis. There is\nno evidence of focal lesions within the limitations of an unenhanced scan. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 0.9 x 0.9 cm nodule in the splenic\nhilum (02:46), likely a cluster vessels.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nmoderate right-sided hydroureteronephrosis, new since the prior exam. There\nis no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Colonic diverticulosis is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There has been significant interval increase in periaortic soft\ntissue density. Soft tissue thickening extends from just inferior to the\nrenal arteries continues to just below level of the aortic bifurcation. A\nconglomerate of nodules measures approximately 5.2 x 3.8 cm to the right of\nthe aorta (2: 70) causing extrinsic right ureteral compression and subsequent\nupstream dilatation and hydroureteronephrosis. Additionally, there are\nmultiple enlarged external and internal iliac chain lymph nodes, new since the\nprior exam. For example the right external iliac node measures up to 13 mm in\nshort axis (2:98) and the left external iliac node measures up to 11 mm in\nshort axis (2:98). There is no mesenteric lymphadenopathy. There is no\ninguinal lymphadenopathy.\n\nVASCULAR: An infrarenal abdominal aortic aneurysm is similar in size,\nmeasuring 3.8 x 3.4 cm, previously 3.6 x 3.7 cm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There has been significant interval increase in retroperitoneal and pelvic\nlymphadenopathy compared to ___, consistent with disease recurrence. \nAdditionally, periaortic soft tissue density extends from just below the renal\narteries to just past the level of the aortic bifurcation, causing extrinsic\nright ureteral compression and subsequent right-sided hydroureteronephrosis.\n2. Infrarenal abdominal aortic aneurysm is stable in size.\n3. Hepatic steatosis.\n4. Please refer to dedicated CT chest performed on the same day for\ndescription of intrathoracic findings.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:59 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER THORAX: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation.\nUnremarkable gallbladder.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: Stable appearance of severe right-sided hydronephrosis and proximal\nhydroureter, with transition point at the level of retroperitoneal soft tissue\nmass. There is associated delayed nephrogram on the right consistent with\nsignificant obstruction. The left kidney is unremarkable. Unremarkable\nbladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are\nnormal in caliber. Uncomplicated colonic diverticulosis. Normal appendix\n\nREPRODUCTIVE ORGANS: Status post hysterectomy. No adnexal mass.\n\nLYMPH NODES: Confluent right periaortic soft tissue mass appears slightly\ndecreased in size, measuring 3.1 x 3.6 cm, previously 2.8 x 4.7 cm. There is\nassociated marked attenuation of the IVC, with no perceptible lumen at the\nlevel of this mass and associated collateral vessels. Ureteric obstruction on\nthe right with severe right-sided hydroureteronephrosis. No pelvic or\ninguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Retroperitoneal soft tissue mass as\ndescribed above. There is mild increased density of the mesenteric fat which\nappears similar to previous. Mild presacral edema is also unchanged.\n\nVASCULAR: Infrarenal abdominal aortic aneurysm measures up to 3.9 cm. \nModerate atherosclerotic calcification. Markedly attenuated IVC as described\nabove.\n\nBONES: No suspicious osseous lesion.\n\nSOFT TISSUES: Unremarkable.", "output": "1. Slight interval decrease in size in confluent right periaortic soft tissue\nmass with associated IVC and right ureteric obstruction with multiple\ncollateral vessels and severe proximal right hydroureteronephrosis. No\nlymphadenopathy is identified elsewhere in the abdomen or pelvis.\n2. Mild stranding of the mesenteric fat is unchanged from previous and may be\nrelated to treated/low-grade lymphoma. Mesenteric panniculitis is a\ndifferential consideration.\n3. Stable infrarenal abdominal aortic aneurysm measuring up to 3.9 cm." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Moderate right-sided hydronephrosis and proximal hydroureter is\nsignificantly decreased in size compared to prior study, with transition point\nagain seen at the level of the retroperitoneal soft tissue mass. The left\nkidney is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe colon is noted, without evidence of wall thickening and fat stranding. \nThe appendix is normal.\n\nPELVIS: There is mild thickening of bladder wall. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. No adnexal\nabnormality is seen.\n\nLYMPH NODES: Confluent right periaortic soft tissue mass appears grossly\nunchanged in size from prior study, measuring 3.6 x 2.7 cm (02:38), compared\nto 3.6 x 3.1 cm on prior study. Again seen is significant associated\nnarrowing of the IVC, with no perceptible lumen at the of the soft tissue mass\nand associated collateral vessels. Mildly increased density in the mesenteric\nfat appears similar to prior. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Infrarenal abdominal aortic aneurysm measures up to 3.9 cm,\nunchanged. Moderate atherosclerotic disease is noted. There is markedly\nnarrowing of the IVC at the level of the retroperitoneal soft tissue mass, as\ndescribed above.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Re-demonstration of confluent right periaortic soft tissue mass, grossly\nunchanged in size from prior study, with associated narrowing of the IVC and\nright ureteric obstruction. No additional new lymphadenopathy identified\nelsewhere in the abdomen or pelvis.\n2. Moderate right-sided hydronephrosis and proximal hydroureter appears\nsignificantly decreased in size from prior study, with transition point again\nseen at the level of the retroperitoneal soft tissue mass.\n3. Mild stranding of the mesenteric fat, similar to previous and possibly\nrelated to treated/low-grade lymphoma.\n4. Stable appearance of infrarenal abdominal aortic aneurysm, measuring up to\n3.9 cm." }, { "input": "LOWER CHEST: Visualized lung bases demonstrate some residual parenchymal\nopacities, improved from prior study. Re-demonstration of bronchiectasis in\nbilateral lower lobes, without mucus plugging. Pleural calcifications are\nagain seen. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates mild diffuse fatty liver. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is collapsed and contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a large rim-enhancing\nfluid collection in the right lower abdomen. No enteric contrast\nextravasation is noted. Patient is status post partial small bowel resection\nand colectomy. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement.\n\nPELVIS: The urinary bladder is distended. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are noted of the visualized spine and the bilateral hips.\n\nSOFT TISSUES: Ileostomy seen in the right lower quadrant. Diastases of the\nrectus muscles again seen. Surgical drains are seen entering in the left\nlower quadrant and in the mid abdomen. Intrathecal pump in the subcutaneous\nsoft tissues of the right lower abdominal wall is again seen.", "output": "1. Large rim-enhancing intra-peritoneal fluid collection in the right lower\nabdomen, highly suggestive of an abscess.\n2. Interval improvement in previously seen bibasilar lung opacification.\n3. Distended urinary bladder.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:44 ___, 30 minutes after\ndiscovery of the findings." }, { "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver density is within normal limits. There is no focal hepatic mass. \nThere is no intra or extrahepatic bile duct dilation. Gallstones are again\ndemonstrated within an otherwise normal gallbladder (series 5, image 70). No\nradiopaque ductal stones are detected.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal mass.\n\nThe spleen size is within normal limits.\n\nThere is slight nodularity to the left adrenal gland, measuring up to 8 mm,\nunchanged in comparison to multiple prior CT examinations, the earliest from\n___ (series 5, image 63).\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis or concerning mass.\n\nThe stomach is normal. Intra-abdominal and intrapelvic loops of small bowel\nare normal in caliber. A right lower quadrant ileostomy is present (series 5,\nimage 76). The patient is post colectomy. A right lower quadrant pigtail\ncatheter terminates within a previously-seen collection first demonstrated on\nthe ___ CT examination. No residual fluid is seen at the catheter\ntermination point. There is a small amount of fluid within the remnant rectal\npouch (series 9, image 38). However, a 2.3 x 2.7 x 3.2 cm focus of fluid with\nrim enhancement is difficult to distinguish between the upper remnant pouch\nfrom residual abscess, as this area appeared to be in communication with the\ndrained collection seen on ___ (series 8, image 32, series\n5, image 102). No free pneumoperitoneum is detected.\n\nModerate atherosclerotic calcifications are again demonstrated throughout the\ninfrarenal abdominal aorta and iliac branches, without aneurysm or\nflow-limiting stenosis. There is no dissection. The celiac trunk, SMA, and\nrenal arteries are patent and normal in caliber. Conventional hepatic\narterial anatomy is demonstrated. The portal veins appear patent.\n\nThere is no mesenteric, retroperitoneal, or intrapelvic lymphadenopathy, and\nno ascites.\n\nA right lower quadrant intrathecal device is partially visualized (series 5,\nimage 83).\n\nThere are no osseous lesions concerning for malignancy or infection.", "output": "1. There is no longer appreciable fluid at the RLQ catheter termination site,\nhowever, a 3.2 x 2.7 x 2.3 cm focus of fluid deeper within the mid-pelvis,\nwhich appears to have been in communication with the main abscess seen on ___, remains. This is difficult to distinguish from the\nrectal pouch that was recently partially resected in ___. A\npouchogram or sinogram injected via the right lower quadrant catheter could be\nconsidered to further delineate the anatomy.\n2. No new abdominopelvic collection.\n3. No bowel obstruction or CT evidence for active IBD.\n4. Cholelithiasis.\n5. Please see the separate chest CT dictation from the same day regarding\nintrathoracic findings.\n\nRECOMMENDATION(S): Consider sinogram/pouchgram.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 16:17 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. A pacemaker wire is noted in the\nright ventricle.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 7 mm calcified splenic artery aneurysm\nthat is incompletely evaluated on this noncontrast study.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon is\ndilated and fluid-filled from the ileocecal valve to the proximal sigmoid\ncolon where it becomes abruptly decompressed to the rectum (4:64). There are\ndiverticuli noted in the decompressed sigmoid colon, and there is mild\npericolonic fat stranding. No discrete mass is identified, however evaluation\nfor mass is limited in the absence of IV contrast. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed and distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a calcified fibroid noted in the uterine fundus.\nNo adnexal abnormalities are identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is bilateral L5 spondylolysis with corresponding 7 mm of\nanterolisthesis of L5 on S1. This causes at least moderate bilateral neural\nforaminal narrowing. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Atrophy\nof the psoas muscles is noted.", "output": "1. The colon is dilated and fluid-filled from the ileocecal valve to the\nproximal sigmoid colon where it becomes abruptly decompressed to the rectum. \nThis may be due to a sigmoid diverticular stricture. While no mass is\nidentified, one cannot be excluded with this examination.\n2. Sigmoid colonic diverticulosis without diverticulitis.\n3. A 7 mm calcified splenic artery aneurysm is incompletely evaluated on this\nnoncontrast study.\n4. There is a calcified fibroid in the uterine fundus.\n5. Bilateral L5 spondylolysis with corresponding 7 mm of anterolisthesis of L5\non S1. This causes at least moderate bilateral neural foraminal narrowing, a\nwhich is incompletely evaluated on this study." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple, hypoattenuating nonenhancing hepatic lesions which are\nunchanged and likely represent hepatic cysts. For example at segment VII is a\n4.6 cm hypoattenuating hepatic lesion which is unchanged compared to most\nrecent prior. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys demonstrate normal nephrograms. There are multiple,\nsubcentimeter hypoattenuating lesions of the bilateral kidneys too small to\nfully characterize on CT but statistically likely simple renal cysts. There\nare two nonobstructing renal stones at the superior pole of the left kidney\nmeasure up to 4 mm, unchanged. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized. There is\nhigh-density material within the ascending colon and distal stomach which is\nlikely ingested material. There is moderate fecal loading within the colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostatomegaly. Seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abdominopelvic process.\n2. Non-obstructing left renal stones measuring up to 4 mm unchanged.\n3. Please see same day CT chest for description of thoracic findings." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. Midline sternotomy wire partially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: Punctate calcified granulomas within the liver likely reflect\nchronic granulomatous disease. There is pneumobilia which is new from the\nprior CT exam and correlation for prior sphincterotomy is recommended. There\nis no worrisome liver lesion. The main portal vein and central branches\nappear patent. The gallbladder is incompletely distended though note is made\nof per cholecystic fluid versus mild gallbladder wall edema. No radiopaque\ngallstones are seen. The common bile duct is dilated up to 10 mm.\nPANCREAS: Since the prior CT exam, the pseudocyst has nearly resolved. There\nis a tiny residual hypodensity within the proximal body of the pancreas likely\nrepresenting residual pseudocyst. This lesion is best seen on series 2 image\n21 measuring approximately 11 x 16 mm. There is no pancreatic ductal dilation\nor pancreatic calcification. No peripancreatic fat stranding. The splenic\nvein and SMV appear patent.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexal structures are normal.\n\nBONES AND SOFT TISSUES: Partially imaged midline sternotomy wires noted. No\nworrisome bony lesion. No fracture. Transitional anatomy at the lumbosacral\njunction with sacralized L5 noted.\nAbdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence for acute cholecystitis. Mild gallbladder wall thickening\nversus pericholecystic fluid is nonspecific. Dilated common bile duct which\ncould reflect a passing gallstone.\n2. Pneumobilia, new from prior CT, correlate for sphincterotomy.\n3. Small hypodense lesion within the proximal body pancreas at the site of\nprior pseudocyst likely represents involuting pseudocyst.\n4. No evidence of portal vein thrombosis." }, { "input": "LOWER CHEST: There is a calcified granuloma in the right lower lobe (series 2:\nImage 12), unchanged from CT abdomen and pelvis ___. There is no\nevidence of pleural or pericardial effusion. Heart size is normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of concerning focal lesions. Mild central intrahepatic\nand extrahepatic biliary ductal prominence is likely due to prior\ncholecystectomy. Common bile duct measures up to 8 mm. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is normal. There is a right ovarian cyst\nmeasuring 3.2 cm in maximal diameter (series 2:77), physiologic given the\npatient's age. The left ovary is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Mesenteric vasculature appears patent. Previously reported\nthrombosis of a branch of the right posterior portal vein is not seen on the\ncurrent exam. Portal vein is patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post median sternotomy.\n\nSOFT TISSUES: Right axillary clips are noted. The abdominal and pelvic wall\nis within normal limits.", "output": "1. No acute abnormality in the abdomen or pelvis to explain patient's reported\nepigastric pain. No evidence of pancreatitis.\n2. No bowel obstruction. Appendix is normal." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is decompressed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Hypodensity arising\nfrom lower pole of left kidney measures 2.3 x 2.8 x 2.6 cm is difficult to the\ncharacterized on unenhanced scan however is likely a cyst (4; 44 and 6; 28). \nThere is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are prominent periaortic lymph nodes that are not\npathologically enlarged. Prominent inguinal lymph nodes with largest\nmeasuring up to 1.5 cm that do not appear pathologically enlarged.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative sclerotic in the right SI joint. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No masses identified on this noncontrast study. If there is continued concern\nconsider MRI to further assess." }, { "input": "LOWER CHEST: Other than mild bibasilar atelectasis, the partially imaged lower\nlungs are clear. No evidence of pericardial effusion or pleural effusion. \nCoronary artery calcifications are present.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver remains shrunken and nodular, consistent with\ncirrhosis. No evidence of concerning focal hepatic lesions for HCC - no\narterial hyperenhancing lesions or lesions with washout. Sub cm hypodensities\nin segment 8, 4, and 2 are too small to accurately characterize but may be\ncysts or biliary hamartomas (e.g., series 10, image 37, 30, 38). No evidence\nof intrahepatic or extrahepatic biliary ductal dilation. The gallbladder is\ncontracted. No evidence of ascites in the abdomen.\n\nThere is an accessory left hepatic artery arising from the left gastric artery\n(series 5, image 27). The hepatic arteries are enlarged, unchanged .\n\nThere is persistent focal narrowing with near complete occlusion/thrombus of\nthe main portal vein at the porta hepatus, similar the prior exam (series 10,\nimage 45). The left and right portal veins are patent. The SMV and splenic\nveins are enlarged and widely patent. Collaterals in the anterior abdominal\nwall are unchanged. There is recanalization of the periumbilical vein. There\nare gastroesophageal and splenic hilus varices.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged up to 14.5 cm in maximum dimension (axial\nimages), similar to prior. No focal splenic lesion is seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cortical cysts are unchanged. No evidence for a renal mass. \nNo hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: Imaged small and large bowel loops in the abdomen are\nunremarkable. The bowel is not fully imaged as the pelvis is not scanned.\n\nLYMPH NODES: Fat stranding in the portal hepatis is unchanged.\nNo retroperitoneal and mesenteric lymphadenopathy in the imaged upper abdomen.\n\nVASCULAR: No abdominal aortic aneurysm in the upper abdomen. Atherosclerotic\ncalcified disease is mild. Liver vasculature is described under the hepatic\nsection of this report.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Numerous bilateral subcutaneous nodules in the ventral abdominal\nwall, slightly different in distribution compared to the prior study, could be\nrelated to subcutaneous injections (e.g. , series 3, image 49, 46).", "output": "1. Cirrhotic-appearing liver without evidence of an arterially-enhancing mass.\n2. Persistent near complete occlusion of the main portal vein at the porta\nhepaticus with collaterals, overall unchanged. Unchanged multiple varices.\n3. Unchanged, relatively mild splenomegaly.\n4. Accessory left hepatic artery.\n5. Numerous bilateral subcutaneous nodules in the ventral abdominal wall,\nslightly different in distribution compared to the prior CT, could be related\nto subcutaneous injections." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: Compared to the prior CT abdomen, the liver remain fibrotic and\nnodular consistent with history of cirrhosis. No evidence of concerning focal\nhepatic lesions for HCC. No arterial hyper enhancing lesions or lesions with\nwashout are visualized. Subcentimeter hypodensities in segments 2 and 6 are\ntoo small to accurately characterize but may be cysts or biliary hamartomas\n(for example series 3 image 126 and 135). Mild bile duct dilatation is noted\nin segment 7 (series 3, image 123).\n\nPortal vein is irregular and diminutive proximally with changes consistent\nwith history of remote thrombus (series 3, image 145). No acute thrombus is\nseen.\n\nAccessory left hepatic artery originates off the left gastric artery, and is\nthe predominant supply to the left lateral segment.\n\nLeft hepatic vein is attenuated, no proper right hepatic vein is visualized\nhowever two small right hepatic veins are seen.\n\nRe-demonstration of esophageal and paraesophageal varices.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged up to 13.7 cm in maximum dimension (coronal images,\nseries 601, image 52), similar to prior. No focal splenic lesions are seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cortical cysts are unchanged in size compared to prior exam\nperformed ___. There is mild bilateral renal pelvic fullness\nwithout evidence of hydronephrosis. An accessory right renal artery is\nvisualized. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is a collateral pathway between the distal branch is of\nsuperior mesenteric vein and the right gonadal vein. Periuterine and gonadal\nveins predominantly drain through the right gonadal vein. There is no\nabdominal aortic aneurysm. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are noted.\n\nSOFT TISSUES: Re-demonstration of a subcutaneous round fluid density lesions\nin the ventral abdominal wall, in a similar distribution from prior CT study,\nlikely represents prior subcutaneous injection sites.", "output": "1. Re-demonstration of cirrhosis. No evidence of hepatic lesions concerning\nfor ___.\n2. Portal vein is irregular and diminutive proximally with changes consistent\nwith history of remote thrombus. No acute thrombus is seen.\n3. Accessory left hepatic artery originates off the left gastric artery and is\nthe predominant supply to the left lateral segment of the liver.\n4. Collateral pathway between the distal branch of the superior mesenteric\nvein and the right gonadal vein, is likely the consequence of portal\nhypertension." }, { "input": "LOWER CHEST: Minimal basal atelectasis. There is a small right Bochdalek\nhernia.\n\nHEPATOBILIARY: Re-demonstration of cirrhotic liver morphology with no\nsuspicious mass lesions meeting OPTN criteria for ___. Common bile duct is\nnormal in caliber. Gallbladder appears unremarkable. There is an isolated\narea of peripheral biliary ductal dilatation within segment 7 (303:25) stable.\n\nMain portal vein remains smaller in caliber secondary to the chronic\nthrombosis. However, the right and left portal veins are patent. Hepatic\nveins are patent as well. There is conventional. Accessory left hepatic\nartery originates from the left gastric artery.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious pancreatic lesions.\n\nSPLEEN: Borderline spleen measures 13.4 cm.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY:There is no hydronephrosis or nephrolithiasis. There are bilateral\nrenal cortical cysts.\n\nGASTROINTESTINAL: Stomach is unremarkable. Small bowel loops are normal in\ncaliber. Large bowel is unremarkable.\n\nPERITONEUM: There is no ascites. There is no free air. There is no\nperitoneal stranding.\n\nLYMPH NODES: Prominent left periaortic lymph node (303:85) is unchanged.\n\nVASCULAR: The abdominal aorta is normal in caliber with moderate\natherosclerotic disease. Splenic vein and SMV are patent. Re-demonstration\nof extensive pelvic gonadal varices with interval l development of eccentric\npartial thrombosis of 1 of the big varices (303:131). There is unchanged\nchronic narrowing of the main portal vein secondary to remote thrombosis. \nRight and left portal veins are patent.\n\nPELVIS: Urinary bladder is unremarkable. Uterus is normal in size for age. \nThere are no adnexal mass lesions.\n\nBONES:There are no acute osseous destructive lesions.\n\nSOFT TISSUES: Subcutaneous soft tissue stranding and granulomas along the\nanterior abdominal wall.", "output": "1. Stigmata of liver cirrhosis without evidence of hepatic lesions meeting\nOPTN criteria for HCC.\n2. Chronic thrombosis of the portal vein remains patent.\n3. Extensive pelvic gonadal varices with new development of eccentric partial\nthrombosis in ones of the big varices (303:131).\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 15:00 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis.\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic in morphology with no focal lesions\nmeeting OPTN criteria identified. Focal segmental intrahepatic biliary\ndilatation segment 7 is re-demonstrated (series 8, images 15 through 22),\nunchanged from prior. No extrahepatic biliary dilatation is identified. The\ngallbladder unremarkable.\n\nThe portal vasculature is diminutive, as on priors. Hepatic venous\nvasculature is patent. A replaced left hepatic artery from the left gastric\nartery is re-demonstrated.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Mild splenomegaly is again seen.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: Bilateral simple renal cysts are demonstrated as well as multiple\nsubcentimeter hypodensities which are too small to characterize, stable. Mild\nUPJ dilation is visualized (8:61) dating back to at least ___.\n\nGASTROINTESTINAL: No bowel obstruction is identified. No abdominal ascites is\nseen.\n\nPELVIS: There is no free fluid in the pelvis.The uterus and adnexae are within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Multiple portosystemic shunts are visualized throughout the upper\nabdomen, as on prior. Additionally, there is re-demonstration of large\nperiuterine varices with associated mural thrombus, the latter slightly\nimproved from prior. The enlarged right ovarian vein communicates with a\nseverely dilated SMV as part of a large portosystemic shunt.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Sequelae of therapeutic injection is visualized in the anterior\nabdominal wall.", "output": "1. Cirrhotic liver with sequelae of portal hypertension and no concerning\nfocal lesions identified.\n2. Large periuterine varices draining into enlarged right ovarian vein with\nsome associated mural thrombus, slightly improved from prior with massive\nportosystemic shunt between the SMV and right ovarian vein.\n3. Unchanged chronic right UPJ dilation dating back to at least ___." }, { "input": "LOWER CHEST: Atelectasis is seen in the lung bases. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates mildly abnormal morphology, with\nperipheral atrophy of the liver, which may suggest some underlying liver\ndisease. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is a 7 mm pancreatic cyst\nin the pancreatic head. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Calcifications are seen in the spleen, likely\nsequela of prior granulomatous infection.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patchy hypodense regions are seen in the right kidney with possible\nstriated nephrogram, which can be concerning for early pyelonephritis. There\nmay be a delayed nephrogram on the left. The left kidney has increased\ncentral enhancement, which may be secondary to the right kidney's possibly\npyelonephrisitis vs mild delayed nephrogram. A subcentimeter hypodensity seen\nin the left upper renal pole, too small to fully characterize but likely renal\ncyst. There is no perinephric abnormality or obvious perinephric fluid\ncollection.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. There is mild fat stranding and thickening of\nthe descending colonic wall, which is compatible with mild colitis. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post right hip fixation. Scoliosis and degenerative changes\nare seen in the lumbosacral spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Small\nfoci of edema are seen in the right gluteal region, likely injection sites. \nThere is a tiny fat containing umbilical hernia.", "output": "1. There is mild wall thickening of the descending colon with associated fat\nstranding, possibly mild colitis.\n2. Patchy hypodense regions are seen in the right kidney with possibly\nstriated nephrogram, which can be concerning for early pyelonephritis.\n3. Mildly abnormal morphology of the liver with some peripheral atrophy may\nindicate underlying liver pathology.\n4. There is a 7 mm cyst in the pancreatic head.\n\nRECOMMENDATION(S): Follow up MRI for the pancreatic cyst could be obtained\nfor further evaluation if clinically desired." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries. The celiac trunk is patent.\nThere is moderate to severe atherosclerotic calcification of the origin of the\nsuperior mesenteric artery. The bilateral renal arteries are patent. The ___\nis patent with mild atherosclerosis at the origin. There is severe narrowing\nof the right common iliac artery near its origin. There is moderate to severe\nnarrowing of the proximal left common iliac artery. There is mild to moderate\natherosclerosis of the right external iliac artery and mild atherosclerosis of\nthe right internal iliac artery. There is mild atherosclerotic calcification\nof the left external iliac artery. There is mild atherosclerotic\ncalcification of the distal left internal iliac artery.\n\nLOWER CHEST: There is moderate centrilobular emphysematous disease. There is\nno pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen is a focus of arterial enhancement in segment 8 (series 3, image\n22), likely representing vascular shunt or flash filling hemangioma. There\nare no new suspicious liver lesions. The portal and hepatic veins are patent.\nThere is moderate pneumobilia related to the patent biliary ductal stent,\nunchanged from ___. There is a small amount of gas within the\ngallbladder as well as layering stones and sludge. There is no wall\nthickening to suggest cholecystitis.\n\nPANCREAS: Again seen is diffuse atrophy of the pancreas with severe pancreatic\nductal dilatation measuring up to 8 mm in diameter. This is unchanged from\nprior imaging.\n\nAgain seen is a small focus of hypoenhancement at the pancreatic head\nmeasuring approximately 1.1 x 0.8 cm. This is unchanged from ___. \nThe superior mesenteric vein remains in close proximity. There is decreased\nnarrowing of the superior mesenteric vein since ___. The\ngastroduodenal artery also is in close proximity without definite involvement.\n\nPreviously noted stranding surrounding the celiac axis appears slightly\ndecreased from ___ and remains less than 180 degrees.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Again seen is a heterogeneous 2 cm left adrenal nodule which is\nunchanged. There is a 1 cm right adrenal nodule which is also unchanged. \nThese lesions were previously characterized as representing adenomas.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid renal lesions, or hydronephrosis. There\nmultiple hypoattenuating cystic lesions within the kidneys which most likely\nrepresent simple cysts. There are no urothelial lesions in the kidneys or\nureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder has mild thickening . There is no evidence of\npelvic or inguinal lymphadenopathy. There is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unchanged. The visualized reproductive\norgans are unremarkable.\n\nBONES: Again seen are moderate degenerative changes of the thoracolumbar spine\nwith dextroscoliosis. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The mass in the pancreatic head is unchanged in size from ___. \nAgain seen is proximity to the superior mesenteric vein and gastroduodenal\nartery. There is slight decreased narrowing of the SMV.\n2. There is trace free fluid in the pelvis which is nonspecific, but should be\ncorrelated with clinical picture. No other concerning peritoneal findings.\n3. Fat stranding surrounding the celiac axis is slightly decreased from prior\nimaging. Again seen is less than 180 degrees of involvement.\n4. There is mild-to-moderate atherosclerotic calcification of the abdominal\naorta and its branches as described above." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHypoattenuation in the region of the falciform ligament may represent focal\nfat or perfusional change. There is no evidence of focal lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. No bowel\nobstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is retroverted. A 2.5 cm right adnexal cyst\nis normal for the patient's age. The left ovary appears normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: No definite hernia is identified.", "output": "1. No definite hernia.\n2. No acute intraabdominal process." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout,\ncompatible with hepatic steatosis. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.1 hypodensity is noted within the left lower renal pole, likely simple\ncyst. There is no evidence of focal renal lesions or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate sized hiatal hernia. Metallic densities\nare identified adjacent to the gastroesophageal junction, likely from prior\nhiatal hernia repair. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is mild mucosal thickening and\nhyperemia of predominantly the distal colon, compatible with mild colitis,\npossibly due to inflammatory vs infectious etiology. Colonic diverticulosis\nis noted without evidence of acute diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Phleboliths are noted in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild thickening of predominantly the distal colon which could represent\nmild colitis. No focal fluid collection.\n2. Colonic diverticulosis without acute diverticulitis.\n3. Hepatic steatosis.\n4. Cholelithiasis.\n5. Small to moderate sized hiatal hernia." }, { "input": "LOWER CHEST: There is mild atelectasis at the lung bases. There is no\nevidence of pleural or pericardial effusion. Coronary artery and mitral valve\ncalcifications are partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Few\nhepatic hypodensities are too small to characterize, however likely represent\nhepatic cysts or biliary hamartomas. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 3.2 cm simple cyst in the right lower pole. Multiple additional\nsubcentimeter cortical hypodensities in the bilateral kidneys are too small to\ncharacterize, however likely represent cysts. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: The bones are demineralized. Mixed lucent and sclerotic appearance of\nthe L4 vertebral body and posterior elements is unchanged, likely representing\nPaget's. A compression deformity at L4 has progressed compared with ___,\nhowever appears chronic in nature. There is no retropulsion of bony\nfragments. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute process in the abdomen or pelvis.\n2. Mixed lucent and sclerotic appearance of the L4 vertebral body and\nposterior elements is unchanged, likely representing Paget's. A compression\ndeformity at L4 is progressed compared with ___, however appears chronic in\nnature." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Within the posterior right hepatic dome there is a wedge shaped\n1.8 x 1.2 cm hyperintense on arterial phase lesion (4:14). The lesion does\nnot enhance on portal venous or delayed images, and is unchanged in size from\nprior CT chest from ___. There are similarly enhancing lesions in\nthe liver, a 0.8 cm lesion within hepatic segment ___, a 0.3 cm lesion within\nhepatic segment VII and a 4 mm lesion within hepatic segment IVB (4:42, 47). \nThese lesions attenuate similarly to the aorta on arterial phase, and are\nisodense with the liver on portal venous and delayed phases, as is the aorta. \nThese lesions likely represent hemangiomas.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\nA 1.1 x 1.0 cm nodule left adrenal gland attenuates to less than 10 ___ on\nunenhanced scan, and therefore represents a benign adrenal adenoma.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMillimetric hypodensities within the renal cortex are too small to\ncharacterize but unchanged from prior imaging. A 0.8 cm hypodensity in the\ninferior pole of the right kidney likely represents a simple renal cyst. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A percutaneous gastrostomy tube is seen with its bumper\nplaced within the body of the stomach. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The visualized colon is\nwithin normal limits. The appendix is not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Several arterial enhancing lesions within the liver, the largest measuring\n1.8 x 1.2 cm within the posterior right hepatic dome, likely represent hepatic\nhemangiomas.\n2. 1.1 x 1.0 cm left adrenal nodule is a benign adrenal adenoma." }, { "input": "LOWER CHEST: There is mild bibasilar atelectatic change, otherwise the lung\nbases are within normal limits.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hepatic hypodensities are seen scattered throughout\nthe liver. The largest is in segment ___ and measures 3.9 x 3.5 cm. This\nlesion is compatible with a hepatic cyst. Numerous other smaller lesions are\nincompletely characterized on the current examination, but statistically\nrepresent either small cysts or hemangiomas. No suspicious liver lesions\nidentified. The gallbladder and biliary tree are within normal limits.\n\nPANCREAS: There is some fatty replacement of the pancreatic glandular tissue,\nwith relative sparing at the very distal pancreatic tail. There are no\nsuspicious pancreatic lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A hyperdense mass measuring 3.2 x 3.2 cm is seen within the\ncecum, likely corresponding to the patient's known tubular adenoma. Is\nsituated at the appendiceal orifice. As a consequence, there is thickening\nand inflammatory change surrounding the appendix. The appendix is dilated and\nmeasures up to 11 mm. There is a surrounding 1.1 x 2.1 cm collection, lying\nbetween the appendix and the cecal pole. The findings are compatible with a\nlocally contained perforated appendicitis. There is significant subcutaneous\nedema and wall thickening involving the cecum and terminal ileum, although\nthis is likely reactive to the appendiceal process.\n\nA solitary right cecal diverticulum is seen, although this is not at the\nepicenter of the inflammatory changes and is likely incidental.\n\nPELVIS: Small left-sided bladder diverticulum is noted. There is no free\nfluid in the pelvis.\n\nLYMPH NODES: There is no size significant abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Contained perforated appendicitis with 1.1 x 2.1 cm collection lying\nbetween the appendix and the cecal pole, likely due to obstruction from the\npatient's known cecal tubular adenoma. Extensive inflammatory change noted at\nthe terminal ileum and cecum, likely reactive.\n\nNOTIFICATION: These findings were transmitted to the treating team by Dr.\n___ at 09:30 on ___." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous hypodensities scattered throughout the liver are\nconsistent with simple cysts, including a 4.3 x 3.5 cm lesion in segment 2. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout. The pancreas is\ndiffusely atrophic with the exception of a short segment in the tail which is\nnonatrophic (series 5, image 62). There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient is\nstatus post right partial colectomy. The remaining colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a ventral hernia which contains several loops of small\nbowel without evidence of complication.", "output": "1. No evidence of recurrence or metastatic disease within the abdomen and\npelvis.\n2. A ventral hernia contains several loops of small bowel without evidence of\ncomplication." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2 mm left upper pole nonobstructing calculus (02:35). There is no\nhydronephrosis. There is no perinephric abnormality. Subcentimeter left\nrenal hypodensities are too small to characterize, but most likely reflect\nsimple cysts. There is no evidence of suspicious renal lesions. There is no\nevidence of urothelial lesions. The distal ureters and bladder are\nunremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Several loops of small bowel\nare fluid-filled and top-normal in caliber to mildly dilated, and there is a\nloop in the right upper quadrant that has the appearance of mild fecalization,\nwith a transition to decompressed small bowel (604:14). Colonic\ndiverticulosis is noted without evidence of diverticulitis. The appendix is\nnormal. Nonspecific trace ascites is noted (2:54, 68).\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLikely subacute to chronic nondisplaced left anterior seventh rib fracture\n(02:16).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Possible partial small bowel obstruction as evidenced by loops of small\nbowel which are fluid-filled and top-normal in diameter to mildly dilated. A\ntransition point in the right upper quadrant after which small bowel is\ndecompressed. Trace free fluid in the abdomen may be related to this\nobstruction. There is no wall thickening or pneumatosis.\n2. 2 mm nonobstructing left upper pole renal calculus. No hydronephrosis.\n3. Subacute to chronic nondisplaced left anterior seventh rib fracture.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 6:34 am, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Extensive bilateral airspace disease with ground-glass and\nnodular opacities and linear components. There is no evidence of pericardial\nor pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of hydronephrosis. A rounded hypodensity in the upper\npole of the right kidney measures 1.3 x 1.4 cm and several subcentimeter\ncortical hypodensities bilaterally are too small to fully characterize and\nlikely represents cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended. Multiple loops of dilated small\nbowel are present with transition point in the right lower quadrant (2:71,\n601b:14) and decompressed loops distally. Diverticulosis of the sigmoid colon\nis noted, without evidence of wall thickening and fat stranding. The appendix\nis normal. No pneumatosis, wall thickening, or pneumoperitoneum is present.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles contain calcifications\nand are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: No acute fracture or concerning osseous abnormality is noted.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted. Superior to the\numbilicus is a fat containing ventral hernia in close proximity to the\ntransition point (602b:31, 2:68).", "output": "1. Distended stomach and dilated loops of small bowel with transition point in\nright lower quadrant concerning for small bowel obstruction. No pneumatosis,\npneumoperitoneum, or free fluid.\n2. Fat containing ventral hernia adjacent to the transition point.\n3. Extensive bilateral airspace disease may be due to atelectasis, pulmonary\nedema, or infection." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in the bilateral lung bases. \nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a exophytic simple cyst measuring 2.0 x 2.0 cm in the upper pole of\nthe left kidney (2:19). There is a sub-centimeter hypodensity measuring 0.3\ncm in the upper pole the left kidney (601:41), best appreciated on coronal\nreformatted images, without definite correlate on the axial sequences, which\nis too small to characterize.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Fluid is noted in\nthe cecum and ascending colon. Otherwise, the colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are bilateral left greater than right hydroceles. \nThe prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild multilevel degenerative changes of the lumbar spine, most\nsevere at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Fluid is noted in the cecum and ascending colon which likely represents\nactive diarrheal disease, given the provided clinical history.\n2. Otherwise, no evidence of acute abnormality in the abdomen or pelvis. \nSpecifically, there is no evidence of colitis and the appendix is normal. No\nevidence of obstruction." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis or scarring. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nhypoattenuating lesion in hepatic segment VIII adjacent to the inferior vena\ncava is too small to completely characterize, but likely reflects a cyst or\nbiliary hamartoma. No other hepatic lesions are seen. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.4 x 1.0 cm simple cyst arising from the upper pole of the right\nkidney. There are small left peripelvic cysts. No suspicious renal lesion. \nNo hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Prominent pylorus, likely related to\nperistalsis. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is extensive diverticulosis in apparent\nwall thickening throughout the sigmoid with subtle adjacent fat stranding and\nprominence of the vasa recta. No focal fluid collection. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm, though the infrarenal\nabdominal aorta is focally ectatic up to 1.8 cm.. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere left and mild right hip osteoarthritis includes joint space narrowing,\nosteophytosis, subchondral sclerosis, and subchondral cyst formation. There\nis mild thoracolumbar scoliosis and spondylosis with transitional anatomy at\nthe lumbosacral junction. Posterior disc protrusions or bulges likely results\nin moderate vertebral canal narrowing at L4-L5 and L5-S1.\n\nSOFT TISSUES: Calcified soft tissue nodules overlying the bilateral gluteus\nmusculature likely reflect injection site granulomas.", "output": "1. Subtle apparent wall thickening of the sigmoid colon may reflect\nunderdistention. However, in the presence of a subtle adjacent fat stranding\nand prominence of the associated vasa recta, sigmoid colitis is a\nconsideration. No focal fluid collection/abscess formation.\n2. Extensive diverticulosis.\n3. Severe left and mild right hip osteoarthritis.\n4. Mild multilevel thoracolumbar spondylosis includes posterior disc\nprotrusions/bulges which likely result in moderate vertebral canal narrowing." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. Trace pleural fluid.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensity adjacent to the inferior vena cava is stable. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.3 cm simple cyst in the right upper pole. Kidneys are otherwise\nunremarkable. There no hydroureteronephrosis.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia. Small bowel is normal in\ncaliber without focal wall thickening. There is persistent wall thickening of\nthe sigmoid colon with prominence of the Vasa recta, similar in severity\ncompared to ___. The rectum is involved. Appendix is normal. There is\nextensive diverticulosis of the sigmoid colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. The right ovary is prominent\nfor the patient's age, but unchanged. Left ovary is not seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are severe degenerative changes of the left hip, as seen previously.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable wall thickening of the rectum and sigmoid colon with prominence of\nthe associated Vasa recta since ___, consistent with colitis.\n2. Diverticulosis.\n3. Moderate hiatal hernia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is enlarged, measuring up to 10\nmm, with wall thickening and a small amount of surrounding fat stranding,\nconsistent with uncomplicated appendicitis, as seen on outside ultrasound. No\nextraluminal air fluid collection or focal fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsliver free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nProminent mesenteric lymph nodes are not pathologically enlarged by CT\ncriteria. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Uncomplicated acute appendicitis, as seen on same-day ultrasound." }, { "input": "Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nCT abdomen without with contrast: 6 mm hypodensity in the hepatic dome is\nunchanged from prior examination, remaining too small to fully characterize\nbut likely representing hamartoma or cyst. The liver otherwise enhances\nhomogeneously without new lesion, or biliary dilatation. CBD is normal in\ncaliber. Gallbladder is surgically absent with clips in place.\n\nThe spleen and adrenal glands are unremarkable in appearance. There is re-\ndemonstration of central pancreatectomy and the pancreaticojejunostomy which\nappears patent. The distal pancreatic body and tail remains atrophied in\nappearance but is otherwise unremarkable without new lesion or main pancreatic\nductal dilatation. There is no evidence of recurrence in the resection bed.\nCollapsed loops of bowel in the porta hepatis and adjacent to the\npancreatectomy site should not be confused for lymphadenopathy or recurrent\nlesion. On coronal view these areas are clearly contiguous with loops of bowel\nextending caudally.\n\nThere is re- demonstration of a simple right upper pole renal cyst measuring\n3.1 cm. The kidneys otherwise present symmetric nephrograms and excretion of\ncontrast without focal solid lesion, hydronephrosis or perinephric\nabnormality.\n\nThe stomach, duodenum and remainder of the small bowel is unremarkable without\nevidence of obstruction. The large bowel is a is thin-walled and unremarkable\nwithout pericolonic fat stranding.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment.\nThere is mild calcified atherosclerotic burden. Scattered retroperitoneal and\nmesenteric lymph nodes are not enlarged by CT size criteria. There is a small\nfat containing umbilical hernia. There is no ascites or pneumoperitoneum.\n\nCT pelvis with contrast: The bladder, seminal vesicles, prostate and rectum\nare unremarkable. There is no inguinal or pelvic sidewall lymphadenopathy by\nCT size criteria. There is a small fat containing right-sided inguinal hernia.\n\nOsseous structures: There is no suspicious focal osseous lesion. There are\nmild multilevel degenerative changes of the imaged thoracolumbar spine, most\nprominent at L4-L5 with large anterior osteophyte, small posterior disc\nosteophyte complex, vacuum disc phenomenon and cortical sclerosis.", "output": "1. No convincing evidence of local or metastatic disease recurrence in the\nabdomen or pelvis.\n2. Stable subcentimeter hepatic hypodensity, likely representing a cyst or\nbiliary hamartoma.\n3. Simple right renal cyst." }, { "input": "The visualized lung bases appear clear. There are no pleural effusions.\n\nA hypodense focus in the dome of the liver measures 5 mm in diameter is too\nsmall to characterize, but unchanged. There is no biliary dilatation. The\nspleen is normal in size and appearance. The adrenal glands appear normal. \nIn the upper pole of the right kidney, a simple cysts measures up to 31 x 27\nmm in axial ___. Otherwise kidneys are unremarkable.\n\nPatient is status post cholecystectomy, central pancreatectomy with a\npancreatic jejunostomy. There is no evidence for fluid collection.\n\nFiducial seeds are present in the hepatic hilum. Not as well visualized on\nthis study is a small hypodense area in the pancreatic head and ill-defined\nincreased soft tissue attenuation in the hepatic hilum, probably unchanged\nallowing for differences in technique but difficult to assess. Increased\nattenuation is noted in upper abdominal fat in the neighborhood of of multiple\nthus fiducial markers. Findings probably can be considered as due to\nanticipated treatment affect.\n\nThe post-operative appearance of small bowel is unremarkable. Sigmoid\ndiverticulosis is mild.\n\nBladder wall again shows borderline thickening but with some enhancement. \nCentral prostatic calcifications are present. Major mesenteric arteries and\nveins appear patent. There is no lymphadenopathy or ascites.\n\nThere are no suspicious bone lesions. Mild degenerative changes affect L4-L5\nand L5-S1 facet joints.", "output": "Questionable bladder wall hyperenhancement; correlation with urinalysis is\nrecommended. No evidence for obstruction or fluid collection. Increased\nattenuation in fat along the upper abdomen which is probably compatible with\nanticipated treatment effect." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter liver hypodensity at the dome is unchanged. No additional focal\nhepatic lesions are seen. There is mild intrahepatic biliary duct dilation\nwith a focal area of ductal dilation at the right dome, unchanged from ___ (series 2, image 13). The common bile duct measures approximately 8 mm not\nsignificantly changed from prior. The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post central pancreatectomy and\npancreaticojejunostomy. The pancreatic tail is atrophic. A 1.0 cm hypodense\nmass in the pancreatic head (series 2, image 24), has not significantly\nchanged from prior. Also unchanged is ill-defined soft tissue density\nadjacent to the fiducial markers (series 2, image 18) measuring approximately\n3.0 x 1.4 cm. Multiple fiducial markers are in place.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.4 cm simple cyst in the right upper pole is unchanged. No additional\nfocal renal lesions are seen. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nThe stomach is relatively decompressed. Small bowel is normal in caliber\nwithout focal wall thickening. There is an intact Jejunal anastomosis is seen\nin the left upper quadrant. Oral contrast extends past the region of the\nanastomosis. Large bowel is normal in caliber without focal wall thickening. \nThe appendix is not visualized but there are no secondary signs of\nappendicitis in the right lower quadrant. There is no intra-abdominal free\nfluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring approximately 3.1 x\n5.1 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable appearance of the pancreatic head mass and ill-defined soft tissue\nsuperior to the pancreas.\n2. Postsurgical changes from the central pancreatectomy and\npancreaticojejunostomy. Intact jejunal anastomosis without evidence of\nobstruction.\n3. Mild intrahepatic biliary duct dilation with a more focal area of right\nintrahepatic ductal dilation at the dome, unchanged from ___, attention\non followup imaging." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nhypodensity near the dome of the liver (601 B, image 23) is consistent with a\nsimple hepatic cyst, unchanged. There is no intrahepatic biliary ductal\ndilatation. The gallbladder is surgically absent. The common bile duct stent\nis in unchanged position with distal aspect within the second portion of the\nduodenum. There is trace associated pneumobilia in the left lobe of the\nliver. Main portal vein is patent.\n\nPANCREAS: The patient is status post central pancreatectomy with Roux-en-Y\npancreaticojejunostomy. Hypodense lesion within the pancreatic head measuring\nat least 7 mm (02:19) is not well assessed given streak artifact from adjacent\nfiducial marker in the common bile duct stent, but appears grossly unchanged. \nPancreatic tail appears unremarkable without pancreatic ductal dilatation. \nMild stranding of the mesenteric fat adjacent to the celiac axis and in the\nsurgical bed is unchanged.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.2 cm hypodensity arising from the upper pole of the right kidney is\nconsistent a simple cyst. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach, duodenum, and loops of small bowel appear\nunremarkable without evidence for obstruction or wall thickening. \nJejunojejunostomy appears unremarkable in the left abdomen. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.1 cm wide with\ncentral coarse calcifications likely the sequela of prior inflammation.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes are noted in the lumbar spine.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. No evidence of obstruction or acute intra-abdominal abnormality.\n2. The patient is status post central pancreatectomy and Roux-en-Y\npancreaticojejunostomy. Re- demonstration of pancreatic head mass, grossly\nunchanged.\n3. Common bile duct stent in place with small amount of pneumobilia, but no\nintrahepatic biliary ductal dilatation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 6\nmm hypodensity at the hepatic dome is unchanged (2:8). There are no new focal\nlesions. There is no evidence of intrahepatic biliary dilatation. Metallic\ncommon bile duct stent is unchanged in position, with trace pneumobilia in the\nleft hepatic lobe (602b:36). The gallbladder is surgically absent. Compared\nwith CT ___, there is been interval in size of a nonocclusive\nthrombus within the main portal vein (2: 17, 601b:23). There is new\nnonocclusive thrombus in the SMV (2:23, 601b:19). The thrombus does not\nextend to the splenic vein.\n\nPANCREAS: Patient is status post central pancreatectomy and Roux-en-Y\npancreaticojejunostomy. Fiducial markers adjacent to patient's known\npancreatic head make it difficult to evaluate, however does not appear\nsignificantly changed. The remnant pancreatic tail is unremarkable, without\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.7 x 2.3 cm simple cyst arising from the upper pole of the right\nkidney. There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2:51).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains central calcifications, unchanged,\nand the seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes at the L4-L5 level are not significantly changed.\nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Interval increase in size in nonocclusive thrombus in the main portal vein\nwith new extension of nonocclusive thrombus into the SMV.\n2. Status post central pancreatectomy and pancreaticojejunostomy. Fiducials\nadjacent to a known pancreatic head mass limit its evaluation, however it does\nnot appear significantly changed.\n3. Unchanged position of a common bile duct stent with trace pneumobilia,\nsuggesting stent patency." }, { "input": "The secondary re- was requested outside hospital CT of the abdomen and pelvis\nto evaluate for potential acute abdominal process.\n\nLOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\ndefinite focal hepatic lesion is identified aside from a tiny hypodense lesion\nat the hepatic dome, unchanged since the prior examination. There is no\nsignificant intrahepatic biliary ductal dilatation. The mild apparent\nprogressed intrahepatic biliary ductal dilatation is appears to be present on\naxial images, is unchanged when compared by coronal images to the prior. A\ncommon bile duct stent is in place, with air noted within. The gallbladder\nsurgically absent. Again noted is thrombus in the portal confluence and in\nthe proximal port vein, with extension into the superior mesenteric vein\n(03:29), overall similar to the prior examination. There is attenuation of\nthe common hepatic artery which remains patent, also similar to prior.\n\nPANCREAS: The patient is status post central pancreatectomy and Roux-en-Y a\npancreaticojejunostomy. The known pancreatic head mass measures 1.3 x 2.3 cm,\ngrossly unchanged since the prior examination.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA cyst is seen in the upper pole of the right kidney. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Small bowel\nanastomosis in the right lower quadrant appears unremarkable. The colon and\nrectum are within normal limits. The appendix is not visualized, but there\nare no secondary signs of appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcifications are seen within the central prostate,\nwhich is enlarged. The seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no mesenteric or retroperitoneal lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes are seen in the visualized\nthoracolumbar spine. These are most severe at L4-L5. No fracture or\nsuspicious bony lesion is identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process, no change since prior or findings to\nexplain symptoms.\n2. Nonocclusive thrombus involving the portal vein and proximal SMV, grossly\nsimilar to the prior examination.\n3. Pancreatic head mass, not significantly changed since the prior\nexamination." }, { "input": "LOWER CHEST: Bibasilar airspace opacities likely represent regions of\natelectasis. There is no evidence of pleural or pericardial effusion. Heart\nsize is normal with Port-A-Cath tip in the proximal right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodensity at the hepatic dome is stable. Patient has\nundergone interval percutaneous right internal-external biliary drain\nplacement, which terminates in the duodenum. Mild intrahepatic biliary duct\ndilatation is not significantly changed. The common bile duct is stented,\nwith expected pneumobilia in the left lobe, slightly increased from prior. \nAgain seen is partially occlusive thrombus in the main portal vein extending\ninto the SMV, not significantly changed compared with prior (2:24, 32). The\nsplenic vein is patent. There has been interval development of new large\nascites. The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post central pancreatectomy and\npancreaticojejunostomy. Known pancreatic head mass appears indistinct and\nill-defined, difficult to precisely measure, but grossly similar to the prior\nstudies. The remnant pancreatic tail is unchanged in appearance.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.1 cm simple cyst arising from the upper pole of the right kidney,\nstable. There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Anastomosis is\nseen in the right mid abdomen which is intact. The ascending colon and\ndescending colon at the splenic flexure demonstrate possible wall thickening\nand edema, may be secondary to third spacing, however colitis cannot be\nexcluded (601:25). The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nlarge ascites in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains calcifications, and the seminal\nvesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes at L4-L5 are not significantly changed. There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted. There is ascitic\nfluid in a small right inguinal hernia.", "output": "1. New large volume ascites.\n2. Possible wall thickening and edema in the ascending colon and at the\nsplenic flexure may be secondary to third spacing, however colitis,\ninflammatory or infectious, cannot be excluded.\n3. Interval placement of a PTBD, which terminates in the duodenum with similar\nmild intrahepatic biliary ductal dilatation. The common bile duct stent is\nunchanged in position, with pneumobilia in the left hepatic lobe.\n4. Nonocclusive thrombus in the main portal vein extending into the SMV is not\nsignificantly changed.\n5. Known pancreatic head mass does not appear grossly changed.\n6. Bibasilar atelectasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nMild hypertrophy of the left hepatic lobe and a patent umbilical vein are\nconsistent with known cirrhosis. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is stable splenomegaly. The spleen demonstrates normal\nattenuation throughout and there is no evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There are numerous esophageal and gastric varices. There is a 1.7\ncm, nonenhancing, nonocclusive thrombus in the SMV (5, 35-36) with associated\nfocal, venous dilatation, most consistent with a bland thrombus.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small region of subcutaneous fat stranding in the left lower\nanterior abdominal wall may reflect prior trauma.", "output": "1. 1.7 cm, likely bland, nonocclusive SMV thrombus.\n2. Unchanged sequelae of portal hypertension including splenomegaly, gastric\nand esophageal varices, and portosystemic shunts." }, { "input": "Aside from minor dependent changes, the lung bases appear clear. There are no\npleural effusions.\n\nThe liver, gallbladder, adrenal glands, pancreas, spleen and kidneys appear\nwithin normal limits. A small accessory spleen appears unchanged.\n\nThe stomach and small bowel are unremarkable. From the upper through mid\ndescending portions, the colon demonstrates wall thickening and mild\nsurrounding fat stranding, most consistent with colitis. However, the length\nof involvement is only moderate.\n\n Surgical clips are present in the lower retroperitoneum near the aortic\nbifurcation. As before, the inferior mesenteric artery does not appear to be\npatent. Otherwise, major mesenteric arteries and veins do appear patent,\nhowever. Atherosclerotic disease is minimal.\n\nThe uterus, adnexa and bladder appear within normal limits. There is no\nlymphadenopathy or ascites.\n\nThere are no suspicious lytic or blastic bone lesions. Very mild\nspondylolisthesis of L4 on L5 appears unchanged. Moderate degenerative changes\nare noted along the facet joints throughout the lumbar spine, particularly\nalong lower lumbar facets.", "output": "1. Findings consistent with colitis along the descending colon. Differential\nconsiderations include an infectious process. In the setting of suspected\nchronic occlusion of the inferior mesenteric artery, and based on the\nrelatively short distribution, the possibility of ischemic colitis could be\nconsidered as a potential diagnosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The right and left hepatic artery are noted to originate from the\nceliac trunk, a normal variant. Surgical clips are noted near the aortic\nbifurcation. As before, the inferior mesenteric artery does not appear to be\npatent. Otherwise, the major mesenteric arteries and veins are patent. There\nis no abdominal aortic aneurysm. Mild atherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: Mild spondylolisthesis of L4 on L5. Moderate\ndegenerative changes throughout to visualize thoracolumbar spine. There is no\nevidence of worrisome osseous lesions or acute fracture. The abdominal and\npelvic wall is within normal limits.", "output": "1. No evidence of intra-abdominal or pelvic pathology." }, { "input": "CT of the abdomen: Please see chest CT report for formal chest findings.\n\nThe liver is homogeneous, no focal masses, no dilated intrahepatic biliary\nradicles, the portal vein and hepatic veins are patent. The gallbladder is\nunremarkable. The previous ascites and perihepatic fluid have resolved.\n\nThe pancreas, spleen, adrenal glands and kidneys appear unremarkable. Note of\na small cyst involving the right kidney, unchanged. There is no free fluid,\nno adenopathy. There is some residual stranding about the celiac axis.\n\nThe retroperitoneal soft tissue -adenopathy has resolved compared to the prior\nexam. In addition, the previously identified left renal vein thrombus has\nalso completely resolved.\n\nCT of the pelvis: The visualized loops of large and small bowel appear\nunremarkable, the previously questionable colonic wall thickening is no longer\nappreciated. There is no free fluid, there is no adenopathy.\n\nCompared to the prior exam, there has been interval development of right-sided\ncommon femoral vein thrombus, extending from the right superficial femoral\nvein.\n\nBone windows demonstrate degenerative changes only, no suspicious areas seen.", "output": "1. Resolution of ascites and extensive retroperitoneal, celiac and SMA\nadenopathy.\n2. Resolution of left renal vein thrombus, resolved ascites.\n3. Interval development of right superficial femoral and common femoral vein\nthrombus.\n\nNOTIFICATION: ___ from oncology was called with these results\nat 10:25 am on ___." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nMain portal vein, SMV, and splenic vein are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Stable 0.5 cm hypodensity within the interpolar region of the right\nkidney (5:65) is too small to characterize. The kidneys otherwise are of\nnormal and symmetric size with normal nephrogram. There is no evidence of new\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: No hiatal hernia. The stomach is unremarkable. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The colon and rectum are otherwise\nunremarkable. Moderate fecal load is present. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No large bilateral adnexal\nmasses.\n\nLYMPH NODES: Interval increase in size of a 4.1 x 3.4 cm right internal iliac\ncentrally necrotic nodal mass. Similar-appearing 2.5 x 2.1 cm (5:82) lesion\nat the level of the ___ has increased in size with the ___ coursing through\nthe ___ this nodal mass. No mesenteric lymphadenopathy. No inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Patent celiac axis, SMA,\n___, renal arteries, and accessory right renal artery. Moderate\natherosclerotic disease is noted. Patent bilateral common femoral, external\niliac, internal iliac, and proximal femoral veins. Previously identified\nright common femoral and superficial femoral vein thrombus have resolved.\n\nBONES: Mild degenerative changes of the thoracolumbar spine are noted with\nosteophyte formation, endplate sclerosis and disc space narrowing. There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Few locules of gas within the anterior abdominal wall are\nconsistent with recent injections. The abdominal and pelvic wall is otherwise\nwithin normal limits.", "output": "1. Progression of disease with increase in size of 4.1 cm right internal iliac\nand 2.5 cm ___ territory necrotic nodal masses.\n2. Resolution of right superficial femoral and common femoral vein thrombus.\n3. Diverticulosis without evidence of acute diverticulitis." }, { "input": "CHEST:\n\nThe heart is mildly enlarged. There is no pleural or pericardial effusion. No\nenlarged lymph nodes or demonstrated.\n\nNo filling defects are visualized among pulmonary arteries.\n\nMinor opacities at the lung bases are most suggestive of atelectasis. A\ncalcified granuloma projects over the left lower lobe.\n\nABDOMEN:\n\nThere is persistent mild to moderate biliary dilatation with a fairly large\namount of pneumobilia particularly in the left lobe of the liver as well as in\nthe common duct. A metallic stent has been placed along the distal common bile\nduct. Immediately above the stent there is mild apparent narrowing.\n\nA mass in the pancreatic head, as measured on portal venous phase imaging, is\ninfiltrative and accordingly difficult to measure with very high accuracy, but\nit measures approximately 38 x 35 mm compared to 36 x 32 mm previously, so\nminimally increased. Dilated sidebranches of the pancreatic duct have\nincreased in caliber within the uncinate process, which appears largely spared\nby tumor. Upstream of the tumor, which involves most of the head of the\npancreas, the neck and more distal portions of the pancreas appear spared. \nHowever there is atrophy and dilatation of the main pancreatic duct, the\nlatter increased. The pancreatic duct now measures up to 14 mm in diameter,\ncompared to 9 mm previously.\n\nThe mass may involve the descending portion of the duodenum to some extent but\nthere is no obstruction. Fat planes appear preserved between the superior\nmesenteric artery as well as the celiac trunk with respect to the mass. There\nis mild increased attenuation in fat between the upper superior mesenteric\nartery and the mass, which closely approach each other within 2 mm but without\nclear invasion, a fat plane still visible between them. It is difficult,\nhowever, to exclude very subtle involvement of the vein but such would\nprobably be minimal if present.\n\nThe common hepatic artery and its branches are all entirely replaced arising\nfrom the superior mesenteric artery. The common hepatic artery courses\nposterior to the pancreatic tail and appears spared by tumor and not even\nparticularly close to tumor. There is a large apparently omental artery\narising from the common hepatic artery. The gastroduodenal artery is\nrelatively small.\n\nThere is new mild gallbladder wall thickening and mural hyperenhancement which\nmay be secondary to obstruction or edema, which can be explained by a variety\nof possible causes including obstruction or fluid overload.\n\nThe adrenal glands and spleen appear normal. In addition to a few small\nhypodense foci measuring under 10 mm in each kidney that are too small to\ncharacterize, there is a small simple cyst on each side. In the mid upper\npole of the right kidney, there is a complex cyst, which measures 12 mm in\ndiameter (3a:121) that appears unchanged with a single septation and both\nhyperdense and hypodense loculations, too small to optimally characterize but\nwithout definite enhancement.\n\nThe jejunum and ileum are unremarkable. The colon also appears within normal\nlimits.\n\nPELVIS:\n\nThe prostate is moderately enlarged with central calcification. The seminal\nvesicles, distal ureters, and bladder appear within normal limits.\n\nThere is no evidence for distant metastatic disease. The major mesenteric\narteries and veins appear patent. There are a few small periportal nodes but\nnot enlarged by size criteria. Mild atherosclerotic thickening is noted along\nthe aorta and iliac arteries.\n\nBONES:\n\nThere are no suspicious bone lesions. The bones appear demineralized.\n\nThere is mild curvature to the left centered at the L2 level but no\nspondylolisthesis. All of the lumbar interspaces from L1-L2 through L3-L4 are\nmild to moderately narrowed. The L4-L5 interspace is more severely narrowed,\non the left side predominantly. Moderate degenerative changes are noted along\nmid through lower facet joints of the lumbar spine. The hip joint spaces\nappear mildly narrowed bilaterally.", "output": "1. No evidence of acute pulmonary embolism.\n\n2. New metallic stent across the distal common bile duct. There is again\nmoderate biliary dilatation in the upstream ducts and liver. Extensive\npneumobilia usually suggests stent patency, although very recent occlusion at\nthe upper margin of the stent is possible - it may be that some tumor is\nincreased immediate above the stent level - although perhaps less likely acute\nliver injury could also be considered as a possible explanation for elevated\nliver function tests.\n\n3. Pancreatic mass consistent with adenocarcinoma, slightly increased, but\nnot locally invasive. No evidence of metastatic disease.\n\n4. Fully replaced common hepatic artery.\n\n5. Small complex right renal cyst to which attenuation in follow-up is\nrecommended." }, { "input": "The lung bases remain clear. There are no pleural or pericardial\neffusions. No concerning discrete pulmonary nodules are identified. The\npatient is status post right hepatic lobectomy. Unchanged position of the\nrecently placed internal/external biliary drainage catheter with the tip\npositioned adjacent to the right hepatic lobectomy resection margin (2:15). \nThere is no evidence of an adjacent fluid collection. Specifically, the\npreviously noted small ___ air and fluid collection has now\ncompletely resolved. The catheter is seen to course inferiorly with no\nevidence of any ___ fluid. A 12 x 13 mm hypodense lesion anteriorly\nin the enlarged left hepatic lobe is again noted and is stable, likely\nrepresenting a focus of invaginated fat as previously described. No new liver\nlesions are identified. Satisfactory appearance of the spleen. Normal\nappearance of both kidneys, which are normal in size and enhance\nsymmetrically. Unchanged appearance of the plastic biliary stent. There is\nno free intra-abdominal fluid. No new fluid collections are identified. \nSatisfactory appearance of the pancreas. There are no enlarged upper\nabdominal or retroperitoneal lymph nodes. Satisfactory appearance of the left\nmain portosplenic vein.\n\nFindings were discussed with Dr. ___. Given the lack of residual abdominal\nfluid collection and the decreased drain output, joint decision was made to\nremove the catheter. The catheter was removed in the CT department under\nsterile technique and a sterile dressing was applied. Overall, the patient\ntolerated the drain removal well with no early complications. The patient\nwill be followed up at the surgical service as an outpatient.", "output": "Satisfactory appearance of the indwelling internal/external\nbiliary drain with the tip positioned adjacent to the right hepatic resection\nmargin. There is no evidence of ___ fluid. Note, this catheter was\nplaced along the tract of the surgically placed drainage catheter. Given the\nlack of residual fluid collection and decreased drain output, a decision was\nmade to remove the catheter, which was performed in CT." }, { "input": "The lung bases remain clear. There are no pleural or pericardial effusions. \n\nPatient is status post right hepatic lobectomy and cholecystectomy.\nSince the prior study of ___, the internal-external drainage catheter\npositioned adjacent to the right hepatic resection margin has been removed. \nIn the region of the hepatic resection margin there is a trace rim of\nlow-attenuation fluid measuring only 6 mm in depth extending for approximately\n3.5 cm along the heaptic resection margin (2:20). There is no fluid seen along\nthe drain tract (2:44, 3:22).\n\nSatisfactory appearance of the adjacent duodenum. \nOf note, a previously placed plastic biliary stent has displaced somewhat\ninferiorly; however, the proximal end of the stent remains within the CBD. \nThere is no intrahepatic biliary dilatation. A rounded 12 x 13 mm\nlow-attenuation focus in the expanded left hepatic lobe is unchanged. No new\nfluid collections are identified. Satisfactory appearance of the portal vein.\nNormal appearance of the spleen and pancreas. \n\nBoth kidneys are normal in size and enhance symmetrically. A 6-mm\nlow-attenuation focus in the lower pole of the left kidney is unchanged,\nlikely representing a simple cyst. There are no pathologically enlarged\nupper abdominal or retroperitoneal lymph nodes. \n\nOSSEOUS STRUCTURES: No concerning lytic or sclerotic bone lesions are\nidentified.", "output": "1. Satisfactory appearance following removal of drain adjacent to the resected\nright hepatic lobe with a tiny adjacent fluid collection measuring 6 mm in\ndepth. \n2. No new liver lesions are identified on this single phase study. \n3. No other fluid collections are identified." }, { "input": "LOWER CHEST: Mild bibasilar dependent changes. There is no evidence of\npleural or pericardial effusion. Extensive calcifications of the coronaries\nwith specks of calcifications of aortic valve leaflets.\n\nABDOMEN:\n\nHEPATOBILIARY: Re- demonstrated within the liver are a calcified granuloma at\nthe hepatic dome. The hyper enhancing lesion in the left hepatic lobe\ndemonstrated on post-contrast CT ___ is not demonstrated in this\nnonenhanced study. No new or concerning focal liver lesions are identified. \nThe gallbladder is full of hyperdense sludge or stones, no signs of\ncholecystitis. Extrahepatic biliary ductal dilation with the common bile duct\nmeasuring up to 1 cm in diameter, is unchanged. There is no clear\nintrahepatic biliary ductal dilation.\n\nPANCREAS: The cystic lesion in the pancreatic head, seen previously is not\nwell evaluated on this nonenhanced study. There is no peripancreatic\nstranding.\n\nSPLEEN: The 1.0 x 1.5 cm lobulated cystic lesion in the spleen , better\ndemonstrated on postcontrast CT in ___, with a peripheral\ncalcification is grossly unchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic, unchanged. No evidence of focal\nlesions, no evidence of hydronephrosis. Extrarenal pelvis is noted\nbilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.\n\nLarge stool burden demonstrated in the rectum and distal sigmoid, with mild\nfat stranding surrounding the rectum, worse since ___, and\nstercoral colitis should be evaluated clinically.\n\nPELVIS: The urinary bladder is empty containing a Foley catheter balloon.\nThere is no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative change of the spine with no evidence of osteo\ndestructive lesions.\n\nPreviously demonstrated extensive stranding in the sub dermal fat of the right\nbuttock with small amount of fluid has significantly improved although not\ncompletely resolved. There are no drainable fluid collections. No \nsubcutaneous emphysema.", "output": "-Marked improvement of right buttock cellulitis with no evidence of fluid\ncollections.\n-Large stool burden in the rectum and distal sigmoid, with mild surrounding\nfat stranding, worse since ___ - stercoral colitis should be\nevaluated clinically." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: In the right adnexa, a heterogeneous focus with\nsurrounding stranding and fluid which altogether measures 6.1 x 4.2 cm. \nWithin this area, there are two rounded hypoattenuated foci measuring up to\n2.0 and 1.7 cm, respectively (2:82). The left ovary is unremarkable.\n\nThe uterus is heterogeneous and lobulated likely representing a fibroid\nuterus. An intrauterine device is visualized within the fibroid uterus. \nThere is a hypoattenuated focus within the lower uterine segment measuring 1.6\nx 1.2 cm (2:95) likely representing a nabothian cyst.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.", "output": "1. Enlarged right ovary with two small collections concerning for tubo-ovarian\nabscess\n2. The appendix is normal. There is no evidence of diverticulosis or\ndiverticulitis. There is no evidence of obstruction.\n\nRECOMMENDATION(S): The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 2:25 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hepatic hemangiomas are unchanged from ___. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder demonstrates\ncholelithiasis without evidence of acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nDuplicated renal collecting systems are noted bilaterally. There is no\nevidence of stones, focal renal lesions, or hydronephrosis. There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The large bowel is normal in caliber but\ndemonstrates active inflammation throughout with wall thickening, pericolonic\nfat stranding, vascular engorgement, and adjacent mesenteric lymphadenopathy.\nThe appendix is grossly unremarkable in appearing.\n\nRETROPERITONEUM: Multiple prominent retroperitoneal lymph nodes are\nidentified, none of which are pathologically enlarged by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Tubal\nocclusion Essure devices are again noted bilaterally. Multiple, mildly\nenlarged bilateral inguinal lymph nodes are again seen, similar to the prior\nexamination. Persistent presacral and perianal inflammatory changes and\nphlegmon are noted consistent with known extensive perianal fistulous disease\n(2:64). A ___ is noted within the left distal perianal space. A right\nperianal fistulous tract is re- demonstrated in the supralevator region,\nperhaps slightly enlarged in size from the prior examination and demonstrating\nseveral tiny foci of air (2:65). There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.", "output": "1. Acute on chronic pancolitis involving the majority of the colon, from the\nhepatic flexure to the distal rectum. No evidence of perforation or free\nintra-abdominal fluid.\n2. Slight enlargement of a chronic right supralevator perianal fistula with\nmultiple small foci of intralesional air that are new from the prior study. \nPersistent left presacral supralevator and perianal inflammatory and\nphlegmonous changes, consistent with known extensive perianal fistulous\ndisease, also perhaps slightly increased from the prior examination. No\ndrainable collection is identified at this time.\n3. Cholelithiasis.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to the ___ surgery\nresident at 00:40 on ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The patient is status post total abdominal hysterectomy with bilateral\nsalpingectomy. The urinary bladder and distal ureters are normal. There is a\n3.5 cm simple density cyst in the left adnexa. No right adnexal abnormality\nidentified. There is mild stranding trace free fluid in the pelvis, not\nunexpected in the postoperative period.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Trace atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of suspicious osseous lesions or acute fracture.\n\nSOFT TISSUES: There is extensive stranding and edema at the right lower\nquadrant incision site. The fascial planes appear intact. There is a large\nintermediate density collection within the subcutaneous tissues of the right\nlower lobe pelvic wall measuring 9.0 x 3.1 cm in axial diameter tracking\nposteriorly to the incision site (5:73, 8:38). More superiorly there is a\nsmaller collection measuring 4.6 x 2.0 cm in the axial dimension also tracking\nposteriorly to the site of the incision (5:65, 8:31). There is marked\nstranding surrounding both collections and a mild degree of peripheral\nenhancement surrounding the superior collection. There is enlargement of the\nright rectus muscle measuring 4.9 x 2.7 cm compatible with hematoma (5:63). \nThere is nonspecific stranding trace fluid just posterior to the anterior\npelvic wall (5:64).", "output": "1. Two large collections within the subcutaneous tissues in the right lower\npelvic wall are most compatible with postoperative hematomas. While no blood\nflow was associated around these collections on the prior day ultrasound there\nis substantial surrounding stranding and mild enhancement, and therefore\nsuperimposed infection cannot be entirely excluded.\n2. A 4.9 x 2.7 cm hematoma involving the lower right rectus abdominus muscle\nis likely postsurgical. Mild associated stranding and trace free fluid\nposterior to the anterior pelvic wall is nonspecific. No organized\nintrapelvic collections.\n3. A 3.5 cm simple density cyst in the left adnexa." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L4 on L5, unchanged from prior. A lucent\nlesion in the left acetabulum is benign-appearing.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process. Specifically, no traumatic injury to\nintra-abdominal structures.\n2. No acute fractures.\n3. A lucent lesion in the left acetabulum is benign-appearing, though new from\nmost recent prior in ___, most likely representing subchrondral cystic\nchange." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of suspicious lesions. 8 mm ovoid hypodensity in the\nright lobe of the liver may represent a cyst. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Congenital\nmalrotation of the bowel is seen. Diverticulosis of the colon is noted,\nwithout evidence of acute inflammation. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Colonic diverticulosis without evidence of diverticulitis.\n2. Congenital small bowel malrotation.\n3. Normal appendix.\n4. Grade 1 anterolisthesis of L4 on L5." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. No pleural pericardial\neffusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The kidneys unremarkable.\n\nGASTROINTESTINAL: There is a small hiatus hernia. No gastrointestinal\nobstruction or ascites. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.There is a multiloculated cystic\nlesion in the left adnexa. The right ovary demonstrates a solid appearing\nround lesion with homogeneous attenuation measuring 2.7 cm (2:70).\n\nLYMPH NODES: No enlarged abdominopelvic lymph nodes are seen.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions. There is grade 1\nanterolisthesis of L4 on L5, associated with moderate spinal canal narrowing\nat this level.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted. There is skin\nthickening with mild subcutaneous fat stranding over the left lower\nanterolateral abdominal wall (2: 66-68). No fluid collections.", "output": "1. Multiloculated left adnexal cystic lesion in the left adnexa could\nrepresent a hydrosalpinx or cystadenoma. Possible 2.7 cm solid-appearing\nright ovarian lesion which could be fibroma/fibrothecoma.\n2. Skin thickening with mild subcutaneous fat stranding over the left lower\nanterolateral abdominal wall may represent cellulitis. No fluid collections.\n\nRECOMMENDATION(S): Nonemergent pelvic ultrasound for impression point 1.\n\nNOTIFICATION: The updated impression and recommendations were submitted to\nthe ED QA nurses on ___ at 09:31." }, { "input": "LOWER CHEST: There are small dependent bilateral pleural effusions. Prominent\ninterlobular septal thickening in the imaged lung bases is nonspecific, but\nmay be seen in setting of pulmonary edema. There is mild bibasilar\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The transplant liver demonstrates homogeneous attenuation\nthroughout. There is no evidence of focal lesions within the limitations of\nan unenhanced scan. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: There is severe fatty atrophy of the pancreas, without focal lesions\nidentified. There is no pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are severely atrophied. There is severe right\nhydroureteronephrosis, new from ___. The native right ureter\ndemonstrates a tortuous course and with an abrupt transition point seen in the\nlower abdomen, at the location of a prior retroperitoneal hematoma seen on the\n___ CT examination (601:37).\n\nThe right iliac fossa transplant kidney is normal in size. Mild enhancement\nof the transplant kidney is likely related to intravenous contrast\nadministration from prior cardiac catheterization. There are no focal mass\nlesions or hydronephrosis involving the transplant kidney.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small and large bowel loops\nare normal in caliber. Uncomplicated diverticulosis of the colon is noted. \nThe appendix is not visualized.\n\nRETROPERITONEUM: No retroperitoneal hematoma.\n\nPELVIS: The urinary bladder is mildly distended, without abnormal wall\nthickening. There is no free fluid in the pelvis. No cystic lesions are seen\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. An infrarenal IVC filter is again noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing right lower quadrant incisional hernia\nmeasuring 1.7 cm (series 2, image 62) there is no evidence of hematoma or\npseudoaneurysm in the imaged bilateral inguinal regions.", "output": "1. Severe hydroureteronephrosis of the right native kidney, with an abrupt\ntransition point in the native right ureter in the lower abdomen. This may be\nthe sequela of a prior retroperitoneal hematoma seen on a CT examination from\n___.\n2. No evidence of hematoma or pseudoaneurysm in the imaged bilateral inguinal\nregions. No retroperitoneal hematoma.\n3. Expected postsurgical changes of liver and right lower quadrant renal\ntransplant." }, { "input": "CT ABDOMEN: The visualized lung bases demonstrate bilateral nonhemorrhagic\npleural effusions with adjacent atelectasis. Please refer to the concurrent\nchest CT report for intrathoracic findings.\n\nThe liver enhances homogeneously. No focal liver lesion is identified. There\nis no intra or extrahepatic bile duct dilation. The gallbladder is not dilated\nand there are no radiopaque stones. The spleen is normal. The pancreas\nenhances homogeneously without focal lesion identified. Pancreatic duct is\nnormal in caliber. Bilateral adrenal glands are normal. The kidneys enhance\nsymmetrically and excrete contrast promptly without hydronephrosis.\n\nCircumferential wall thickening in the distal esophagus and gastric wall are\ncompatible with esophagitis and gastritis in the setting of toxic ingestion.\nThere is no bowel obstruction in the imaged portions of the bowel. There is\nsmall to moderate ascites in the abdomen. No free intraperitoneal air. The\nabdominal aorta is of normal caliber throughout without significant\natherosclerotic calcifications. There is small mural plaque in the distal\naorta (05:45). The main portal vein, splenic vein and SMV are patent.\n\nRim enhancing retroperitoneal lymph nodes measure up to 1.1 cm (05:29) with\ncentral hypoenhancement, which may be due to necrosis. The finding is\nnonspecific but may be related to an atypical infection.\n\nCT PELVIS: Please note that the pelvis was not imaged.\n\nBONE WINDOWS: No bone finding suspicious for infection or malignancy is seen.", "output": "1. Rim enhancing low density lymph nodes in the retroperitoneum may be due to\ninfection in the setting of HIV, including TB, although malignancy cannot be\nexcluded, perhaps with testicular origin given the retroperitoneal nodes. \nSimilar lymph nodes are seen in the right axilla on concurrent CT chest.\n\n2. No other evidence for malignancy in the abdomen. Please note that the\npelvis was not ordered nor imaged.\n\n3. Lower esophageal and diffuse gastric wall thickening, compatible with\nesophagitis and gastritis in setting of toxic ingestion.\n\n4. Small intra-abdominal ascites.\n\n5. CT chest reported separately." }, { "input": "Lower Thorax: There are moderate and increased bilateral pleural effusions\nwith adjacent compressive atelectasis +/- consolidation in the lower\nlobes.There is stable cardiomegaly.\n\nPeritoneal Cavity and Abdominal Wall: There has been interval\nesophagogastrectomy with Roux-en-Y procedure and surgical staples in the\nanterior abdominal wall. There is a ___ drain terminating near the\nproximal anastomosis and a feeding jejunostomy in place. There is a small\namount of pneumoperitoneum likely related to the recent procedure, but no\nfocal collection to suggest abscess.\n\nLiver: The liver is normal with no focal lesion.\n\nGallbladder and Biliary System: The gallbladder is not distended and there are\nno calcified gallstones.There is periportal edema but no significant biliary\ndilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: The spleen is not enlarged.There are multiple tiny round hypodense\nlesions in the spleen, which appear more conspicuous on the current\nexamination.\n\nKidneys and Adrenals: The kidneys are unchanged in appearance with no\nhydronephrosis bilaterally.The adrenal glands are normal bilaterally.\n\nBowel: There is interval significant distension of the large bowel,\nparticularly on the right, to the level of the descending colon. There is no\ndefinite evidence of mechanical obstruction on the provided images, although\nthis is limited by the lack of pelvic images.\n\nLymph Nodes: There is stable appearance of the multiple enlarged and hypodense\nretroperitoneal lymph nodes with rim enhancement, as previously described.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: There has been interval left T8 anterior thoracotomy related to the\nrecent surgical procedure. There is no suspicious bone lesion.", "output": "1. No focal collection to suggest abscess.\n2. Multiple unchanged hypodense and rim enhancing retroperitoneal lymph\nnodes, in addition to multiple splenic hypodensities, for which mycobacterial\nand/or fungal infection should be excluded.\n3. Interval esophagogastrectomy with formation of a Roux-en-Y.\n4. Colonic dilatation likely related to ileus from recent procedure." }, { "input": "CT OF THE CHEST WITH IV CONTRAST:\nIncluded views of thyroid are normal. Prominent right axillary lymph nodes\nare incidentally noted (series 2 image 16, 17), the largest conglomeration\nmeasuring 2.2 x 3.6 cm axially (series 2 image 18), unchanged since the ___ chest CT. There is no left axillary lymphadenopathy.\n\nEnlarged, predominately prevascular mediastinal lymph nodes measure up to 11\nmm along the short axis (series 2 image 18, 22), also unchanged since the ___ chest CT. There is no pericardial effusion. The heart size is\nnormal. The great vessels are patent and normal in caliber. No pulmonary\nembolus is detected to the proximal segmental levels.\n\nA moderate left pleural effusion is minimally changed since the ___, with persistent moderate to severe left lower lobe atelectasis (series 2\nimage 34). There are new consolidations within the lingula (series 2 image\n32) and right lower lobe (series 2 image 35). Mild basilar scarring is\nunchanged. There is no pneumothorax.\n\nCT OF THE ABDOMEN AND PELVIS WITH IV CONTRAST:\nNo concerning hepatic mass is detected. There is moderate periportal edema\n(series 2 image 56). The portal and hepatic veins remain patent. The spleen,\nadrenal glands, kidneys, and pancreas are normal. The gallbladder wall is\nedematous, likely an secondary to third spacing. There is a small amount of\nascites (series 2 image 59, 75).\n\nThere is diffuse ill-defined nodularity across the omentum (series 2, image\n53, 62, 72), appearing slightly increased in comparison to the ___ CTs, which, in combination with multiple large retroperitoneal and\nmesenteric lymph nodes (series 2, image 68, 66, 81), may reflected\ndisseminated tuberculosis. Lymph nodes are largely unchanged in size since the\nprior examination, but appear more uniform in density, whereas previously many\ndemonstrated central hypodensity.\n\nThe gallbladder wall is edematous, likely reflecting third spacing (series 2,\nimage 71). Post gastrectomy changes are again demonstrated (series 2, image\n46, 39). Intra-abdominal loops of small bowel are normal in caliber. There is\na moderate amount of fluid within a mildly distended proximal colon and\nthroughout the intrapelvic small bowel, tapering smoothly to a normal-caliber,\nlargely-collapsed distal colon.\n\nThe abdominal aorta, celiac trunk, SMA, and renal arteries are patent and\nnormal in caliber.\n\nThe prostate is normal in size (series 2, image 118). The bladder is\nunderdistended, but appears normal. A 9 mm left external iliac lymph node is\nunchanged (series 2, image 100). Other prominent left iliac lymph nodes are\nalso stable (series 2, image 106, 100 and 7).\n\nThere are no osseous lesions concerning for malignancy or infection.", "output": "1. Right axillary, mediastinal, and diffuse abdominal and pelvic\nlymphadenopathy is minimally changed in size since ___ and ___.\nHowever, there is increased omental caking, concerning for interval\nprogression of known disseminated TB. Other atypical infections or neoplastic\nprocess can also demonstrate a similar appearance.\n2. Moderate periportal edema and mild intra-abdominal ascites. No focal fluid\ncollections.\n3. Moderate amount of fluid within the proximal colon and intrapelvic small\nbowel, without obstruction, which may represent underlying enteritis, though\nthis is a nonspecific finding.\n4. Small consolidations within the lingula and right lower lobe, concerning\nfor infection.\n5. Severe left lower lobe atelectasis secondary to compression from moderate\nleft pleural effusion remains stable since the ___ CT examinations." }, { "input": "LOWER CHEST: Atelectasis is noted in the right middle lobe and lingula. There\nis no pleural or pericardial effusion. The cardiac size is mild to moderately\nenlarged. Atherosclerotic calcifications are seen along the aortic annulus.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is minimally distended. There is no distal\nhydroureter. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not well seen, possibly resected.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic foci in the bilateral proximal femurs likely represent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute CT findings in the abdomen or pelvis to correlate with patient's\nreported symptoms. Specifically, no evidence of nephrolithiasis or\nhydronephrosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHypodensity in the right hepatic lobe is too small to characterize by CT\n(series 2, image 17), a 1.0 cm hypodensity near the intrahepatic IVC\ndemonstrates fluid attenuation and is likely a simple cyst or biliary\nhamartoma. There is no evidence of suspicious focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\ncontains a 5 mm density which may represent a gallstone versus a gallbladder\npolyp (series 2 image 22).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral fluid density cortical cysts measuring up to 2.1 cm on the\nright, as well as multiple cortical hypodensities too small to characterize by\nCT but statistically likely representative of benign cysts. There is no\nevidence of concerning focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid, ascending, transverse and descending colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate demonstrates punctate calcifications, the\nseminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are demonstrated which are most prominent at L2-L4 and\ninclude intervertebral disc height loss, subchondral sclerosis and cystic\nchanges as well as vacuum disc phenomena.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic findings to explain patient's\nsymptoms.\n2. 5 mm density within the gallbladder likely represents gallstone or small\npolyp with no evidence of cholecystitis.\n3. Diverticulosis without evidence of diverticulitis." }, { "input": "Heart size is normal. 2 mm nodule in the right lung base. Trace linear\nbibasilar atelectasis.\n\nCTA abdomen: Millimetric hypodensity in in the hepatic dome is too small to\nfully characterize but likely represents a biliary hamartoma. 11 mm hyper\nattenuating lesion in hepatic segment II is subtly apparent on arterial phase\nwith progressive enhancement on delayed phase and likely represents hemangioma\n(4B: 203). Liver otherwise enhances homogeneously without biliary dilatation.\nPortal vein is patent. Gallbladder is unremarkable.\n\nSpleen, pancreas and adrenal glands are unremarkable.\n\n6 mm right lower pole renal hypodensity is too small to fully characterize but\nlikely represents a cyst. Kidneys otherwise present symmetric nephrograms\nwithout focal solid lesion or hydronephrosis. No renal calculi.\n\nStomach and duodenum are unremarkable. Small bowel loops are normal caliber\nwithout evidence of obstruction. Re- demonstration of bowel wall thickening\nof the descending colon and proximal sigmoid colon with mild surrounding fat\nstranding and peritoneal thickening, appearing slightly improved compared to\nprior exam. Proximal large bowel is thin-walled and unremarkable without\npericolonic fat stranding or fluid collection. Sigmoid predominant\ndiverticulosis. No evidence of bowel ischemia.\n\nAbdominal aorta is normal caliber with mild calcified atherosclerotic plaques.\nCeliac axis, SMA, bilateral renal arteries and ___ are patent. No mesenteric\nor retroperitoneal lymphadenopathy by CT size criteria. No ascites,\npneumoperitoneum or ventral abdominal hernia.\n\nCTA pelvis: 17 mm anterior uterine fibroid. Adnexa, bladder and rectum are\nunremarkable. No free pelvic fluid or air. No inguinal or pelvic sidewall\nlymphadenopathy by CT size criteria.\n\nBones and soft tissues: 6 mm left iliac bone island. No suspicious focal\nbone lesion. Moderate to severe T12 compression fracture, unchanged.", "output": "1. Descending/proximal sigmoid colitis length of involvement and distribution\nis consistent with ischemic colitis, appearing mildly improved compared to the\nprior examination.\n2. No evidence of bowel ischemia. Mesenteric vasculature is widely patent.\n3. No focus of arterial extravasation.\n4. 11 mm hepatic segment II hyper attenuating lesion, likely a hepatic\nhemangioma.\n5. Moderate to severe T12 compression fracture, unchanged.\n6. 2 mm nodule in the right lung base requires no further surveillance.\n7. Fibroid uterus.\n8. Diverticulosis.\n\nNOTIFICATION: Findings regarding a diagnosis of ischemic colitis were\ndiscussed by Dr. ___ with Dr. ___ at 10:50 on ___ by\ntelephone" }, { "input": "LOWER CHEST: Limited assessment of the lung bases are notable for bilateral\nlower lobe atelectasis. Mild cardiomegaly is noted. No pleural effusion or\npericardial effusion. A small hiatal hernia is present.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains gallstones without\nwall thickening or surrounding inflammation.Small possible intra-abdominal\nlipoma causing mass effect on the liver, is likely of doubtful clinical\nsignificance\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A 2.7 x 2.4 cm (02:22) left upper pole renal cyst is present. Few\nsubcentimeter renal hypodensities are too small to characterize. The kidneys\nare of normal and symmetric size with normal nephrogram. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is decompressed. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild fatty\ninfiltration of the terminal ileum is nonspecific and can be seen in the\nsetting of chronic inflammatory disease. The colon and rectum are within\nnormal limits. The appendix is not visualized however no secondary signs of\nacute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is grossly unremarkable. A 2.2 x 2 cm (2:65)\nleft ovarian and 1.6 x 1.3 cm (2:69) right ovarian cystic lesions are noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: 0.6 cm densely sclerotic lesion within the left femoral neck is most\nconsistent with a bone island. There is no evidence of worrisome osseous\nlesions or acute fracture.Mild degenerative disease of the lumbar spine noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence to explain patient's symptoms.\n2. Right lower lobe heterogeneous opacity is most consistent with atelectasis.\nClinical correlation recommended to assess for early pneumonia.\n3. Fatty infiltration of the terminal ileum is nonspecific and can be seen in\nthe setting of chronic inflammatory disease.\n4. Bilateral ovarian cysts largest measuring 2.2 cm within the left ovary is\nnormal in a premenopausal patient. If postmenopausal consider dedicated pelvic\nultrasound for further evaluation.\n5. Cholelithiasis without evidence of acute cholecystitis.\n6. Small possible intra-abdominal lipoma causing mass effect on the liver, is\nlikely of doubtful clinical significance." }, { "input": "LOWER CHEST: Scattered bilateral lower lobe ground-glass opacities are\nsimilar to the prior exam and may reflect atelectasis but are nonspecific. No\nevidence of a pleural or pericardial effusion. The heart size is similar to\nthe prior exam.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The gallbladder is surgically absent\nwith minimal prominence of the intrahepatic bile ducts as well as extrahepatic\nbile duct, compatible with post cholecystectomy state.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nA left upper renal pole simple cyst and right interpolar cyst are unchanged. \nNo hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: A hiatal hernia is small. Fat within the bowel wall of a\nlong segment of ileum as well as the terminal ileum is nonspecific but may be\nseen with chronic inflammation and was noted on the prior exam (e.g., series\n601b, image 30, 24, 19). No evidence to suggest active inflammation. No\nabnormally dilated loops of bowel. Bowel wall enhancement is otherwise\nnormal. No bowel obstruction or free air. A few nonspecific foci of\nhyperdense material within the small bowel lumen (series 2, image 37, 29, 55)\ncould represent hemorrhage, however ingested contents is favored given the\nlack of high density intraluminal material distally within the bowel. The\ncolon and rectum are normal. No evidence of diverticulosis. No secondary\nsigns of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Scattered mesenteric lymph nodes are probably reactive and\nnonspecific. No retroperitoneal or mesenteric lymphadenopathy by CT size\ncriteria. No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Mild to\nmoderate degenerative changes are most prominent at L4-L5 and L5-S1. No\nevidence of sacroiliitis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No bowel obstruction, free air, or diverticulosis.\n\n2. A few foci of hyperdense material in the small bowel lumen likely reflect\ningested contents rather than foci of hemorrhage given the lack of high\ndensity intraluminal material distally within the bowel.\n\n3. Intramural fat within the terminal ileum and long segment of the ileum\nsuggests sequela of chronic inflammation, similar to the CT from ___. No\nevidence of active inflammation.\n\n4. Non-specific bilateral lower lobe ground-glass opacities, likely\natelectasis, unchanged.\n\n5. Post-cholecystectomy with mild prominence of the bile ducts.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:10 ___, 5 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post left nephrectomy. A 1 cm hypodensity in\nthe right kidney is grossly similar to the prior exam. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis, nephrolithiasis, or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Extensive distal colonic\ndiverticulosis is again noted without evidence of diverticulitis. Rectum is\nunremarkable. The appendix is normal. No bowel obstruction. No evidence of\na drainable fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. The right renal artery stent appears intact and unchanged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Colonic diverticulosis.\n3. Extensive atherosclerosis." }, { "input": "LOWER CHEST: There is minimal atelectasis in the visualized lower lobes. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder lumen contains hyperdense material within its\ndependent portion, either sludge or small stones. Gallbladder otherwise is\nunremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post left nephrectomy and the right kidney is\nnormal in size. An 11 mm hypodensity in the right kidney is unchanged from\n___, likely a cyst. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is colonic diverticulosis\nwithout evidence of diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Patient is status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe calcified\natherosclerotic disease is noted. A right renal artery stent is re-\ndemonstrated.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process. Normal appendix. No evidence of small\nbowel obstruction.\n2. Colonic diverticulosis without evidence of diverticulitis.\n3. Moderate to severe calcified atherosclerosis." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. Partially imaged coronary\nartery calcifications. No pericardial or pleural effusion. Relative low\ndensity of the blood pool, may represent underlying anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There are layering stones in the gallbladder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable. Thickening of the left\nadrenal gland is unchanged.\n\nURINARY: The left kidney is surgically absent. There is a punctate\nnonobstructing stone in the midpole of the right kidney measuring 4 mm,\nunchanged from prior. Also unchanged is a 9 mm simple right renal cyst. \nThere is no right hydroureteronephrosis.\n\nGASTROINTESTINAL: The distal esophagus is unremarkable. There is no bowel\nobstruction. There is extensive diverticulosis of the sigmoid colon. \nAppendix is normal. There is no intra-abdominal free fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. A right renal artery stent is in place.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the lumbar spine.\n\nSOFT TISSUES: The muscles are diffusely atrophic.", "output": "1. No acute intra-abdominal or pelvic process.\n2. Cholelithiasis.\n3. Diverticulosis.\n4. Non-obstructing right renal stone." }, { "input": "There is mild bibasilar atelectasis, right worse than left. There is no\npleural or pericardial effusion.\n\nCT of the abdomen: Evaluation of solid abdominal viscera is limited by lack of\nIV contrast. The liver is homogeneous with no focal hepatic lesions\nidentified. The gallbladder is normal. There is no gallbladder wall thickening\nor pericholecystic fluid to suggest acute cholecystitis. The adrenal glands,\npancreas and spleen are normal. Patient is status post left nephrectomy. The\nright kidney is grossly unremarkable with no renal masses or hydronephrosis.\nSmall hypodensities within the right kidney are again seen but not fully\ncharacterized on this study.\n\nThere is significant amount of ingested material and contrast within the\nstomach. An NG tube is seen terminating within the stomach. There are multiple\ndilated loops of small bowel some of which are fecalized, consistent with a\nsmall bowel obstruction. A transition point is noted at the right lower\nquadrant (series 2, image 58; series 601b: Image 18). Stool is seen within the\nascending colon. There are extensive diverticula throughout the sigmoid colon\nwith no evidence of diverticulitis. There is no free fluid. There is no free\nair. There is moderate to severe atherosclerotic calcifications throughout the\nintra-abdominal aorta. Vessel patency cannot be evaluated in this examination.\nNote is made of a right renal artery stent.\nCT of the pelvis: The urinary bladder is normal. There is no pelvic free\nfluid. There is no inguinal or pelvic lymph node enlargement by CT size\ncriteria. There is no pelvic free fluid.\n\nOsseous structures: Significant degenerative changes are noted along the\nthoracolumbar spine. No blastic or lytic lesion identified.", "output": "Small bowel obstruction with a transition point noted at the right lower\nquadrant.\n\nNOTIFICATION: Findings discussed in person with the surgical team, Dr. ___,\nby NSR via telephone on ___ at 03:50." }, { "input": "The imaged lung bases demonstrate stable pleural parenchymal scarring in the\nright middle lobe. Limited imaging of the heart reveals no pericardial\neffusion or cardiomegaly.\n\nCT ABDOMEN: The liver is diffusely hypo attenuating on the non-contrast exam\nconsistent with fatty infiltration. Following the administration of contrast,\nthe liver enhances homogeneously without focal liver lesions. The portal and\nhepatic veins are patent. There is no intra or extrahepatic biliary\ndilatation. The gallbladder is surgically absent. The right adrenal gland\ndemonstrates a 2.2 x 2.0 cm adenoma, which is unchanged (previously 2.4 x 1.8\ncm). The spleen and left adrenal glands are normal.\n\nThe kidneys enhance and excrete contrast promptly without hydronephrosis or\nconcerning renal lesions. The ureters are normal in course and caliber. No\nurolithiasis is identified.\n\nThere is stranding about the head and uncinate process of the pancreas with\nadjacent fat stranding involving the third portion of the duodenum and the\nmesenteric root. The pancreatic parenchyma remains relatively homogeneous in\nenhancement. No fluid collection is identified. There are multiple prominent\nperipancreatic lymph nodes, measuring up to 9 mm in short axis (7:67), which\nis not pathologically enlarged. There is no evidence of chronic pancreatitis.\n\nThere is no retroperitoneal or abdominal adenopathy. No free air or free fluid\nis present. The aorta and its major branches are patent and not dilated. The\nportal, splenic and superior mesenteric veins are well opacified with\nintravenous contrast. Calcification of the left gonadal vein is unchanged. The\nstomach and intra-abdominal loops of bowel are normal caliber and appearance.\nNote is made of dense material within distal loops of small bowel in the\npelvis, which may be related to ingested contents since no enteric contrast\nwas administered.\n\nCT PELVIS: A few sigmoid diverticula are noted without inflammatory changes. \nThe rectum is unremarkable. The bladder, uterus and bilateral adnexae are\nnormal. There is no free pelvic fluid. There is no inguinal or pelvic\nadenopathy.\n\n OSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesion\nidentified.", "output": "1. Evidence of acute pancreatitis involving the head and uncinate process of\nthe pancreas with adjacent fat stranding involving the third portion of the\nduodenum and the mesenteric root with reactive peripancreatic lymph nodes. No\nabnormal enhancement of the pancreas, fluid collection or thrombosis of\nadjacent vessels.\n2. No urolithiasis.\n3. Stable right adrenal adenoma.\n4. Mildly fatty liver." }, { "input": "LOWER CHEST: Normal cardiac configuration. Mild mitral annular calcification.\nNo cardiomegaly. No pericardial effusion. Linear bibasal atelectasis\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: No pancreatic masses. There is no conclusive imaging findings to\nsuggest acute or chronic pancreatitis. No peripancreatic collections. No\npancreatic calcification. The pancreatic duct is not dilated. A few small\nmillimetric lymph nodes inferior to the head of the pancreas appears fairly\nsimilar compared to prior MRCP done ___. pancreatic head and uncinate\nlipomatosis was better visualized on prior MRCP done ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 26 mm lipid rich right adrenal adenoma appears fairly similar\ncompared to prior imaging. The left adrenal is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal suspicious renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild diastasis of the rectus abdominus muscles.", "output": "No significant interval change in imaging compared to prior MRCP done ___.\n\nNo conclusive CT features of acute or chronic pancreatitis. No peripancreatic\ncollections. There are a few small millimetric lymph nodes inferior to the\nhead of the pancreas, but this appears similar compared to prior MRCP done ___.\n\nStable right lipid rich adrenal adenoma." }, { "input": "LOWER CHEST: Please review stented dedicated chest CT. The gynecomastia. \nSmall hiatal hernia. Gastroesophageal varices.\n\nABDOMEN:\n\nHEPATOBILIARY: 1.8 x 1.8 cm arterially enhancing lesion in segment IV with a\nwashout on portal venous and delayed images and pseudo capsule, meets OPTN\nimaging criteria for ___.\n\nSmall foci of nodular enhancement, to small to characterize, none meet\ncriteria for ___.\n\nStatus post right hepatectomy. Nodular shrunken liver with a heterogeneous\nperfusion consistent with known cirrhosis. No ductal dilation.\n\nInterval complete thrombosis of the portal veins with early cavernous\ntransformation. Focal main portal vein thickening, luminal widening,\nhyperdensity, and haziness, can be seen in acute thrombus. Location and lack\nof enhancement speaks against tumor thrombus. Thrombosed umbilical vein. \nSplenic an gastroesophageal varices with a small splenorenal shunt.\n\nPatent hepatic artery and veins. Moderate ascites. Unremarkable gallbladder.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: Nodular spleen with atrophy, unchanged. Three arterially enhancing\nsplenic lesions measuring 1.5, 2.2, and 2.2 cm. The lesions equilibrate with\nthe spleen in the portal venous and delayed phases.\n\nADRENALS: Unremarkable.\n\nURINARY: No nephrolithiasis or hydronephrosis.No discrete lesion.\n\nGASTROINTESTINAL: No intestinal obstruction. No pneumoperitoneum.\n\nLYMPH NODES: 1.6 x 3.8 cm pre caval lymph node. Prominent mesenteric and\nretroperitoneal lymph nodes.\n\nVASCULAR: Patent aorta and major branches. Mild arteriosclerosis.\n\nBONES AND SOFT TISSUES: No acute fracture or suspicious osseous lesion. No\nsoft tissue mass.", "output": "1. 1.8 cm liver lesion.\nOPTN CRITERIA (any lesion greater than 1cm, up to 5 lesions)\nMaximum lesion diameter (late arterial or portal venous phase): 1.8cm\nLocation: Segment IV\nArterial enhancement: yes\nWashout:yes\nLate capsule or pseudocapsule enhancement on delayed phase: yes\nGrowth (maximal diameter increase >50% in <=6 months): no\n\nClassification: Class 5A: size 1-2cm, arterially enhancing, washout AND\npseudocapsule\n\n2. Relatively acute portal vein thrombosis.\n\n3. Cirrhosis, gastroesophageal varices, moderate ascites.\n\n4. Increased in size presumed splenic hemangiomas/unusual regenerative\nnodules secondary to splenic atrophy.\n\n5. 3.8 cm precaval adenopathy.\n\nNOTIFICATION: Findings were communicated by phone to Dr. ___\n___ Zapora) on ___ @ 10:30 by Dr. ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 2.3 x 2.7 cm hypodensity in the right lobe of the liver (09:24)\nthat likely represents a hepatic cyst and has increased in size from ___\nstudy (previously measured 1.3 x 1.4 cm). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is hydronephrosis of left kidney. The kidneys are otherwise\nof normal and symmetric size with normal nephrogram. There is no evidence of\nfocal renal lesions bilaterally. There is no perinephric abnormality. There\nis no evidence hydronephrosis in the right kidney.\n\nPELVIS: At the left distal ureter there is contrast enhancement along the\ntortuous past posterior to the bladder extending into the vagina compatible\nwith a left ureterovaginal fistula (14:38 and 14:36). The urinary bladder is\notherwise unremarkable. There is no free fluid in the pelvis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nREPRODUCTIVE ORGANS: The uterus surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Contrast enhancement along a tortuous path posterior to the bladder\nextending from the left distal ureter to the vagina compatible with left\nureterovaginal fistula.\n2. 7 mm hepatic cyst that has increased in size when compared to ___ study." }, { "input": "ABDOMEN: Slightly limited examination as the upper abdomen is not imaged.\n\nHEPATOBILIARY: The visualized liver demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient status\npost proctocolectomy. The overall size of the pelvic collection has decreased\nafter placement of a pigtail drainage catheter. The collection now measures\n10.9 x 6.1, previously 13.8 x 10.7 cm. The pigtail is on the right side of the\ncollection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Slight interval decrease in size of the pelvic abscess with pigtail catheter\nin place. Drain repositioning and upsizing can be attempted." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. Gallstones\nare present within an otherwise unremarkable gallbladder.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation. There is no peripancreatic stranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Colon and rectum are within normal limits.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. Bilateral external\niliac lymph nodes are prominent, measuring 1.0 cm in short axis on the left\nand 9 mm in short axis on the right, top normal in size but morphologically\nnormal (series 3, image 95). There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: The patient is post hysterectomy. Surgical clips along\nthe proximal left external iliac vessels are noted.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Moderate to severe multilevel\ndegenerative changes are noted with grade 1 anterolisthesis of L4 on L5 and\nanterior wedging of T12 and L2. Abdominal and pelvic wall is within normal\nlimits.", "output": "1. Limited examination in the absence of contrast. No concerning abdominal or\npelvic mass. Prominent bilateral iliac lymph nodes are top normal by size\ncriteria.\n2. Cholelithiasis." }, { "input": "LOWER CHEST: Again seen, is a fat containing diaphragmatic hernia on the left.\nThere is a small right pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is mild pericholecystic fluid. \nGallbladder is otherwise unremarkable. There is no surrounding fat stranding.\nThere is mild periportal edema.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 2.0 cm simple cyst in the upper pole of the right kidney. \nSubcentimeter hypodensity in the right lower pole is too small to\ncharacterize, but statistically likely also a simple cyst. There is no\nhydroureteronephrosis. The kidneys enhance symmetrically. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is no hiatal hernia. There is no bowel obstruction or\nwall thickening. The appendix is normal. There is no intra-abdominal free\nfluid or free air.\n\nPELVIS: The bladder is distended. There is trace free fluid.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is dilated up to 3.5 cm in its proximal portion,\nmildly increased unchanged from prior. There is extensive atherosclerotic\ndisease.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Radiodense objects projecting over the left thorax, as seen\npreviously.", "output": "1. Mild periportal edema and pericholecystic fluid, likely secondary to IV\nhydration.\n2. No acute intra-abdominal or pelvic process. Normal appendix.\n3. Stable suprarenal abdominal aortic aneurysm." }, { "input": "LOWER CHEST: There are bilateral small dependent pleural effusions. Trace\npericardial fluid is likely physiologic. There is mild bibasilar atelectasis.\nA 5 mm solid nodule is seen in the lateral right lower lobe (3:3). There is a\n3 mm pulmonary nodule in the Left lower lobe (3:6).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A\n2.2 cm hypoattenuating lesion in the posterior right lobe (03:19), previously\ncharacterized as a hemangioma, is unchanged. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or evidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis.\n\nA right nephroureteral stent is in situ. A cluster of heterogeneous stones in\nthe right lower pole, the largest of which measures 4 mm (5:27). A 0.3 cm\nnonobstructing stone is seen in the left lower pole (3:31).\n\nGASTROINTESTINAL: The stomach is unremarkable. There is no gastrointestinal\nobstruction, ascites or pneumoperitoneum. There is thickening of the second\nand third portions of the duodenum, similar to prior MRI. Anastomosis sutures\nfrom prior ileocecectomy in the right lower quadrant are again noted. The\nbowel wall thickening and distension surrounding the anastomotic sutures is\nnot significantly changed compared to prior CT. There is a large amount of\nstool within the large bowel.\n\nPELVIS: Evaluation of the pelvis is limited by beam hardening artifact from\nright hip prosthesis.\n\nLYMPH NODES: No enlarged lymph nodes are identified.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\npartially imaged right hip prosthesis is noted, without evidence of hardware\nfailure.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cluster of several small stones in the right lower renal pole, the largest\nof which measures 4 mm. A 3 mm nonobstructing left lower renal pole stone.\n2. No hydronephrosis.\n3. Right nephroureteral stent in situ.\n4. A 5 mm right lower lobe pulmonary nodule and a 3 mm Left lower lobe\npulmonary nodule which are unchanged since ___. No follow-up is recommended.\n5. Additional findings, as above.\n6. For incidentally detected nodules smaller than 6mm in the setting of an\nincomplete chest CT, no CT follow-up is recommended. See the ___\n___ Society Guidelines for the Management of Pulmonary Nodules\nIncidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There are no adnexal\nabnormalities noting cystic structure in the left ovary.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 1.3 cm accessory spleen is noted (series 2,\nimage 11).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Extensive colonic\ndiverticulosis is noted. Mild wall thickening and inflammation around a\nsigmoid diverticulum concerning for early sigmoid diverticulitis. The rectum\nis within normal limits. The appendix is not visualized. No secondary signs\nof appendicitis. No focal fluid collection or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild anterolisthesis of L4 on 5 is chronic. There is mild degenerative\nchanges with facet joint arthropathy of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Mild/early sigmoid diverticulitis. No focal fluid collection or free air.\n\nNOTIFICATION: The findings were emailed to ED QA nurses by ___,\nM.D. on ___ at 9:19 AM, 5 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. There is fat stranding\nsurrounding the distal right ureter, in the region of prior stone (2:69). \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Fat stranding adjacent to the distal right ureter, in the region of prior\nstone.\n2. No renal or ureteral stones are identified." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Unchanged bilateral renal cysts, largest in the left in the upper\npole measuring 3.0 cm and largest on the right in the lower pole measuring 3.7\ncm. There is no evidence of focal renal lesions or hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: No significant change in 2.5 cm right seminal vesicle\ncyst which contains a 7 mm stone, possibly secondary to obstruction. \nProstatic calcifications noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted particularly of the distal abdominal aorta and proximal iliac\narteries.\n\nBONES: Mixed sclerotic appearance of the right iliac bone, most consistent\nwith Paget's disease.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No new findings or evidence of intra-abdominal or intrapelvic malignancy to\nexplain patient's weight loss." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis and subpleural reticulation.\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. There is mild intrahepatic biliary\nductal dilatation, pneumobilia, and periportal edema. The gallbladder\nsurgically absent. Pneumobilia, expected post Whipple.\n\nPANCREAS: Postsurgical changes are seen from Whipple procedure. No pancreatic\nductal dilatation is seen in the remaining atrophic pancreatic body and tail.\n\nSPLEEN: Spleen is mildly enlarged at 13.0 cm.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable.\n\nGASTROINTESTINAL: Status post Whipple procedure.\n\nNew ventral abdominal wall hernia at the level of the left renal vein is the\nwhich contains a loop of small bowel without evidence for focal strangulation.\nThere is no free air in the abdomen. There are dilated fecalized loops of\nsmall bowel in the left upper quadrant with two transition points ___\nand ___ associated with swirling in the mesentery concerning for closed\nloop obstruction. The walls of the affected loops of small-bowel are\nthickened without evidence of pneumatosis. The appendix is normal. Small\namount of free fluid in the abdomen and pelvis. Diffuse mesenteric stranding.\n\nPELVIS: Trace fluid is noted.\n\nLYMPH NODES: Stable 9 mm peripancreatic lymph node on ___:36. No enlarged\npelvic lymph nodes.\n\nVASCULAR: Again seen are changes of endovascular aortic aneurysm repair\nwithout type 2 endoleak secondary to lumbar collaterals, some prior exam there\nis severe calcium burden in the abdominal aorta and great abdominal arteries.\n\nThere is unchanged appearance of mild stenosis at the anastomosis of the SMV\nto the main portal vein and severe stenosis at the anastomosis of the splenic\nvein to the main portal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: New anterior abdominal wall hernia containing a loop of\nobstructed small bowel without evidence for focal obstruction in this\nlocation.", "output": "1. Status post Whipple. Findings are compatible with closed loop obstruction\nin the left upper quadrant. There is thickening of the walls of the affected\nloops of small bowel. No definite pneumatosis is seen. There is no free air.\n2. No evidence of metastatic disease in the abdomen or pelvis.\n3. Stable appearance of the aorto bi-iliac stent graft with type IIa endoleak\nas seen on prior studies." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Compared to\nprior exam there has been interval improvement of a small left-sided pleural\neffusion. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: Compared to exam dated ___ there has been interval\nimprovement in interstitial pancreatic edema. A rim enhancing peripancreatic\ncollection abutting the distal pancreatic body and tail measures approximately\n6.9 x 4.2 cm, previously 9.3 x 5.7 cm (03:28). There are multiple adjacent\nsmaller rim enhancing fluid collections adjacent to the pancreatic body and\ntail which appear more organized compared to prior exam (03:30). There\ncontinues to be moderate soft tissue stranding in the mid abdomen involving\nthe distal stomach, proximal small bowel loops, and transverse colon. No\nevidence of pseudoaneurysm formation.\n\nSPLEEN: The spleen is top-normal measuring 13.2 cm and is otherwise\nunremarkable without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized however there\nare no secondary signs of appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate free fluid in the pelvis, similar to prior exam.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Scattered retroperitoneal and mesenteric lymph nodes are likely\nreactive. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Mild attenuation of the SMV is unchanged compared to ___\nand is potentially secondary to nonocclusive thrombus (03:35). The splenic\nvein appears slightly narrowed though is patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interstitial edematous pancreatitis appears improved compared to ___ with interval decrease in size of an encapsulated peripancreatic fluid\ncollection measuring up to 6.9 cm along the pancreatic body and tail. \nAdditional smaller encapsulated peripancreatic collections likely represent\nsmaller pseudocysts.\n2. Mild attenuation of the SMV is unchanged compared to prior exam and may be\nsecondary to nonocclusive thrombus.\n3. Moderate free fluid in the pelvis, similar to prior exam.\n\nNOTIFICATION: The updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:10 pm, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Aside from mild bibasilar atelectasis, visualized lung fields are\nwithin normal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. The\nliver is diffusely hypodense on noncontrast images, likely related to\nsteatosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder surgically\nabsent.\n\nPANCREAS: There are multiple fluid collections around the pancreas, somewhat\ndecreased in size when compared to prior exam. For example, the largest fluid\ncollection along the anterior margin of the body and tail of the pancreas\nmeasures 5.7 x 3.9 cm, previously 6.9 x 4.2 cm (___). A tiny 1.4 cm\nfluid collection inferior to the uncinate process (03:29) appears to\ncommunicate with the aforementioned dominant collection. The lobulated and\nelongated fluid collection along the posterior margin of the pancreas,\nextending to the level of the gastric fundus and coursing anteriorly to the\nneck of the pancreas (03:25) also persists, though smaller compared to prior\nexam. For example, the coronal dimension near the fundus now measures 1.9 cm,\npreviously 3.0 cm (601:33). A third fluid collection at the tail of the\npancreas has also decreased in size, now measuring 3.7 x 1.7 cm, previously\n5.5 x 2.4 cm (03:29). No new fluid collection is seen. The pancreatic\nparenchymal enhancement is homogeneous throughout. No main pancreatic ductal\ndilation is seen. There is no suspicious lesion within the pancreas. There\nis no peripancreatic stranding.\n\nSPLEEN: The spleen is top-normal in caliber. Otherwise, the spleen\ndemonstrates normal attenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (03:55).\n\nPELVIS: The mildly distended bladder urinary bladder and distal ureters are\notherwise unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Pre-existing gastrohepatic ligament lymph node now measures 0.6\ncm, previously 1.0 cm (03:18). There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMinimal degenerative changes are noted at L5-S1 with mild disc bulge. \nRudimentary disc at S1-S2 is again noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Interval decrease in the size of pre-existing pseudocysts as described above. \nNo new fluid collections. Unremarkable enhancement of the pancreatic\nparenchyma." }, { "input": "LOWER CHEST: Right lower lobe consolidation demonstrate homogeneous\nenhancement, likely representing atelectasis. There is no evidence of pleural\nor pericardial effusion. Severe gross fixation along the right coronary\nartery is partially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The most superior aspect of the liver was excluded from the\nfield of view. The imaged liver is slightly heterogeneous in attenuation\nwithout evidence of focal lesions, though evaluation is limited due to streak\nartifacts. There is marked intra and extrahepatic bile duct dilation with\ndistension of the gallbladder. There is a small stone in the gallbladder. \nHowever, gallbladder wall is not thickened. The common bile duct measures up\nto 18 mm. There is subtle enhancement of the walls of the posterior ducts.\n\nPANCREAS: The pancreas is diffusely atrophic. At the head of the pancreas\nthere is a 12 mm stone within the main pancreatic duct with upstream dilation\nof the main pancreatic duct measuring 9 mm proximally and 6 mm distally. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Bilateral adrenal glands are diffusely thickened without nodularity,\nlikely due to hyperplasia.\n\nURINARY: The kidneys are mildly atrophic. Scattered cortical hypodensities\nare too small to characterize by CT, though likely cysts. There is no\nevidence of focal solid renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a loop of small bowel\nwith fecalized material in the right lower quadrant. Hyperdense material\nwithin the fecalized loop is likely an ingested pill. Otherwise small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThere is interposition of the right colon between the diaphragm and the liver.\nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is levo scoliosis with severe degenerative changes of the\nthoracolumbar spine, apex at L1. Patient is status post bilateral dynamic\nscrew and plate placement in the femurs. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Intra and extrahepatic biliary ductal dilation with a dilated CBD measuring\nup to 1.7 cm in diameter, tapering towards the ampulla. The main pancreatic\nduct is also dilated up to 1 cm in diameter. No large obstructing mass seen\nin the periampullary region. Underlying etiology for obstruction may be\nampullary stenosis. ERCP recommended for further evaluation for etiology of\nobstruction, either related to a mass or stenosis.\n2. A 12 mm nonobstructing calculus is noted within the proximal main\npancreatic duct.\n3. Markedly distended gallbladder with no evidence for acute cholecystitis.\n4. Multiple incidental findings in the form of severe degenerative changes of\nthe thoracolumbar spine, old healed pelvic fractures, bilateral femoral\nfracture fixation devices; severe sigmoid diverticulosis.\n\nRECOMMENDATION(S): ERCP for the above described reason." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse fatty infiltration of the liver. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Several loops of small bowel\nwithin mid abdomen are hyperemic and edematous. The colon is normal in course\nand caliber without wall thickening. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Moderate\nvolume non-hemorrhagic ascites is seen in the abdomen and pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Small bowel hyperemia and wall thickening are consistent with small bowel\nenteritis.\n2. Fatty infiltration of the liver.\n3. Moderate volume ascites." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The visualized small and large bowel loops are unremarkable\nin appearance.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite acute intra-abdominal abnormality.\n2. Hepatic steatosis.\n\nNOTIFICATION: The minor discrepancy between the final impression and the\novernight wet read was communicated via e-mail to the ED QA nurses." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout,\nconsistent with hepatic steatosis. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2:56).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A tiny umbilical hernia containing fat is noted.", "output": "1. No acute process in the abdomen or pelvis.\n2. Hepatic steatosis." }, { "input": "LOWER CHEST: Heart size is normal without significant pericardial effusion. \nThere is mild linear atelectasis in the left lung base. The imaged lung bases\nare otherwise grossly clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Dobhoff tube tip terminates at the level of the pylorus\nproducing streak artifact. The stomach is otherwise grossly unremarkable. \nThe duodenum and distal small bowel loops are normal caliber without evidence\nof obstruction. Ingested oral contrast reaches the level of the rectum. \nThere is mild rectal fecal loading. The large bowel and rectum are otherwise\nthin-walled without pericolonic fat stranding or fluid collection identified. \nThe appendix is normal.\n\nPELVIS: The bladder is partially collapsed, though the wall appears thick and\nthere is mild surrounding inflammatory fat stranding. There is trace free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. There is trace non organized free\nfluid in the retroperitoneum (02:57).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia. Stranding in\nthe ventral abdominal superficial soft tissues are consistent with injection\nsites.", "output": "1. Thickened bladder wall with surrounding inflammatory fat stranding with\ntrace free pelvic fluid and trace free abdominal fluid tracking superiorly\nconsistent with cystitis. Correlate with urinalysis.\n2. No other acute findings in the abdomen or pelvis." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in the lower lobes of both\nlungs. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Layering high-density material within the\ngallbladder could be secondary to extravasation of contrast.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized but no\nsecondary sign of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nHeterotopic ossification is noted adjacent to the posterior aspect of both\nischium, increased since ___. the adjacent obturator internus muscle\nhas increased hypodensity compared to the prior study.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "Increased heterotopic ossification adjacent to the bilateral ischium. There\nis associated increased hypodensity of the left obturator internus muscle,\nwhich may be due to myositis, possibly inclusion body myositis.\n\nOtherwise no other acute intra-abdominal or pelvic process seen." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. No pleural or\npericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable. A small accessory spleen is noted\n(02:32).\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The kidneys are unremarkable.\n\nGASTROINTESTINAL: No gastrointestinal obstruction or ascites. The appendix is\nunremarkable (601:33). There is an inflamed epiploic appendage with\nsurrounding fat stranding in the left lower quadrant, adjacent to descending\ncolon (2:64).\n\nPELVIS: There is no free fluid in the pelvis.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes are seen.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There are no aggressive appearing osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Left lower quadrant epiploic appendagitis." }, { "input": "CT OF THE ABDOMEN: LUNG BASES SHOW NO ABNORMALITIES. THE LIVER IS\nHOMOGENEOUS WITHOUT FOCAL MASSES, NO DILATED INTRAHEPATIC BILIARY RADICLES,\nTHE PORTAL HEPATIC VEINS ARE PATENT.\n\nWITHIN THE GALLBLADDER FOSSA THERE IS A PERSISTENT FLUID COLLECTION MEASURING\nAPPROXIMATELY 32 X 48 MM, ROUGHLY THE SAME AS ON THE PRIOR EXAM. THE\nCOLLECTION NO LONGER CONTAINS AIR. ADJACENT SURGICAL CLIPS ARE IDENTIFIED,\nSTATUS POST CHOLECYSTECTOMY.\n\nMILDLY PROMINENT EXTRAHEPATIC COMMON BILE DUCT, UNCHANGED. THE PANCREAS,\nSPLEEN AND VISUALIZED LOOPS OF LARGE SMALL BOWEL APPEAR UNREMARKABLE. \nHYPODENSITY WITHIN THE LEFT KIDNEY LIKELY REPRESENTING A SIMPLE CYST AND\nUNCHANGED. THE RIGHT KIDNEY IS UNREMARKABLE. MODERATE ATHEROSCLEROTIC\nDISEASE WITH HEAVY CALCIFICATION AT THE ORIGIN OF THE CELIAC AND SMA AND RENAL\nARTERIES.\n\nTHE PREVIOUS FLUID COLLECTION MEASURING 23 X 35 MM WITHIN THE RIGHT LOWER\nQUADRANT IS NO LONGER VISUALIZED. SMALL NON PATHOLOGICALLY ENLARGED\nRETROPERITONEAL LYMPH NODES ARE IDENTIFIED.\n\nCT OF THE PELVIS: IN THE RIGHT PELVIS THERE IS A RESIDUAL WELL-DELINEATED\nFLUID COLLECTION WITH SURROUNDING RIM OF ENHANCEMENT MEASURING 31 MM, THIS IS\nCOMPARED TO 64 MM ON THE PRIOR STUDY. WITHIN THE LEFT PELVIS THERE IS A 12 MM\nWELL DELINEATED COLLECTION WITH RIM ENHANCEMENT. THIS PREVIOUSLY MEASURED 51\nMM. VISUALIZED LOOPS OF LARGE SMALL BOWEL ARE UNREMARKABLE, NOTE OF THE\nSIGMOID AND DESCENDING COLONIC DIVERTICULOSIS.\n\nDEGENERATIVE CHANGES OF THE BONY STRUCTURES ONLY, OLD FRACTURE OF THE LEFT\nSUPERIOR PUBIC RAMUS WITH BRIDGING CALLUS .", "output": "1. RESIDUAL FLUID COLLECTION WITHIN THE GALLBLADDER FOSSA AS DESCRIBED ABOVE,\nMARKED DECREASE IN THE SURROUNDING INFLAMMATION.\n2. RESOLVED RIGHT LOWER QUADRANT FLUID COLLECTION.\n3. MARKEDLY DECREASED BUT PERSISTENT FLUID COLLECTIONS WITHIN THE RIGHT AND\nLEFT PELVIS.\n4. MULTIPLE CHRONIC FINDINGS INCLUDING ATHEROSCLEROTIC DISEASE, DEGENERATIVE\nCHANGES OF THE BONY STRUCTURES, LEFT RENAL CYST, DIVERTICULOSIS." }, { "input": "There is a persistent trace persistent pleural effusion on the right but from\nmarkedly decreased. Opacifications of right lower lobe has also markedly\nimproved leaving only band-like opacification suggesting residual scarring. A\nright middle lobe nodule measuring 7 mm is stable. On the left, there is a\nnew moderate pleural effusion with associated atelectasis of the left lower\nlobe. There is also patchy atelectasis in the imaged lingula. A central\nvenous catheter terminates at the cavoatrial junction. Bilateral breast\nimplants are again present.\n\nA hypodense focus in the spleen measuring 6 mm in diameter is not well\ncharacterized but doubtful in clinical significance and unchanged. The liver,\ngallbladder, and pancreas appear within normal limits. Adrenal glands again\nshow slight thickening but stable. Kidneys are unremarkable.\n\nThere is a gastrostomy tube in position. The stomach and small bowel are\nunremarkable.\n\nA Foley catheter is present in a partly full bladder with air. The uterus\nappears normal. No adnexal masse is demonstrated. Increased attenuation in\nsubcutaneous fat along each flank as well as along intra-abdominal fat\nsuggests a state of fluid overload but there is no discrete ascites. There is\nno lymphadenopathy. The major mesenteric arteries and veins appear patent. An\ninferior vena cava filter is in place.\n\nCalcifications posterior to the left hip joint space suggest sequela of prior\ninjury or perhaps hematoma (sees myositis ossificans). There are no\nsuspicious bone lesions. There are bilateral pars interarticularis defects\nwith grade I spondylolisthesis of L5 on S1 including moderate narrowing of the\nL5-S1 interspace, small osteophytes and striking subchondral sclerosis.", "output": "1. Moderate sized left-sided pleural effusion with basilar opacification\nsuggesting extensive atelectasis of the left lower lobe, although an\ninfectious process is not excluded.\n\n2. No evidence of acute intra-abdominal process.\n\n3. Anasarca.\n\n4. Heterotopic bone posterior the left hip suggesting sequela of remote prior\ninjury or perhaps hemorrhage.\n\n5. Bilateral spondylolysis with spondylolisthesis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. There is a moderate pleural\neffusion on right with associated atelectasis. There is moderate pleural\neffusion on the left with associated atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Tiny hypodensity within the mid spleen is unchanged in appearance and\nmeasures 7 mm (02:57).\n\nADRENALS: The right and left adrenal glands are within thickened, however\nsimilar in appearance compared to prior.\n\nURINARY: The right kidney shows a striated nephrogram consistent with\npyelonephritis. Left kidney enhances normally. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. Gastrostomy tube is\nin position.\n\nPELVIS: The urinary bladder is partially distended, however with thickened\nwall measuring 7.8 mm (2: 113). There are foci of air, consistent with prior\nFoley placement. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Infrarenal IVC filter is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits. \nPatient is status post bilateral breast implants. There are degenerative\nchanges, with prior multiple avulsion fractures with ossification.", "output": "1. Right kidney shows striated nephrogram consistent with pyelonephritis\nwithout hydronephrosis. Bladder wall thickened possibly due to concomitant\ncystitis. Nondependent foci of air in bladder is likely related to prior\ninstrumentation.\n2. IVC filter and gastrostomy tube are in place.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on ___ on the telephone at 17:15, 5 minutes after discovery of the\nfindings." }, { "input": "Lung bases: Innumerable pulmonary nodular metastatic lesions are again noted\nin the lower lungs. The imaged portion of the heart is interval for mitral\nannular calcification. No pleural or pericardial effusion is seen.\n\nAbdomen: New from prior are left and right sided percutaneous transhepatic\nbiliary drainage catheters which appear well positioned terminating in the\nduodenum. Numerous hepatic metastatic lesions are seen, better visualized on\nthe recent prior MRI. Evaluation for biliary ductal dilation is limited in\nthe absence of IV contrast. Hyperdense material and gas is noted within the\ngallbladder which could represent vicarious excretion of contrast. \nPneumobilia is expected post ERCP. The pancreas appears normal. The spleen\nis stably enlarged at 15.5 cm in length. Adrenal glands are normal. The\nkidneys appear unremarkable without stones or hydronephrosis. The abdominal\naorta is normal in course and caliber with mild atherosclerotic calcification.\nThere is no free air or free fluid. Mildly prominent lymph nodes are again\nseen in the region of the porta hepatis not significantly changed. The\nstomach and duodenum appear normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. There\nis a fat containing periumbilical hernia appearing uncomplicated. The\nappendix is normal. The colon contains a moderate fecal load. Dense material\nwithin the colon reflects a prior contrast administration. Suture material in\nthe left lower quadrant reflects a prior colonic resection. The anastomosis\nappears uncomplicated. The uterus appears prominent which could be due to the\npresence of a fibroid. There is no adnexal mass. Urinary bladder is mostly\ndecompressed. No pelvic free fluid. No pelvic sidewall or inguinal\nadenopathy.\n\nBones: Bones appear demineralized. A sclerotic focus is noted within the left\nanterior acetabular wall unchanged and thought to represent a bone island.", "output": "1. Interval placement of right and left-sided percutaneous transhepatic\nbiliary drains.\n2. Metastatic disease within the lungs and liver in this patient with known\ncolon cancer.\n3. Splenomegaly, unchanged." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Mild degenerative changes are visualized in lower lumbar spine evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No findings of metastatic disease identified within the abdomen or pelvis.\n2. Please refer to same-day CT chest for characterization of intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous background attenuation\nthroughout. A 3.0 x 1.6 cm hypodense lesion in segment 7 was previously\ncharacterized on MRCP as a hemangioma (2:51). A 5 mm hypodensity in segment\nII was previously characterized on MRCP as a hepatic cyst or biliary hamartoma\n(601b:19). There are no new focal hepatic lesions. Mild intrahepatic biliary\nduct dilatation is slightly increased from priors. There has been interval\nincrease dilation of the common bile duct up to 1.7 cm, compared with 0.9 cm\npreviously. The gallbladder is within normal limits. The hepatic arterial\nanatomy is conventional.\n\nPANCREAS: Again seen is a hypodense mass involving the pancreatic neck and\nbody, and extending into the pancreatic head and into the peripancreatic soft\ntissue between the aorta and IVC, overall slightly increased in size compared\nwith CT ___. The portion in the pancreatic neck and body measures\napproximately 2.4 x 1.7 cm, in the portion in the pancreatic head measures\napproximately 2.5 x 2.2 cm, and again is abutting and causing external\ncompression of the common bile duct (2:62). Distal to the mass, the\npancreatic parenchyma is atrophic, and the main pancreatic duct is dilated,\nsimilar to recent MRCP (2:59). The mass completely encases and narrows the\nmain portal vein, however it remains patent. There is extension to the SMV,\nwith tear drop deformity, however the SMV remains patent. The infiltrative\nsoft tissue component between the aorta and IVC appears increased compared\nwith outside CT torso on ___, and encases the celiac artery, the SMA,\nthe common hepatic artery, and the splenic artery, however the vessels remain\npatent. Only the proximal 2 cm of the splenic vein is visualized, likely\nrepresenting chronic thrombosis.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small accessory spleen.\n\nADRENALS: The right adrenal gland is normal in size and shape. The left\nadrenal gland is thickened, measuring 1.4 cm, similar to recent MRCP, however\nnew compared with outside CT torso on ___, and appears contiguous\nwith the periaortic infiltrative soft tissue, consistent with metastatic\ndisease (2:59, )60.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: Bladder is not distended. The distal ureters are unremarkable. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Again seen is a comminuted left anterior iliac wing pathologic\nfracture with callus formation, similar to CT pelvis on ___ (2:88). \nThe mottled appearance of the left iliac crest with a area of cortical\nbreakthrough posteriorly is stable in appearance (2:85). The left sacrum is\nmottled in appearance, better evaluated on recent MRI (601b:40). Previously\nseen right lesser trochanteric is better evaluated on recent MRI. There is no\nnew evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild anasarca. There is a small fat containing left\ninguinal hernia.", "output": "1. A hypodense mass in the pancreatic body and neck, extending to the\npancreatic head, and contiguous with a infiltrative retroperitoneal soft\ntissue mass, is slightly increased in size compared with ___. The soft\ntissue is encasing the celiac trunk, SMA, portions of the common hepatic\nartery, splenic artery, main portal vein and extends to the SMV, with teardrop\ndeformity, however these vessels remain patent. The majority of the splenic\nvein is not visualized, and is likely chronically thrombosed.\n2. There has been interval increase in dilatation of the common bile duct,\nmeasuring up to the 1.7 cm, compared with 0.9 cm previously, as well as slight\ninterval increase in intrahepatic biliary duct dilatation compared with ___.\n3. Thickening of the left adrenal gland is not significantly changed compared\nwith ___, however is new compared with CT torso ___, and appears\ncontiguous with the retroperitoneal infiltrative soft tissue, consistent with\nmetastatic disease.\n4. The previously seen left anterior iliac wing pathologic fracture is similar\nto prior. Additional metastatic lesions in the left iliac crest and left\nsacrum are not significantly changed. The previously seen right lesser\ntrochanteric metastatic lesion is better evaluated on recent MRI. There no\nnew osseous lesions suspicious for metastatic disease in the abdomen or\npelvis.\n5. No lymphadenopathy in the abdomen or pelvis.\n6. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:52 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Bibasilar atelectasis is identified. Visualized lung fields are\notherwise within normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver again demonstrates diffuse hypodense rounded masses,\ncompatible with known metastatic disease. Overall, these are mildly\nprogressed as compared to the prior examination. For example, a dominant\nright hepatic mass measures 6.7 x 5.2 cm (02:18), previously measuring 4.9 x\n4.5 cm in ___. Mild intrahepatic biliary ductal bilobed station is\nnoted, which appears unchanged from the prior examination. A CBD stent and\ninternal biliary drain are noted, grossly unchanged in position from the prior\nexamination. The gallbladder is within normal limits, and contains air which\nis compatible with the patient's prior CBD stenting.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA large right simple cyst measuring up to 5.2 cm is extending from the\nsuperior pole of the right kidney. Multiple additional subcentimeter renal\nhypodensities are is too small to characterize but likely cysts. There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: Diffuse sclerotic metastasis is seen throughout the\nimaged osseous structures. No superimposed pathologic fracture is identified.\nThe abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged, mild intrahepatic biliary ductal dilation and is stable\nappearance the patient's CBD stent and internal biliary drainage catheter.\n2. Modest interval progression of diffuse hepatic metastatic lesions.\n3. Extensive osseous metastatic disease, minimally changed from the prior\nexamination. No pathologic fracture." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen are diffuse hypodense lesions throughout the liver,\nconsistent with known metastatic disease. Overall, these have mildly improved\nsince the prior examination, with the dominant mass in the right hepatic lobe\nmeasuring approximately 5.8 x 5.4 cm (4:62), previously 6.7 x 5.2 cm in\n___. Mild intrahepatic biliary ductal dilatation is unchanged. CBD\nstent and internal biliary drains in situ with mild pneumobilia, unchanged. \nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA large simple cyst arising from the upper pole of the right kidney measures\n5.0 x 4.7 cm. Multiple additional subcentimeter hypodensities, too small to\nfurther characterize, most consistent with simple renal cysts. There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Diffuse sclerotic lesions of the imaged skeleton are consistent with\nknown metastatic disease, overall unchanged since prior study from ___. No pathologic fractures identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Re-demonstrated diffuse hepatic metastases with mild interval decrease in\nsize of dominant lesion in the right hepatic lobe, now measuring approximately\n5.8 x 5.4 cm.\n2. Unchanged mild intrahepatic biliary ductal dilatation. Stable mild\npneumobilia with CBD stent and internal biliary drains in unchanged position.\n3. Extensive osseous metastatic disease, similar in appearance and extent to\nprior examination. No pathologic fractures identified.\n4. Please see separate, same-day CT chest report for further description of\nintrathoracic findings." }, { "input": "Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nCT abdomen with contrast: At least eight scattered hepatic hypodensities\nmeasuring up to 14 mm in segment 3 are unchanged from the prior study. The sub\ncm lesions remain too small to fully characterize. The liver otherwise\nenhances homogeneously without new lesion, intra or extrahepatic biliary\ndilatation. The gallbladder is unremarkable. The portal vein is patent.\n\nThe spleen, pancreas and adrenal glands are unremarkable in appearance. Simple\n4.3 cm interpolar right renal cyst is unchanged. Other scattered millimetric\nrenal hypodensities remain too small to fully characterize by CT but likely\nrepresent cysts. The kidneys otherwise present symmetric nephrograms and\nexcretion of contrast without focal solid mass, hydronephrosis or perinephric\nabnormality.\n\nThe stomach, duodenum and remainder of the small bowel is unremarkable without\nevidence of obstruction. There is mild fecal loading in an otherwise\nunremarkable large bowel.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment.\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size\ncriterion. There is no ascites, pneumoperitoneum or ventral abdominal wall\nhernia.\n\nCT pelvis with contrast: The uterus and ovaries are not seen. The bladder and\nrectum are grossly unremarkable. There is no free pelvic fluid or air. There\nis no inguinal or pelvic sidewall lymphadenopathy by CT size criterion.\n\nOsseous structures: Diffuse, sclerotic bony metastatic lesions seen throughout\nthe image spine and pelvis are unchanged compared to the prior study. Focus of\nlysis adjacent to sclerotic lesion in the left iliac bone is slightly\nincreased measuring 14 mm, previously 10 mm. Another similar area of adjacent\nlysis posteriorly (4:93) today measures 11 mm, previously measuring 9 mm. No\nnew bone lesion is identified. There is mild thoracolumbar levoscoliosis.\nMultilevel degenerate changes are minimal.", "output": "1. Minimal increase in two lytic portions of a mixed lytic/sclerotic lesion in\nthe left iliac bone as above. Diffuse bony metastases are otherwise stable. No\nnew focus of metastatic disease involvement in the abdomen or pelvis.\n2. Stable hepatic and renal low attenuation lesions." }, { "input": "LOWER CHEST: A 6 mm left lower lobe pulmonary nodule is not significantly\nchanged dating back to ___ and was not FDG avid on prior PET-CT. No new\npulmonary nodules are seen.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple hypodense liver lesions with the largest\nmeasuring 2.1 x 2.0 cm in segment VII (series 4, image 15), although it is\ndifficult to accurately compare these lesions due to the lack of IV contrast\non the PET-CT scan these are overall no worse compared to prior. In addition,\nthere are multiple hepatic simple cysts measuring up to 1.2 cm in segment ___\n(series 4, image 11). The anechoic globular structure described on prior\nultrasound corresponds to a 2.9 x 2.9 cm cystic structure in the porta hepatic\nregion which appears to connect to the common bile duct. The common bile duct\nis dilated up to 11 mm. Additionally, there is new mild dilation of the left\nintrahepatic biliary tree as well as dilation of the gallbladder. There is no\npericholecystic stranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 4.7 cm simple cyst in the midpole of the right kidney. The left\nkidney is unremarkable. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nSmall and large bowel are normal in caliber without focal wall thickening. \nThe appendix is not well seen but there are no secondary signs of appendicitis\nin the right lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: A hypodense lesion adjacent to the head of the pancreas measures\napproximately 0.9 x 1.4 cm in corresponds to an FDG avid region on recent\nPET-CT, this likely represents an enlarged lymph node. Common bile duct\ndilation begins more inferior to this enlarged node, this therefore is\nunlikely to act as the site of biliary obstruction. Other FDG avid lymph\nnodes are difficult to identify on conventional CT scan. There is no pelvic\nsidewall or inguinal adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Diffuse sclerotic osseous metastatic lesions are again seen, not\nlargely changed from prior PET-CT. There is no evidence of pathologic\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Progressive dilation of the common bile duct and gallbladder. There is no\nclear cause for these finding on CT scan (including no mass lesion\nidentified), differential considerations include a non radiopaque ductal stone\nor sphincter of Oddi dysfunction, findings may be further evaluated by MRCP as\nindicated.\n2. Anechoic intrahepatic lesion described on previous ultrasound corresponds\nto a 2.9 cm cyst which appears to be in continuity with common bile duct,\nfindings are most suggestive of a choledochal cyst, the enlargement of this\ncyst may be related to the mild left intrahepatic biliary duct dilation.\n3. Multiple hepatic metastases are not overtly worse compared to ___.\n4. FDG avid lymphadenopathy not well seen by conventional CT.\n5. Stable osseous metastatic disease. No evidence of pathologic fracture.\n\nRECOMMENDATION(S): MRCP (and/or ERCP) may be useful for further evaluation of\nthe biliary tree as well as the cystic structure adjacent to the biliary tree.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 330 ___, 10 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Faint peripheral parenchymal calcification, again seen, and\nunchanged from prior. There are no suspicious arterial enhancing lesions. \nAreas of peripheral arterial hyperenhancement specifically within the right\nhepatic lobe demonstrate no washout and are likely perfusional, and are\nunchanged from ___. Mild biliary duct dilation involving the right\nposterior lobe, unchanged. Mild common bile duct dilation, likely secondary\nto prior cholecystectomy. Portal vein is patent. A small subcapsular\nhypodensity along the right posterior lobe of the liver has decreased from\n___ (series 3, image 13), likely representing a resolving postoperative\ncollection. The gallbladder is surgically absent.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 11 mm hypodensity in the lower pole of the left kidney is unchanged from\nprior and compatible with a simple cysts.\nGASTROINTESTINAL: Views of the small and large bowel are unremarkable without\nwall thickening or dilation. There is no mesenteric adenopathy by CT size\ncriteria.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is minimal calcification in the included abdominal aorta. \nThere is no evidence of abdominal aortic aneurysm.\n\nBONES AND SOFT TISSUES:\n\nPartially visualized posterior spinal fusion hardware is present. There are\nno concerning lytic or sclerotic bony lesions. Abdominal and pelvic wall is\nwithin normal limits.", "output": "No suspicious liver lesions to suggest hepatocellular carcinoma." }, { "input": "LOWER CHEST:\nThere is mild centrilobular emphysema and scarring or linear atelectasis at\nthe lung bases, which are otherwise clear. There is no pleural or pericardial\neffusion. There is a small right cardiophrenic angle lymph node that is\nslightly more prominent than previous (3b:68) measuring 8 mm versus 5 mm, with\ntwo other tiny adjacent nodes also slightly increased in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post liver transplant. There are\nunchanged faint peripheral parenchymal calcifications that may be related to\nan ischemic type injury. There are areas of peripheral hyperarterial\nenhancement in the right hepatic lobe without correlate that are likely\nperfusional. With There are no areas of focal abnormal hyper enhancement,\nwashout or other suspicious findings to suggest HCC. There is no cystic lesion\nthat would correlate to the reported history on outside ultrasound. There is\nmild stable dilatation of the segment VI intrahepatic bile duct and the\nextrahepatic duct. The gallbladder is surgically absent.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is an unchanged simple cyst measuring 1.2 cm in the lower pole of the\nleft kidney. There is no evidence of stones, focal renal lesions or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\nGASTROINTESTINAL: Visualized small and large bowel loops demonstrate normal\ncaliber, wall thickness and enhancement throughout.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries. There is a\npartially visualized retro aortic left renal vein. The portal, splenic,\nhepatic and superior mesenteric veins are patent and unremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.There is partially visualized\northopedic hardware in the lumbar spine. Abdominal and pelvic wall is within\nnormal limits.", "output": "Status post liver transplant with no suspicious lesions to suggest HCC." }, { "input": "LOWER CHEST: There are trace bilateral pleural effusions with associated\natelectasis, right greater than left. The heart is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nfew foci of subcapsular patchy enhancement in the right hepatic lobe are again\nnoted, likely perfusional variants. There is mild central intrahepatic\nbiliary dilation that is unchanged compared to ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There is a 10 x 13 mm cyst in the\nlower pole of the left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute\nfracture.Posterior fusion is noted in the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Status post liver transplant with stable mild intrahepatic biliary ductal\ndilation.\nNo acute process seen in the abdomen or pelvis to account for patient's right\nupper quadrant pain." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate mild subsegmental atelectasis.\nThere is no evidence of pleural effusion. Small subcentimeter epiphrenic\nlymph nodes, largest measuring 5 mm (series 5, image 6).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged measuring 14.5 cm in the AP dimension. \nTiny accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSmall subcentimeter cortical hypodensity the left kidney is too small to be\ncharacterized. There is no evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. There is no\nevidence of any intraperitoneal abscess or collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple prominent gastrohepatic, periportal and retroperitoneal\nlymph nodes are seen, largest periportal lymph node measures 1.1 cm (series 5,\nimage 27, largest retroperitoneal lymph node measures 8 mm (series 5, image\n39). Multiple prominent obturator and external iliac lymph nodes are also\nseen, largest measuring 9 mm on the right (series 5, image 75). Few prominent\nbilateral inguinal nodes are seen, not significantly enlarged.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No clear source of sepsis identified.\n2. Mild nonspecific epiphrenic, gastrohepatic, retroperitoneal and pelvic\nlymphadenopathy. Mild splenomegaly." }, { "input": "LOWER CHEST: Mild worsening of small bilateral pleural effusions and\ncompressive airspace disease per\n\nABDOMEN: The unenhanced liver, adrenal glands and kidneys are unremarkable. \nDistal pancreatectomy and splenectomy changes are again seen.\n\nGASTROINTESTINAL: No bowel obstruction or ascites. The appendix is within\nnormal limits. There is no free air.\n\nPELVIS: There is no free fluid in the pelvis. The uterus and adnexa are\nwithin normal limits for age. Air in the urinary bladder can be correlated\nwith instrumentation.\n\nLYMPH NODES: No abdominopelvic adenopathy.\n\nVASCULAR: No retroperitoneal hematoma demonstrated..\n\nBONES: Unchanged.\n\nSOFT TISSUES: No abdominal wall hematoma. Trace hematoma is seen in the right\nfemoral region, possibly at the puncture site. A few prominent right inguinal\nlymph nodes are likely reactive.", "output": "1. Trace hematoma in the right femoral region, possibly at the puncture site. \nNo retroperitoneal or abdominal wall hematoma demonstrated.\n2. Worsening of still small bilateral pleural effusions with bibasilar\nairspace disease, possibly compression atelectasis." }, { "input": "LOWER CHEST: There is a small amount of right middle lobe dependent\natelectasis. There is no evidence of pleural effusion. There is trace\npericardial fluid. Aortic valve leaflet calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: A poorly defined hypoattenuating lesion measuring up to 1.4 cm\nis noted in segment 4B on contrast-enhanced images likely represents an area\nof focal steatosis or perfusion abnormality. There is also mild diffuse\nhepatic steatosis. Otherwise, the liver demonstrates homogenous attenuation\nthroughout. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 5 mm hypodensity in the inferior pole of the right kidney with no\nwhich is too small to characterize, but which is unchanged from ___. No\nother focal renal lesions are seen. There is no evidence hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is small hiatal hernia. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged at 4.5 x 4.2 x 4.9 cm and\nthe seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted with calcification most prominent at the aortic bifurcation and in\nthe proximal iliac vessels.\n\nBONES: Mild degenerative changes of the lumbar spine are noted. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted. Otherwise,\nthe abdominal pelvic wall is unremarkable.", "output": "1. No renal, ureteral or bladder stones or solid enhancing mass. No filling\ndefects within the opacified portions of the collecting systems and ureters on\nboth sides. Plaque-like bladder wall masses are better evaluated by\ncystoscopy.\n2. Mildly enlarged prostate." }, { "input": "LOWER CHEST: There are small bilateral fat containing Bochdalek hernia is\nseen. Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post RFA of a segment 7 lesion. There are\nno hepatic lesions meeting OPTN criteria. There are numerous arterially\nenhancing foci noted, which are indeterminate and may represent focal\ntransient hepatic intensity differences. For example, a 1 cm arterially\nenhancing lesion is seen in segment 6 (04:53), unchanged from previous. A 0.7\ncm lesion is seen in segment ___ (05:59, not definitely seen on prior exam but\nnot meeting criteria at current time. A 0.5 cm lesion is seen in segment 2\n(04:26), not significantly changed from previous and again not meeting\ncriteria. These warrant close evaluation on follow-up. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: A proper spleen in the left upper quadrant is not identify; instead\nthere are multiple splenules noted scattered in the left upper quadrant,\nlargest measuring 3.4 x 4.4 cm. Additionally, there are 2 peritoneal nodules\nnoted at the left anterior abdominal wall, measuring 7 mm and 8 mm\nrespectively. These demonstrate a heterogenous arterial enhancement pattern\nreminiscent of splenic tissue, and are likely related to foci of splenosis. \nThey are unchanged when compared to priors.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There are\nmillimetric nonobstructing stones noted in the upper and lower pole regions of\nthe left kidney.\n\nGASTROINTESTINAL: Partially visualized small and large bowel loops are\nunremarkable.\n\nLYMPH NODES: Few prominant retroperitoneal lymph nodes are seen. No definite\nsize significant lymphadenopathy is identified.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite hepatic lesions meeting OPTN criteria. Several subcentimeter\narterially enhancing foci without associated washout, extensively detailed in\nthe body of the report which will require close evaluation on follow-up.\n2. Findings compatible with splenosis, with multiple left upper quadrant\nspleens identified, as well as peritoneal splenic deposits, all of which are\nunchanged prior." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is status post RFA of a segment VII mass. There are\nno new concerning lesions. Again seen are multiple sub-centimeter arterially\nenhancing foci, for example, a 9 mm focus in segment VI (3A: 48), a 4 mm focus\nin segment VI (3A: 41), and a 5 mm focus in segment II (3A: 28). These foci\nare all grossly unchanged as compared to ___. A 10 mm peripheral\nlinear arterially enhancing focus in segment II (3A: 46) likely represents\nperfusion artifact. These foci demonstrate no washout and likely represent\nperfusion artifact. There is no evidence of intra or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without pericholecystic fluid\nor a distended appearance of the gallbladder.\n\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is not identified in the left upper quadrant. However,\nthere are multiple splenules, the largest of which measures 4.1 x 3.6 cm\n(3B:126), which are grossly unchanged as compared to prior studies. There are\n2 peritoneal nodules in the anterior abdomen measuring 9 and 7 mm (3B: 166),\nrespectively, with heterogeneous arterial enhancement compatible with focal\nareas of splenosis. These nodules are grossly unchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are multiple\nnonobstructive calculi in the upper and lower poles in left kidney. There is\nno hydronephrosis or perinephric abnormality.\n\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nunremarkable.\n\nLYMPH NODES: A lymph node at the porta hepatis measures 2.2 x 1.0 cm (3B:\n125), grossly unchanged in size dating back to CT abdomen ___.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Mild atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite hepatic lesion meeting OPTN criteria.\n2. Multiple scattered arterially enhancing foci in the liver are all grossly\nunchanged as compared to CT abdomen and pelvis ___ and likely\nrepresent perfusion artifact. Regular imaging follow-up is recommended.\n3. Multiple splenules in the left upper quadrant as well as peritoneal splenic\ndeposits are unchanged as compared to prior studies." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Post RFA in the right lobe again seen with no interval change\nand no evidence of local recurrence. Upper several arterially hyper enhancing\ncare small lesions are again seen with no washout and with no interval change\nthe previous study:\n\n1. Left lobe i segment II: Images 3a; 19 and 21\n2. Right lobe segment VII: Image 3a; 23\n3. Right low segment VI: Two lesions in image 3a; 45\nThere is no bile duct dilatation and the gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Multiple slight is again seen in the are of the splenic bed, unchanged\nsince the previous exam.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nLYMPH NODES: Prominent lymph node in the porta hepatis again seen as\npreviously.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.", "output": "1. Liver cirrhosis and status post RFA with no evidence of recurrence.\n2. Several arterially hyper enhancing lesions without washout\n3. Multiple splenic hours in the region of the splenic bed." }, { "input": "LOWER CHEST: Please see the dedicated CT chest report from the same day for\ndetails of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is post liver transplantation. The transplanted liver\ndemonstrates homogenous attenuation throughout. No evidence of focal lesions.\nNo evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: There is mild-moderate atrophy and fatty replacement of the\npancreas, but otherwise the pancreas has normal attenuation without evidence\nof focal lesions or pancreatic ductal dilatation. No peripancreatic\nstranding.\n\nSPLEEN: The need of spleen is surgically absent. There are 3 regenerative\nsplenules that appear unchanged without suspicious focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of solid renal lesions or hydronephrosis. There are millimetric,\nnonobstructive renal calculi within the left upper and lower poles, unchanged\nsince ___. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nLYMPH NODES: No retroperitoneal lymphadenopathy. Subcentimeter, slightly\nprominent mesenteric lymph nodes are not pathologically enlarged by CT\ncriteria calf displayed stability since ___. No new or growing lymph nodes.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted. The celiac axis, SMA and bilateral renal arteries are patent with\nconventional anatomy of the celiac axis. Again, there is aberrant left renal\nvein drainage through a lumbar collateral (2:62) which may be related to a\nmild nutcracker phenomenon with slight compression of the left renal vein\nbetween the SMA and aorta (2: 59, 602:43).\n\nBONES: There is no evidence of acute fracture. There is mild to moderate\nmultilevel degenerative changes with notable endplate sclerosis and facet\ndegeneration of L3-L4, and mild chronic compression deformity of T12. In the\narea of increased tracer uptake on the bone scan of ___, there is a\ntiny sclerotic focus of the anterior right sixth rib (601:23). Compared to\nthe CT study of ___, however there is significantly decreased\nsclerosis.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Patient is status post liver transplantation. No evidence of recurrent HCC\nwithin the liver or metastatic disease within the abdomen.\n2. Decreased, but persistent small sclerotic focus of the right anterior sixth\nrib which showed increased tracer uptake on the bone scan of ___.\n3. Non-obstructing, millimetric left nephrolithiasis.\n4. Please refer to dedicated CT chest report from the same day for details of\nintrathoracic findings." }, { "input": "Lung bases: A punctate nodule in the right lower lobe is seen on series 2,\nimage 2. Otherwise the imaged lung bases are clear. The imaged portion of\nthe heart is unremarkable.\n\nAbdomen: The unenhanced appearance of the liver is normal. The gallbladder is\nsurgically absent. The spleen is normal in size. Adrenals are normal\nbilaterally. There is a small fat containing left Bochdalek hernia. The\npancreas is unremarkable. Several small nonobstructing kidney stones are\nnoted, the largest on the left measuring 4 mm. No hydronephrosis, hydroureter\nor ureteral stone is seen. The abdominal aorta is normal in course and\ncaliber with mild atherosclerotic calcifications. No retroperitoneal\nlymphadenopathy. The stomach and duodenum appear normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is normal. The colon contains a moderate fecal load. Relatively\ndecompressed segment of the sigmoid colon is seen best on series 2, image 139\nwith equivocal mild thickening. Prostate is normal in size. The urinary\nbladder is well distended appearing normal. No pelvic sidewall or inguinal\nadenopathy.\n\nBones: There is no worrisome lytic or blastic osseous lesion.", "output": "1. Nonobstructing left kidney stone measuring 4 mm. No hydronephrosis or\nureteral stone.\n2. Equivocal mild thickening versus decompression of the mid sigmoid colon,\nfor which nonemergent colonoscopy is advised to exclude underlying lesion." }, { "input": "LOWER CHEST:\nTrace bibasilar atelectasis. Small right pleural effusion. Unchanged small \nright subpulmonic fluid. Small hiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: Status post liver transplant. Persistent left-sided\nintrahepatic ductal dilation. Absent gallbladder.\n\nPANCREAS: Small dorsal pancreatic body calcification. No ductal dilation.\n\nSPLEEN: 14.2 cm splenomegaly, unchanged\n\nADRENALS: Unremarkable.\n\nURINARY: Mild bilateral perinephric fluid. Right iliac fossa transplant\nkidney. No nephrolithiasis or hydronephrosis. Simple cyst superior pole\ntransplant kidney.\n\nGASTROINTESTINAL: Contrast seen to the rectum without obstruction. \nUnremarkable appendix. No fluid collection.\n\nPELVIS: Unremarkable rectum and seminal vesicles . Process calcifications. \nMild bladder wall thickening.\n\nLYMPH NODES: More prominence of porta hepatis and lesser omentum adenopathy up\nto 14 mm, nonspecific.\n\nVASCULAR: Noncontrast examination. No aortic aneurysm. Minimal aortic\ncalcifications.\n\nBONES AND SOFT TISSUES: No acute fracture or suspicious was lesion.", "output": "No acute abdominopelvic abnormality.\n\nSmall right pleural effusion." }, { "input": "LOWER CHEST: Small left greater than right pleural effusions with some\ncompressive atelectasis. Partially visualized cardiac lead. Partially\nvisualized coronary artery and mitral valve calcifications. Cardiomegaly.\n\nABDOMEN:\n\nHEPATOBILIARY: Scattered hepatic hypodensities, some too small to accurately\ncharacterize, others measuring water density and likely representing cysts or\nbiliary hamartomas. There is no evidence of concerning focal lesions within\nthe limitations of an unenhanced scan. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Scattered renal hypodensities, not fully characterized on this\nnoncontrast exam, but likely cysts. There is a 5 mm left upper pole\nnonobstructing renal stone. There is no evidence of focal renal lesions\nwithin the limitations of an unenhanced scan. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia is noted. The stomach is unremarkable.\nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nColonic diverticulosis without evidence of diverticulitis. The appendix is\nnormal.\n\nPELVIS: Bilateral hip prosthesis limits evaluation of the pelvis. There is a\nsmall focus of gas in the bladder, question recent catheterization, otherwise,\nthe urinary bladder is grossly unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Bilateral hip prostheses, the right more recently placed and containing\npostsurgical changes in the subcutaneous tissues including gas. There is no\nevidence of worrisome osseous lesions or acute fracture. Moderate\ndegenerative changes of the lumbar spine. Osteopenia.\n\nSOFT TISSUES: There is asymmetric enlargement of the right vastus lateralis\nand intermedius musculature, consistent with postoperative changes, although\nno discrete or drainable collection is identified.", "output": "1. Bilateral hip prostheses, the right more recently placed and containing\npostsurgical changes in the subcutaneous tissues including gas. There is\nasymmetric enlargement of the right vastus lateralis and intermedius\nmusculature, which likely represents postoperative changes, with no discrete\ncollection is identified.\n2. 5 mm nonobstructing left renal stones.\n3. Extensive arterial atherosclerotic disease." }, { "input": "LOWER CHEST: There is atelectasis or scarring in the left lower lobe. There\nis 0.6 cm nodule in the right lower lobe. Heart is enlarged. Coronary artery\ncalcifications. Cardiac pacemaker. Suggestion of anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A\npunctate calcified granuloma is noted the left lobe of the liver. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis contracted and contains a small gallstone. Small volume perihepatic\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A splenule is noted. Small volume perisplenic\nascites.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 1.5 cm\nsimple cyst arising from the upper pole of the right kidney. There is a 0.7\ncm hyperdense lesion arising from the lower pole of the right kidney which may\nrepresent a a hyperdense cyst however is incompletely evaluated on this exam. \nHyperdense foci within the renal hila bilaterally are likely vascular\ncalcifications. There may be 1 punctate nonobstructing renal stone within the\nupper pole of the left kidney. There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. Normal appendix.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nFLUID: There is a small amount of simple free fluid in the abdomen in the\nperihepatic and perisplenic regions. .\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Spinal fusion hardware is present in the L4 through S1 without\nevidence of hardware complication. Evaluation of the lumbar plexus is limited\nby modality. There is no retroperitoneal hematoma. No CT evidence of the\nlumbosacral plexus abnormality.", "output": "1. Small volume simple ascites. No evidence of retroperitoneal hematoma.\n2. Evaluation of the lumbar plexus is limited by modality.\n3. Cholelithiasis.\n4. Small hyperdense lesion arising from the lower pole of the right kidney may\nrepresent a hemorrhagic cyst but is incompletely evaluated. Ultrasound could\nbe performed for further evaluation.\n5. 0.6 cm lung nodule right lower lobe. If there is no history of smoking,\nfollow-up chest CT without contrast in 12 months recommended. If there is\nhistory of smoking, follow-up chest CT in ___ months, then at ___ months\nrecommended.\n\nRECOMMENDATION(S): Chest CT in ___ months then at ___ months ; or single\nfollow-up at 12 months depending on smoking history, see above" }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are numerous scattered coarse calcifications throughout the liver,\nsuggesting prior granulomatous infection, but no suspicious or focal masses. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is nondistended containing several gallstones. There is no\ngallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size. There are numerous scattered coarse\ncalcifications throughout the spleen suggesting prior granulomatous infection.\nMultiple ill-defined millimetric hypodensities are scattered throughout the\nspleen, likely cysts. Two enhancing foci in the spleen (601b:46) persist on\ndelayed phase imaging, consistent with hemangiomas.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple subcentimeter renal cortical hypodensities are too small to fully\ncharacterize but most likely represent tiny renal cysts. There is no evidence\nof stones, suspicious renal lesions or hydronephrosis. There are no urothelial\nlesions in the kidneys or proximal to mid ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout.\nColon and rectum are within normal limits. Note is made of a redundant\nsigmoid colon.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: There is moderate aortoiliac atherosclerotic disease. The abdominal\naorta is markedly tortuous with aneurysmal dilatation of the distal infrarenal\naorta measuring up to 4.4 cm in maximum diameter (602b:44). There is\narteriomegaly of the common iliac arteries, measuring up to 2.3 cm on the left\nand 1.9 cm on the right. There is mild narrowing of the celiac artery ostium.\nThe proximal celiac artery is aneurysmally dilated, measuring 1.7 cm in\nmaximum diameter (3:59).\n\nPELVIS:\n\nThe urinary bladder is largely distended with a left lateral urinary\ndiverticulum (3:98) and bilateral anterior urinary diverticula extending into\nbilateral inguinal hernias. There is no appreciable abnormal thickening of the\nbladder wall. The distal ureters are not dilated. There is no evidence of\npelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is massively enlarged and heterogeneously\nenhancing, measuring 8.8 x 8.1 x 7.4 cm.\n\nBONES AND SOFT TISSUES:\n\nIndeterminate partially sclerotic foci in the right iliac wing (3:85, 90) and\nthe vertebral body of L2 are noted.\n\nThere is no evidence of worrisome lesions. There are multilevel degenerative\nchanges of the imaged thoracolumbar spine with retrolisthesis of L2 on L3.\nAbdominal and pelvic wall is within normal limits.", "output": "1. No definitive evidence of malignancy in the abdomen or pelvis.\n2. Massively enlarged, heterogeneous prostate with a largely distended urinary\nbladder and multiple urinary diverticula likely related to obstruction. No\nhydronephrosis.\n3. Aortoiliac atherosclerotic disease with aneurysmal dilatation of the\ninfrarenal abdominal aorta, left common iliac artery, and celiac artery.\n4. Incidental findings of cholelithiasis and prior granulomatous infection.\n5. Intrathoracic findings are separately reported.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ in\nperson on ___ at 3:16 ___, 90 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Expected right pneumonectomy changes with hydropneumothorax,\nchanges of thoracostomy, right anterolateral subcutaneous and deep soft tissue\nedema as well as extensive subcutaneous emphysema. Subsegmental left basilar\natelectasis.\n\nABDOMEN: The liver, pancreas, spleen and adrenal glands are unremarkable.There\nare bilateral small parapelvic cysts and a few hypodense renal lesions too\nsmall to characterize. No hydronephrosis.\n\nGASTROINTESTINAL: An enteric tube is present with the tip in the distal\nstomach. There is a small bowel obstruction with a transition point in the\nmid lower abdomen, likely due to adhesion. The distal ileum is collapsed. No\nfree air or ascites. There is contrast reflux into the esophagus.\n\nPELVIS: Foley catheter is present in a collapsed bladder. The uterus and\nright adnexa are unremarkable on CT for age. A 2.4 cm left ovarian cystic\nlesion is noted, amenable to follow-up.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: No aggressive osseous lesions.\n\nSOFT TISSUES: Fat containing umbilical hernia, now containing a small amount\nof fluid.", "output": "1. Small-bowel obstruction with transition in the lower abdomen. No free air.\n2. Postoperative changes in the right hemithorax and additional findings as\nabove.\n3. No findings of metastatic disease." }, { "input": "Heart size is normal without significant pericardial fluid. Lung bases are\nclear.\n\nCT abdomen with contrast: Liver enhances homogeneously without focal mass or\nbiliary dilatation. Gallbladder is normal. Portal vein is patent.\n\nSpleen, pancreas and adrenal glands are normal.\n\nKidneys present symmetric nephrograms and excretion of contrast without focal\nmass or hydronephrosis.\n\nStomach, duodenum and remainder of the small bowel loops are normal caliber\nwithout evidence for obstruction. Large bowel is thin-walled and unremarkable\nwithout pericolonic fat stranding or fluid collection. Top normal caliber,\nfluid-filled appendix is visualized in the right lower quadrant measuring up\nto 6 mm in diameter with similar appearance to the prior studies (2:54,\n602b:37, 601b:23). No findings such as appendiceal hyperemia, surrounding fat\nstranding or fluid collection to suggest appendicitis.\n\nAbdominal aorta is normal caliber. Scattered mesenteric and retroperitoneal\nlymph nodes are not pathologically enlarged. No ascites, pneumoperitoneum or a\nventral abdominal hernia.\n\nCT pelvis with contrast: The bladder, uterus, ovaries and rectum are normal.\nNo pelvic free fluid or air. Inguinal and pelvic sidewall lymph nodes are not\npathologically enlarged.\n\nBones and soft tissues: No suspicious focal bone lesion.", "output": "Normal CT examination of the abdomen and pelvis. Top normal caliber appendix\nlacks imaging features to suggest acute appendicitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n1.1 cm cyst noted in the upper pole of the left kidney. No concerning renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a large\nstool burden in the colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcifications noted at the uterine fundus, nonspecific.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture\ncommon noting multilevel degenerative changes and a levo scoliotic deformity\nof the lower thoracic/upper lumbar spine..\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Large stool burden in the colon. Otherwise unremarkable CT of the abdomen and\npelvis." }, { "input": "LOWER CHEST: The lung bases are clear. There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Cystic lesions seen in the\nuncinate process on prior MRCP not well seen by CT. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nSmall and large bowel are normal in caliber without focal wall thickening. \nThe appendix is well-visualized and normal there is no intra-abdominal free\nfluid or free air.\n\nPELVIS: The bladder is distended. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged measuring 5.3 x 3.8 cm.\n\nLYMPH NODES: There is no retroperitoneal adenopathy. There is subtle\nstranding in the left lower quadrant surrounding multiple mesenteric lymph\nnodes (series 2, image 46). There is no pelvic sidewall or inguinal\nadenopathy.\n\nVASCULAR: The abdominal aorta is ectatic measuring up to 2.1 cm with\ncalcified and noncalcified thrombus. The celiac axis and SMA are patent but\nthere is calcification at their takeoffs.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of appendicitis or diverticulitis.\n2. Mild stranding surrounding mesenteric lymph nodes in the left lower\nquadrant, compatible with mild mesenteric panniculitis.\n3. Severe atherosclerotic disease of the abdominal aorta with both calcified\nand noncalcified plaque.\n\nNOTIFICATION: Updated findings (impression # 2) emailed to the ED QA nurses\nby Dr. ___ on ___ at 09:00, 10 minutes after they were\nmade." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nhypodensity in hepatic segment IV measures 2.0 x 1.3 cm (05:51), and is\nsimilar to that seen in ___ a second hypodensity in hepatic segment II 8\nmeasures 1.2 by 1.2 cm, and is new in comparison with ___ (05:47). An\nill-defined hypodensity in hepatic segment VII is unchanged. Subcentimeter\nhypodensity in hepatic segment VI is too small to characterize, but probably\nrepresents a cyst and is unchanged (05:55). None of these lesions appear to\nbe FDG avid PET-CT ___. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nleft sacral Tarlov cyst is unchanged. Multilevel thoracolumbar degenerative\nchanges are noted.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Multiple nonenhancing hypodense hepatic lesions were not FDG avid on recent\nPET from ___, and are probably simple cysts.\n3. Please see separately dictated chest CT report from the same date for\ndescription of thoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is homogeneously low in attenuation, suggesting\nsteatosis. There is focal fatty sparing gallbladder fossa. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.4 cm left renal hypodensity is better characterized as a simple cyst on\nprior MR. ___ is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of bowel inflammation. No acute intra-abdominal abnormality.\n2. Hepatic steatosis." }, { "input": "LOWER CHEST: Bibasilar ground-glass opacities are most consistent with\natelectasis. There is mild traction bronchiectasis at in the lingula. \nMinimal pleural thickening is noted posteriorly. Small to moderate\npericardial effusion is mostly simple in density. Aortic valvular and mitral\nannular calcifications are moderate.\n\nABDOMEN:\n\nHEPATOBILIARY: The right hemidiaphragm is mildly elevated. The liver\ndemonstrates homogeneous attenuation throughout. There is no evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas is atrophic. No focal lesion is seen within the limits\nof a noncontrast scan. There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right gland is normal in size and shape. The left adrenal gland\nis mildly diffusely thickened.\n\nURINARY: Bilateral kidneys are mildly atrophic, left smaller than right. \nThere is a 2.8 cm hypodensity in the lower pole of the left kidney, likely\nrepresenting a simple cyst. Otherwise, there is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Redundant sigmoid colon in the\npresacral space, posterior to the bladder demonstrate adjacent fat stranding. \nThe involved loop are not dilated. There is mild stranding around the\nanterior aspect of the rectum. However the rectal wall does not appear\ndilated. Air-fluid level is seen within the rectal vault. The appendix is\nnot visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is rightward curvature of the spine with moderate to severe\ndegenerative changes of the lumbar spine. There is no evidence of worrisome\nosseous lesions or acute fracture. Patient is status post gamma nail\nplacement in the left femur.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "-Fat stranding around redundant sigmoid colon in the presacral space. The\nloops of bowel are not distended. The findings may represent distal\ncolitis/proctitis.\n-Mild to moderate pericardial effusion. Please correlate with cardiac history\nand function.\n-Atrophic left kidney." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous increased attenuation\nthroughout, consistent with hepatic steatosis. There is an area of focal\nfatty sparing around the gallbladder. There is no evidence of focal lesions\nwithin the limitations of an unenhanced scan. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Subcentimeter cortical\nhypodensities are too small to characterize, however likely represent cysts. \nThere is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are dilated small bowel\nloops measuring up to 3.3 cm in the mid abdomen which taper in the mid to\nright lower quadrant, with no clear transition point (2:52). There is\nsurrounding mesenteric haziness and stranding. There is no mesenteric free\nfluid. The colon and rectum are within normal limits. The appendix is normal\n(601b:39).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Old healed right inferior and superior pubic rami fractures are noted.\nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Findings concerning for partial small bowel obstruction vs ileus, with dilated\nsmall bowel loops in the mid abdomen which taper in the mid to right lower\nquadrant, with no clear transition point. Mesenteric edema is seen. No\nmesenteric free fluid identified." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: In this patient with recent EGD, the stomach appears\nunremarkable. There is subtle thickening along the second segment of the\nduodenum which is nonspecific and could be post procedural. No adjacent fat\nstranding or free air. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Postsurgical changes/suture noted in\nthe lower rectum. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent. There is no adnexal\nmass. Ovaries not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Total right hip arthroplasty is re-demonstrated, resulting in streak\nartifact. Degenerative changes are noted focally at L5-S1 with significant\ndisc space narrowing and prominent endplate osteophytosis along the anterior\naspect. Additionally, there is degenerative disease in the lower thoracic\nspine, specifically at T10-11.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of bowel perforation. Subtle thickening along the second\nsegment of the duodenum may be related to recent procedure.\n2. Diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: There is linear atelectasis of the left lung base. Lungs are\notherwise clear. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Pancreas is normal in attenuation. There is a 9 mm lesion of the\npancreatic body (series 5; image 24). This finding may represent a side\nbranch IPMN. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions. There is mild\nhydroureteronephrosis on the right with perinephric stranding and minimal\ndelay excretion of contrast. There is a 3-4 mm density in the region of the\nright ureterovesicular junction which is most suspicious for a\nureterovesicular junction calculus. There is no left-sided. Evaluation for\nadditional renal stones is limited by contrast enhanced nature of this exam. \nThere is no left-sided perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\nmultiple sigmoid diverticula without surrounding inflammation to suggest\ndiverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Probable approximately 1.3 cm fibroid identified within\nthe uterus on the right. Uterus and adnexae are otherwise unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild hydroureteronephrosis on the right with perinephric stranding and\nminimal delay of excretion of contrast. A 3-4 mm density in the region of the\nright ureterovesicular junction most suspicious for a calculus.\n2. Normal appendix.\n3. A 9 mm lesion in the body of the pancreas may represent side branch IPMN. \nRecommend nonemergent MRI of the abdomen for further evaluation.\n4. Diverticulosis without surrounding inflammation to suggest diverticulitis.\n\nRECOMMENDATION(S): Nonemergent MRI of the abdomen for further evaluation of\npancreatic body lesion." }, { "input": "LOWER CHEST: Scarring is noted at the left lung base, the visualized lungs are\notherwise clear. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 4 mm nonobstructing renal stone is noted on the right. There is no\nperinephric fluid collection.\n\nGASTROINTESTINAL: The stomach is unremarkable. With the exception of the\nduodenum and a short segment of terminal ileum the small bowel is fluid and\nair-filled and dilated measuring up to 4.7 cm. A gradual tapering of the\nsmall bowel is seen in the right upper quadrant (series 601, image 43). No\ncontrast is seen distal to the jejunum. There is no focal mass or wall\nthickening. The colon is decompressed without wall thickening. The appendix\nis not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Chronic fractures of the posterior right ___ ribs and left tenth\nand eleventh ribs are noted. There is extensive DISH in the thoracic spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Small bowel obstruction, indeterminate for partial or complete obstruction,\nfavoring partial given a small amount of gas and fluid distal to the\nobstruction. A transition point is seen in the right upper quadrant and may\nbe due to adhesion.\n\n\n2. Rib fractures with callus formation are noted at multiple lower ribs\nbilaterally." }, { "input": "LOWER CHEST: There is minimal bilateral dependent atelectasis. No pleural or\npericardial effusion is seen. There is a very small hiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: No hydronephrosis is seen. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is relatively collapsed. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Within the right hemipelvis adjacent to and at least abutting the\nright uterine fundus is a 5.3 x 7.5 x 5.7 cm calcified structure with thick\nrim calcification. Findings may represent a a large calcified fibroid,\nhowever, it is difficult to discern if this is truly arising from the uterus\nand it may be adnexal in origin. Recommend pelvic ultrasound for further\nassessment. The urinary bladder and distal ureters are unremarkable. There is\nno free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process. Normal appendix. No evidence of bowel\nobstruction or bowel wall thickening.\n2. 7.5 cm thick rim calcified structure within the right hemipelvis that at\nleast abuts the right uterus and could represent a calcified fibroid; however,\nit is difficult to discern if this is truly arising from the uterus and may be\nadnexal in origin. Recommend further assessment non emergent with pelvic\nultrasound.\n\nNOTIFICATION: Findings and recommendation discussed with Dr. ___ on\n___ at 21:15 via telephone by Dr. ___." }, { "input": "LOWER CHEST: There is moderate coronary artery calcification and heart size is\nmildly enlarged. Bibasilar atelectasis is noted. There is mild bronchiolar\nwall thickening compatible with airways disease, improved from the prior exam.\nNo pericardial effusion or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is moderate to severe intra and extrahepatic biliary dilation. The\ncommon bile duct measures 1.7 cm with abrupt cut off of the distal common bile\nduct at the ampulla where there appears to be a heterogeneous soft tissue\ndensity lesion. The gallbladder is distended with multiple gallstones and\ndemonstrates mild mural edema adjacent to the liver and mild adjacent\npericholecystic stranding.\n\nPANCREAS: The pancreas is atrophic and the pancreatic duct is dilated up to 6\nmm with abrupt cut off at the ampulla. A heterogeneous soft tissue density\nrounded lesion at the level of the ampulla measures approximately 1.7 x 1.7 cm\n(601:23). No peripancreatic fluid collections or abnormal enhancement of the\npancreas.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.0 cm simple cyst is seen in the right kidney. There is no evidence of\nhydronephrosis. Multiple subcentimeter hypodensities are seen in bilateral\nkidneys, too small to characterize, likely simple cysts. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Mild circumferential distal esophageal wall thickening\nsuggests esophagitis, similar to the prior CT. Stomach and duodenum are\nunremarkable. The small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. A left lower quadrant colostomy is\npresent with a parastomal hernia containing non-obstructed colon noted. The\nappendix is not visualized. ___ pouch appears unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 L4 on L5 anterolisthesis is noted. Severe degenerative changes of the\nthoracolumbar spine and bilateral hips are noted.\n\nSOFT TISSUES: A left lower quadrant parastomal hernia containing colonic loops\nof bowel are noted. A small right fat containing inguinal hernia is noted.", "output": "1. 1.7 cm heterogeneous soft tissue density round lesion at the level of the\nampulla obstructing the pancreatic duct and common bile duct with upstream\nmoderate to severe intra and extrahepatic biliary dilation. This could\nrepresent an obstucting mass or possibly an impacted calculus at the ampulla. \nWhile ERCP or MRCP can be obtained further evaluation, ERCP will also allow\nfor biliary decompression.\n2. Cholelithiasis with acute cholecystitis, the latter due to the obstucting\nlesion at the level of the ampulla.\n3. Mild bronchiolar wall thickening compatible with airways disease.\n4. Mild distal esophageal wall thickening likely reflective of esophagitis, as\nseen on the prior CT chest.\n5. Left lower quadrant colostomy with a parastomal hernia containing\nnon-obstructed colon.\n\nRECOMMENDATION(S): ERCP/MRCP for further evaluation, however ERCP can also\nprovide decompression of the biliary system.\n\nNOTIFICATION: The findings were discussed with the emergency room clinician\nby ___, M.D. on the telephone on ___ at 11:42 pm." }, { "input": "Heart size is normal without significant pericardial fluid. Imaged lung bases\nare clear.\n\nCT abdomen with contrast: Liver enhances homogeneously without focal lesion\nor biliary dilatation. Gallbladder is unremarkable. Portal vein is patent. \nPunctate calcification is seen adjacent to hepatic segment IV B.\n\nSpleen, pancreas and adrenal glands are unremarkable.\n\nMultiple bilateral sub cm renal hypodensities are too small to fully\ncharacterize but likely represent cysts. Kidneys otherwise present symmetric\nnephrograms and excretion of contrast without focal solid lesion or\nhydronephrosis.\n\nStomach is unremarkable duodenum and small bowel loops are normal caliber\nwithout evidence of obstruction. Large bowel is thin-walled and unremarkable\nwithout pericolonic fat stranding or fluid collection. Appendix is not\nvisualized though there is no evidence for appendicitis.\n\nAbdominal aorta is normal caliber. There is no mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria. There is no ascites, pneumoperitoneum or\nventral abdominal hernia.\n\nCT pelvis with contrast: Bladder, prostate and rectum are unremarkable. \nThere is no inguinal or pelvic sidewall lymphadenopathy by CT size criteria. \nThere is no free pelvic fluid or air.\n\nBones and soft tissues: There is no suspicious focal bone lesion.", "output": "1. No acute findings in the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2: 57).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute findings in the abdomen or pelvis. Normal appendix." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 1 cm\nhypodense lesion in the right lobe liver is unchanged likely cyst or biliary\nhamartomas. There is mild intrahepatic biliary ductal dilatation which has\nincreased from prior. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple hypodense renal lesions measuring up to 1 cm are incompletely\ncharacterize though statistically likely represent cysts. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical changes in the region of the distal stomach are\nnoted. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is aneurysmal dilatation of the abdominal aorta measuring up\nto 3.9 cm. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of recurrent or metastatic disease in the abdomen or pelvis.\n2. Aneurysmal dilatation of the infrarenal abdominal aorta measuring up to\n3.9 cm which has increased from prior examination in ___ where it measured\n3.4 cm." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The bladder is thickened which can be seen in cystitis. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Thickening of the bladder wall which can be seen in cystitis.\n2. No evidence of appendicitis.\n\nRECOMMENDATION(S): Recommend clinical correlation of bladder wall thickening\nwith UA." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: There is a fatty lesion within the body of the pancreas measuring 8\nmm (series 6, image 65), felt to most likely represent a lipoma with\ninterdigitating fat being less likely. The pancreas is otherwise\nunremarkable.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are no focal renal lesions. There is no evidence of hydronephrosis. \nBilateral nonobstructing renal stones are present with the largest in the\nright lower pole measuring 6 mm (series 4, image 42). There are no urothelial\nlesions in the kidneys or ureters. There is no perinephric abnormality.\nGASTROINTESTINAL: Known esophageal lesion, not well seen on CT. The stomach\nis decompressed. The small bowel is normal in caliber without focal wall\nthickening. The large bowel is also normal in caliber without wall\nthickening. There is diverticulosis of the sigmoid colon without evidence of\ndiverticulitis. The appendix is well-visualized and normal. There is no\nmesenteric adenopathy. The left gastric chain is normal.\nRETROPERITONEUM: There are scattered mediastinal lymph nodes with the largest\nadjacent to the left psoas muscle measuring 8 mm (series 6, image 97). There\nare no pathologically enlarged retroperitoneal lymph nodes.\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nBONES AND SOFT TISSUES:\n\nA sclerotic lesion within the posterior L3 vertebral body, sacrum, and right\niliac bone are most compatible with bone islands. There are no concerning\nlytic or sclerotic bony lesions.\nAbdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen and pelvis. Known\nesophageal lesion not well seen by CT.\n2. Fatty lesion within the body of the pancreas, likely represents a small\nlipoma, this can be confirmed by MRI or re-evaluated on followup CTs.\n3. Bilateral nonobstructive renal stones." }, { "input": "LOWER CHEST: Please refer to the separately dictated report of same day CT\nchest..\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.4 cm low-attenuation cortical hypodensity involving the left\nrenal cortex likely representing a renal cyst. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatus hernia, otherwise the stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. The\nvisualized reproductive organs are unremarkable. No pelvic free fluid seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no significant pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative disc disease, most marked at L5-S1 level. \nDegenerative disc bulge at L4-5 level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease seen in the abdomen or pelvis.\n2. Multilevel degenerative disc disease involving the lumbar spine as\ndescribed above.\n3. Please refer to the separately dictated report of same day CT chest." }, { "input": "LOWER CHEST: There is bibasilar atelectasis without focal consolidation. \nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. There are multiple renal hypodensities, which are\ncortically based and too small to characterize, likely cysts. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is colonic\ndiverticulosis without surrounding inflammation to suggest diverticulitis. \nThe appendix is normal.\n\nPELVIS: Streak artifact from patient's left hip arthroplasty limits evaluation\nof the pelvis. Within these limitations, there is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged. Seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post left hip arthroplasty. Serpiginous sclerosis along the\nupper right femoral head could represent very early avascular necrosis (series\n601, image 52). There is no fracture or collapse.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No etiology identified for flank pain. No signs of intra-abdominal\ninfection.\n2. Serpiginous sclerosis along the upper right femoral head could represent\nvery early avascular necrosis. There is no fracture or collapse. Correlate\nwith any symptoms for right hip pain." }, { "input": "LOWER CHEST: Multiple pulmonary nodules are seen at the lung bases, better\nevaluated on chest CT from ___. There are new small bilateral with\nassociated atelectasis.\n\nABDOMEN:\n\nAgain seen, are diffuse hypodense hepatic lesions, not significantly changed\nfrom ___, consistent with metastatic disease. The largest lesion is in\nsegment VI of the liver and measures approximately 6.4 x 4.9 cm (series 5,\nimage 33). The gallbladder is normal without radiopaque stones. There is no\nintra or extrahepatic biliary duct dilation. The main, right, and left portal\nveins are patent.\n\nThe spleen, kidneys, adrenal glands, and pancreas are unremarkable.\n\nThe distal esophagus is normal without a hiatal hernia. Oral contrast is seen\nextending through the proximal transverse colon. There is no small bowel wall\nthickening or dilation. A new colostomy seen in the left lower quadrant. A\ntube extends from the colostomy and loops within the sigmoid colon ending just\nproximal to the known mass. There is no evidence of large bowel obstruction. \nAgain seen, is a necrotic mass centered at the rectosigmoid junction with foci\nof air along the left lateral aspect. Overall the mass has not significantly\nchanged from prior causing mass effect and anterior displacement of the\nbladder with loss of the fat plane between the mass and the prostate, seminal\nvesicles, as well as the posterior wall of the bladder, concerning for direct\ninvasion. There is no drainable intra-abdominal fluid collection identified. \nThere is no large volume of free intra-abdominal air. The abdominal aorta is\nnormal in caliber without aneurysmal dilation. There is moderate\natherosclerotic disease. The celiac axis, SMA, and ___ are patent.\n\nEvaluation for lymphadenopathy is limited without mesenteric fat, but no\nobvious retroperitoneal or mesenteric adenopathy is seen.\n\nPELVIS: A focus of air at the dome of the bladder large pelvic mass, as\ndescribed above. There is no pelvic sidewall or inguinal adenopathy.\n\nOSSEOUS STRUCTURES/SOFT TISSUES: Sclerotic lesion in the left iliac bone\n(series 5, image 53) and left superior pubic ramus (series 5, image 69) are\nnonspecific and may represent bone islands. There is no acute fracture. \nThere is diffuse anasarca.", "output": "1. Postsurgical changes from diverting colostomy. No evidence of\nintra-abdominal fluid collection.\n2. Re- demonstrated large rectosigmoid mass which appears to invade\nsurrounding structures including the prostate, seminal vesicles, and posterior\nwall of the bladder.\n3. Diffuse hepatic metastatic disease, not significantly changed.\n4. Multiple bibasilar lung nodules, concerning for metastatic disease, better\nevaluated on chest CT from ___.\n5. New bilateral small pleural effusions.\n6. Diffuse anasarca." }, { "input": "LOWER CHEST: Visualized lung fields are notable for multiple metastatic\nlesions which have increased since prior examination largest measuring 1.7 x\n1.6 cm within the left lower lobe (2:7) (previously 0.9 x 0.7 cm). Left lower\nlobe plate like opacity is most consistent with atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Diffuse hepatic hypodensities are scattered throughout the\nliver, largest measuring 6.4 x 5.6 cm (02:21) within segment ___ (previously 3\nx 3 cm). No intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient status\npost diverting colostomy for large rectal carcinoma. The remaining colon is\nunremarkable. The appendix is normal.\n\nPELVIS: No definite colovesicular fistula although there is invasion of the\nposterior bladder wall by a large partially necrotic pelvic mass. There is no\nfree fluid in the pelvis. The distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The reproductive organs are not fully evaluated.\n\nLYMPH NODES: Multiple prominent right inguinal lymph nodes are noted largest\nmeasuring 1.1 x 0.7 cm (2:60) (previously 1 x 0.7 cm). There is no pelvic or\ninguinal lymph node enlargement by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate calcified and\nnoncalcified atherosclerotic disease is noted. The celiac axis, SMA, and ___\nare patent.\n\nBONES: A 0.9 x 0.4 cm (02:52) and 0.2 cm densely sclerotic lesion within the\nleft iliac bone the left superior pubic ramus respectively is stable since\nprior examination and most consistent with bone islands. There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Progression of diffuse metastatic disease.\n2. Status post diverting sigmoid colostomy with associated postsurgical\nchanges. No fluid collection.\n3. No definite colovesicular fistula although large partially necrotic rectal\nmass invades into posterior bladder wall, which has increased since prior\nexamination." }, { "input": "LOWER CHEST: Views of the lower lungs demonstrate diffuse metastatic disease\nwith the largest pulmonary nodule measuring 1.7 x 2.0 cm (series 2, image 8),\nnot significantly changed from prior. There is no pericardial effusion. \nThere trace bilateral pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse hepatic metastatic disease with the largest\nconglomerate of masses located in segment III of the liver measuring\napproximately 6.7 x 6.8 cm, not largely changed compared to prior, possibly\nslightly progressed. The gallbladder is unremarkable without radiopaque\nstones. There is no intra or extrahepatic biliary duct dilation. The portal\nvein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nThe stomach is relatively decompressed. The patient is status post diverting\ncolostomy for a large rectal carcinoma. Postsurgical changes remain grossly\nunchanged. Again seen is a large partially necrotic rectal mass which invades\nthe posterior are bladder wall, overall size is stable to slightly increased\ncompared to ___.\n\nPELVIS: The posterior wall of the urinary bladder is invaded by a large\npartially necrotic rectal mass.\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nProminent right inguinal lymph nodes are unchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Sclerotic lesion within the left iliac bone is unchanged from prior,\nstatistically likely represents a bone island. . No new bony lesions are\nseen\n\nSOFT TISSUES: There is diffuse anasarca. Possible small amount of ascites.", "output": "1. Minimal to no large interval change compared to ___ including diffuse\npulmonary and hepatic metastases.\n2. Again seen large partially necrotic rectal mass invading the posterior\nbladder wall.\n3. Stable postsurgical changes from diverting sigmoid colostomy. No\nintra-abdominal fluid collection. Possible small amount of ascites per" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post right ileal conduit placement with bilateral\nureteral urinary diversion. The kidneys are of normal and symmetric size with\nnormal nephrogram. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The ileal conduit anastomotic\nsite is intact. Otherwise the small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: There is re-demonstration of multiple sutures and surgical clips\nthroughout the pelvis secondary to lymph node dissection, prostatectomy, and\ncystectomy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence recurrent or new metastatic disease within the abdomen or\npelvis.\n2. Patient is status post ileal conduit urinary diversion without evidence of\nleak or related complications.\n3. Please see same day dedicated CT chest for description of thoracic\nfindings." }, { "input": "LOWER CHEST: Previous refer to separately reported chest CT from the same day\nfor further thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: Stable bilateral cortical cysts in the left upper pole and right\nlower pole. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of focal renal lesions or hydronephrosis.\nPatient is status post right ileal conduit placement with bilateral ureteral\nurinary diversion. Contrast progresses to the ileum without extravasation.\n\nGASTROINTESTINAL: The stomach is unremarkable. The ileal conduit anastomotic\nsite is intact. Otherwise small-bowel loops are unremarkable. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Patient is status post cystectomy with ileal loop. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post prostatectomy.\n\nLYMPH NODES: Bilateral surgical clips along the pelvis and retroperitoneum\nthere is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Conventional anatomy of the celiac axis and SMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. 1\ncm well-circumscribed with sclerotic margins bone lesion in the left iliac\nbone, likely represents bone cyst, and has been stable since at least ___. Few bone islands in the right ischion and bilateral pubic bones.\n\nSOFT TISSUES: Ileal loop diverted through the right lower abdominal wall. \nPelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen and pelvis.\n2. Patient is status post ileal conduit urinary diversion without evidence of\nleak.\n3. Please refer to separately reported chest CT performed on the same day for\nthoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 1.2 cm accessory spleen is re-demonstrated\nmedially.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cysts remain measuring 1.7 cm in the right lower pole, as well\nas a exophytic 3.5 x 2.3 cm left upper pole lesion, unchanged from prior. \nThere is no evidence of hydronephrosis. There is no perinephric abnormality. \nPatient is status post cystectomy with ileal conduit which terminates from a\nright lower quadrant ostomy which remains patent and without focal\nabnormalities at the stoma or anastomotic signs. Previously visualized soft\ntissue surrounding the left renal vein and left ureter demonstrates near\ncomplete resolution with only mild stranding remaining.\n\nGASTROINTESTINAL: The stomach is unremarkable. Ileal anastomotic sites are\ngrossly unremarkable and otherwise the small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits.\n\nPELVIS: There is no free fluid in the pelvis. The prostate is surgically\nabsent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Bilateral iliac surgical clips are re-demonstrated and unchanged\ncompared to prior. There is no abdominal aortic aneurysm. Mild\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Previously visualized enhancing subcutaneous soft tissue nodules\nare no longer visualized. The abdominal and pelvic wall is within normal\nlimits.", "output": "1. Interval resolution of previously visualized enhancing soft tissue nodules\ninvolving subcutaneous anterior abdominal wall and retroperitoneum. No new\nabdominopelvic metastasis or lymphadenopathy.\n2. Please refer to same-day CT chest for characterization of findings above\nthe diaphragm." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 1.2 cm accessory spleen is again noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cysts are re-demonstrated measuring 1.7 cm in the right lower\npole and 3.6 cm in the left upper pole. There is no evidence of\nhydronephrosis. There is no perinephric abnormality. Again seen are changes\nstatus post cystectomy with ileal conduit with a right lower quadrant ostomy\nwhich remains patent and is without focal abnormality identified.\n\nGASTROINTESTINAL: The stomach is unremarkable. Ileal anastomoses are without\nfocal abnormalities in the remaining small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. Surgical clips are visualized\nthroughout the bilateral iliac and retroperitoneal region, unchanged from\nprior.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No findings of metastatic disease identified within the abdomen or pelvis.\n2. Please refer to same-day CT chest for characterization of intrathoracic\nfindings." }, { "input": "There is a new small to medium size but incompletely imaged and characterized\nleft-sided pleural effusion with new associated compressive atelectasis in the\nbasilar left lower lobe. Minor new dependent atelectasis is also found in the\nright lower lobe.\n\nThere is no biliary dilatation. Gallbladder is full without wall thickening. \nContents are hyperdense, unlike the recent prior study. This suggests\ninterval development of sludge, less likely vicarious excretion of contrast\nfrom the prior study given the time interval. No focal liver lesions are\nidentified. There is no biliary dilatation. The pancreas appears normal. \nSpleen is normal in size and appearance. Adrenals are unremarkable. A\nmedium-size simple cyst is unchanged along the lower pole of the right kidney.\nOn each side, hydronephrosis has resolved. At the site of a simple cortical\ncyst along the upper pole of the left kidney, there is new marked inflammatory\nchange and slight wall thickening and hyperenhancement. The cyst is also\nlarger, now measuring up to 47 x 46 mm in axial ___ (05:25). The\npararenal fascia is thickened with increased stranding. There is no perfusion\ndefect found in the left kidney, however.\n\nNasogastric tube terminates in the stomach, which is non-distended. Patient\nis status post radical cystectomy with neobladder emptying into a stoma in the\nright lower quadrant. Previously the stoma was distended both inside and\noutside of the abdomen. There is now a catheter in the stoma which is coiled\nin the extra-abdominal part of the ileal conduit. The whole ileal conduit is\nnow decompressed. Postoperative appearance of the bowel is unremarkable. The\ncolon shows mildly prominent stool content throughout, as seen previously.\nTrace ascites is found in the pelvic cul de sac.\n\nMajor vascular structures appear widely patent. Atherosclerotic changes are\nfairly mild along the aorta. Small periaortic lymph nodes are probably\nreactive and not enlarged by size criteria.\n\nThere are no suspicious bone lesions. Small sclerotic focus in the left ilium\nis unchanged, suggesting a benign lesion.", "output": "1. Marked new inflammatory changes involving a exophytic cyst along the\nposterior upper pole of the left kidney most consistent with super\ninfection/conversion to abscess, including interval enlargement of the cyst. \nPercutaneous aspiration and/or drain placement would not be difficult\ntechnically.\n\n2. Interval decompression of ileal conduit with resolution of bilateral\nhydronephrosis." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally without focal concerning lesion. \nMain portal vein is patent. No intrahepatic or extrahepatic biliary ductal\ndilation. The gallbladder is surgically absent. No fluid collection is seen\nnear the clips in the gallbladder fossa.\n\nPANCREAS: The pancreas enhances normally without concerning focal lesion signs\nof inflammation or ductal dilation.\n\nSPLEEN: The spleen is normal in size without focal lesion.\n\nADRENALS: Both adrenal glands are normal.\n\nURINARY: The kidneys enhance symmetrically with prompt excretion of contrast\nnoted. No focal abnormality, hydronephrosis.\n\nGASTROINTESTINAL: The stomach is decompressed. The duodenum appears normal. \nSmall bowel loops demonstrate no signs of ileus or obstruction. The appendix\nis normal. The colon is fairly decompressed throughout. No overt signs of\ncolitis. No free air or free fluid.\n\nPELVIS: The urinary bladder is mostly decompressed. Distal ureters opacify\nnormally. The prostate gland and seminal vesicles appear relatively\nunremarkable. No pelvic sidewall or inguinal adenopathy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No appreciable\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Status post cholecystectomy. No findings to account for right upper quadrant\nand epigastric pain. Incidental findings as detailed." }, { "input": "LOWER CHEST: There is mild mosaic attenuation in the lung bases, likely air\ntrapping. The cardiac size is moderately enlarged. Coronary artery and\naortic valve calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains layering hyperdense material, likely\nsmall stones vs sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of symmetric size. Mild cortical thinning\nbilaterally. The previously described left Bosniak 2 renal cyst is not well\nseen on today's study. There is no evidence of focal renal lesions within the\nlimitations of an unenhanced scan. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nThere is again regions of extensive fat stranding, granulation tissue,\nscarring, and soft tissue density along the anterior midline with hyperdense\nmaterial, likely prior barium and enteric contents, consistent with known\nmultiple prior mesh repair and enterocutaneous fistula. Overall appearance is\nunchanged from prior.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is atrophic\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen along the lumbosacral spine with mild grade 1\nanterolisthesis of the L4-L5 vertebral level.", "output": "1. No hematoma.\n2. Similar appearance of extensive granulation tissue and scarring along the\nanterior abdominal wall containing radiopaque material for which clinical\ncorrelation is advised." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Small perihepatic ascites is noted.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nLayering hyperdense material is again seen in the gallbladder, which likely\nrepresents small stones and/or sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.4 cm hypoattenuating lesion in the left interpolar region (02:36) is\nincompletely characterized, but is decreased in size from ___, and is\nlikely benign. Additional bilateral subcentimeter hypodensities are too small\nto characterize. There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: No bowel obstruction is seen. The appendix is not\nidentified.\n\nA chronic enterocutaneous fistula with the transverse colon is again seen in\nthe mid abdominal wall (02:44), with extensive surrounding subcutaneous edema\nand fat stranding.\n\nA large 9.5 x 6.7 x 9.1 cm collection of fluid and gas in the subcutaneous fat\nof the left mid anterior abdominal wall is new (02:48). No definite fistulous\nconnection is seen between this collection and the adjacent enterocutaneous\nfistula or the abdominal cavity, but this is difficult to exclude; there is\nlack of clear fat plane between this and the fistula. No oral contrast is\nseen within this collection. No pneumoperitoneum.\n\nPELVIS: The urinary bladder is thin walled. There is trace free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is very minimal anterolisthesis of L4 over L5. Degenerative changes are\nseen at the lower lumbar spine/lumbosacral junction.\n\nSOFT TISSUES: There is diffuse subcutaneous edema. A large defect in the\nventral midline abdominal wall is seen (2:63).", "output": "1. Re-demonstration of known enterocutaneous fistula of the transverse colon\nin the mid abdomen, with extensive surrounding fat stranding.\n2. New large 9.5 cm collection of fluid and gas in the subcutaneous fat layer\nof the left mid anterior abdominal wall. No definite fistulous connection is\nseen between this collection and the adjacent enterocutaneous fistula or the\nabdominal cavity, although this is difficult to exclude; lack of clear fat\nplane between the fistula and fluid collection. No oral contrast is seen\nwithin the collection.\n3. Additional findings, as above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. in person on ___ at 11:01 pm, 3 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense foci are seen scattered throughout the liver, with the\nlargest measuring up to 1.2 cm in the right hepatic lobe, likely hepatic cysts\nor biliary hamartomas. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Patient\nis status post total right hip replacement.", "output": "1. No CT evidence of acute intra- abdominal or intrapelvic findings to\ncorrelate with patient's symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Subcentimeter peripheral hepatic hyperdensities (02:16, 02:22)\nare most likely biliary hamartomas, characterized on the prior MR. ___\nhypodensities in segments II and V, also seen on the prior MRI, are most\nlikely simple cysts. Otherwise, the liver demonstrates homogenous attenuation\nthroughout. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Layering stones or sludge within the gallbladder is similar to\nprior.\n\nPANCREAS: A 2.2 cm hypodense lesion with an anterior mural nodule appears\nsimilar to prior, previously characterized as a possible cystic pancreatic\nneuroendocrine tumor. A 1.4 cm cystic lesion in the tail of pancreas is also\nsimilar to prior, characterized as a side branch IPMN. Otherwise, the\npancreas has normal attenuation throughout, without evidence of pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: An approximately 2.3 cm right adrenal adenoma is similar to prior. \nThe left adrenal gland is unremarkable.\n\nURINARY: A 2.1 cm hypodense lesion of the upper pole of the left kidney is\nmost likely an angiomyolipoma, previously characterized on the MRI. A\nsubcentimeter hypodensity of the interpolar right kidney is better seen on the\nprior MR, likely another angiomyolipoma. ___, bilateral hypodensities are\nmost likely cysts. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: No bowel obstruction or bowel wall thickening is seen. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: A 1.8 cm periaortic node (02:35) superior to the left renal hilum\nappears similar to the prior study. Otherwise, there is no ___\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Mild anterolisthesis of L4 on L5 and mild retrolisthesis of L5 on S1,\nmost likely chronic. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: Small, fat containing umbilical hernia. Otherwise, the\nabdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal abnormality.\n2. No significant change in the known, probable pancreatic metastatic disease." }, { "input": "LOWER CHEST: The lung bases are clear. There is no pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild prominence of the central\nintrahepatic biliary ducts is unchanged from prior study. There is no\nevidence of extrahepatic biliary dilatation. The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size without evidence of a focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of a solid renal lesion or hydronephrosis. There is no\nperinephric abnormality. The urinary bladder and distal ureters are\nunremarkable.\n\nGASTROINTESTINAL: There is extensive thickening and submucosal edema of the\ndistal esophagus, which is most likely related to recent vomiting. No\nextraluminal air is identified. The stomach is mildly distended with fluid. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is not\ndefinitively visualized.\n\nOTHER: There is no free fluid or air in the abdomen or pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Mildly prominent retroperitoneal lymph nodes measuring up to 10\nmm are unchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild to moderate\natherosclerotic calcifications are noted.\n\nBONES: There is no suspicious osseous lesion or acute fracture. Mild\nmultilevel degenerative changes of the spine are noted.\n\nSOFT TISSUES: Mild anasarca is noted.", "output": "1. No acute findings in the abdomen or pelvis.\n2. Diffuse wall thickening and submucosal edema of the distal esophagus, which\nis most likely related to recent vomiting.\n3. Mild anasarca." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN: The unenhanced liver, gallbladder, adrenal glands, and spleen are\nunremarkable. Mild soft tissue stranding is seen surrounding the kidneys,\nsimilar to the prior exam. There is no hydronephrosis.\n\nThe spleen appears atrophic, some prior. There is no intestinal obstruction. \nFew scattered colonic diverticula are noted. The appendix demonstrates\nalthough round contrast and appears unremarkable.\n\nNo abdominal or pelvic adenopathy.\n\nPELVIS: Small amount of nonspecific fluid is seen in the deep pelvis, as on\nprior.\n\nNo aggressive osseous lesions.", "output": "1. No acute findings. No intestinal obstruction or free air.\n2. Trace pelvic free-fluid, as on prior." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Mild thickening of the distal\nesophagus is noted with small amount of edema.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic duct\ndilatation with top normal common bile duct measuring 6 mm. The gallbladder\nis within normal limits. The main portal vein, SMV and splenic vein are\npatent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized however no\nsecondary signs of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Small amount of hyperdensity within the left lower\npelvis represents vessels within the seminal vesicle. The prostate and\nseminal vesicles are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process to explain patient's symptoms.\n2. Mild intrahepatic biliary duct dilatation with top normal CBD may be\nphysiologic in this patient.\n3. Mild edema of the distal esophagus can be seen in the setting of\nesophagitis.\n\nRECOMMENDATION(S): Correlation with clinical and laboratory data is\nrecommended to assess for biliary obstruction." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. Slightly prominent central intrahepatic and\ncommon bile duct to 5 mm is similar to prior. The gallbladder is within normal\nlimits.\n\nPANCREAS: Pancreas is atrophic likely related to history of type 1 diabetes. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. Perinephric\nfat stranding may be related to mild flu overload.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The distended urinary bladder and distal ureters are unremarkable. \nMild free pelvic fluid may also represent sequela of mild flu overload.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal pathology.\n2. Unchanged mild prominence of the central intrahepatic and common bile duct." }, { "input": "LOWER CHEST: The moderate sized pericardial effusion with complex density,\nunchanged in size. Redemonstration of small, bilateral pleural effusions,\nsimilar in size to prior. Additionally, there is dependent atelectasis at the\nright lung base, similar in appearance to prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation.\n\nSPLEEN: Overall similar degree of splenomegaly, measuring up to 19 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Redemonstration of\nseveral nonobstructive 1-2 mm stones in the lower pole of the right kidney. \nThere is no suspicious renal lesions within the limitations of an unenhanced\nscan. There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Enteric catheter is seen coursing through the stomach with\ntip in a post pyloric position, likely in D1. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. A left lower quadrant end\ncolostomy is redemonstrated. The remainder of the visualized colon is\nunremarkable.\n\nPERITONEUM: There is a partially visualized heterogeneous fluid collection\nextending from the left paracolic gutter to the midline pelvis. Once again,\nthis collection contains several locules of air of unclear clinical\nsignificance. There appears to have been mild-to-moderate interval decrease\nin size of the visualized portions of this collection compared to the prior\nexam, for example, the AP dimension the collection in the left pericolic\ngutter measures 2.5 cm on current exam, compared with 3.6 cm on prior (2:58\ncompared with 2:58). However, please note that the larger pocket within the\npelvis is not imaged on current exam and cannot be assessed for interval\nchange. A abdominal wall, large bore drainage catheter is partially\nvisualized positioned within this fluid collection.\n\nAgain, there is diffuse mesenteric fat stranding and edema with a trace amount\nfree fluid around the mesentery and right pericolic gutter. No additional\ndrainable fluid collections are seen.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. No atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Left lower quadrant colostomy and left abdominal wall drain, as\ndescribed above.", "output": "1. Mild to moderate interval decrease in size of the visualized portions of\nthe heterogeneous left paracolic gutter collection. Please note that a\nsignificant portion of this collection is also located in the pelvis, which is\nnot imaged on current exam.\n2. Stable to minimally enlarged pericardial effusion with complex fluid\ndensity suggesting hemorrhagic component.\n3. Similar appearance of diffuse mesenteric fat stranding and edema, with\ntrace free fluid. No additional drainable fluid collections.\n4. Stable splenomegaly.\n5. Small bilateral pleural effusions with right lung base atelectasis, similar\nto prior.\n6. Nonobstructive right renal nephrolithiasis.\n\nRECOMMENDATION(S): Imaging of the pelvis would probably be needed to assess\nthe main port of collection." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Coronary calcifications are\nseen.\n\n___\n\nHEPATOBILIARY: Liver demonstrates heterogeneous enhancement, possibly related\nto the timing of injections and less likely due to infiltrative disease or\ndiffuse fibrosis. Previously demonstrated multiple hypodensities within the\nliver are not well seen on today's exam. 1.2 cm hypodensity in segment IV of\nthe liver is better assessed on prior exam from ___. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Compared to ___, there has been interval development of hydronephrosis on the\nright kidney. There is decreased enhancement and decreased excretion of the\nright kidney. However, the enhancement of the right kidney is uniform. \nMultiple hypodensities in bilateral kidneys are likely simple cysts, the\nlargest measuring up to 2.5 cm. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS:\nPatient is status post prostatectomy. There is asymmetric thickening of the\nposterior wall of the bladder with extension of the soft tissue enhancement\nalong the left suture line. The right hydronephrosis continues distally\nthroughout the course of the ureter measuring up to 1.5 cm, concerning for\ndistal obstruction near the right UVJ. There is no free fluid in the pelvis.\n\nLYMPH NODES: There are multiple enlarged retroperitoneal lymph nodes in the\npara-aortic, aortocaval stations, measuring up to 1.0 cm (04:42, 43, 39). \nThere is a 7 mm enhancing lymph node adjacent to the left iliac artery,\nconcerning for metastatic disease.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval development of right hydronephrosis with hydroureter. Decreased\nenhancement and excretion of the right kidney compared to the left.\n2. Diffuse heterogeneous perfusion of the liver. Likely due to timing of\ninjection. Less likely due to diffuse infiltrative disease or fibrosis. US of\nthe liver is recommended for further evaluation.\n3. Infiltration of the posterior bladder wall and soft tissue extension along\nthe suture line, better assessed on prior MRI and concerning for metastatic\ndisease.\n\nRECOMMENDATION(S): US of the liver is recommended for further evaluation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:00 AM, 10 minutes after\ndiscovery of the findings.\n The impression and recommendation above was entered by Dr. ___ on\n___ at 11:47 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is absent. The right kidney is unremarkable in\nappearance without evidence of focal renal lesions or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Nodularity within the bilateral anterior abdominal wall is\nlikely due to injections. There is a large left lateral abdominal wall hernia\ncontaining fat and a nonobstructed loop of colon, which has increased in size\ncompared to the CT dated ___. There is a small amount of\nsurrounding subcutaneous fat stranding, which has overall decreased compared\nto the prior examination, but unclear whether it resolved in the interval, and\nfindings today are new..", "output": "1. Large left lateral abdominal wall hernia containing fat and a nonobstructed\nloop of colon, which has increased in size compared to ___. \nModerate amount of subcutaneous fat stranding, which has decreased compared to\nprior, however it is unclear if this reflects improvement or is new. \nCorrelate with site of pain.\n2. No other acute abnormalities within the abdomen or pelvis." }, { "input": "LOWER CHEST: There is bibasilar atelectasis without concerning focal\nconsolidation. There is a small left pleural effusion. Cardiac silhouette is\nmildly enlarged. There is no pericardial effusion. Right upper extremity PICC\ntip terminates in the region of the tricuspid valve.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is mildly shrunken, suggestive of possible underlying\ncirrhosis. There is no evidence of focal lesions within limitations of\nnoncontrast exam. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder shows gallbladder wall edema, although\nthis is not well visualized and is likely due to third spacing. There is\nmoderate to large volume, nonhemorrhagic ascites, most notable in the right\nabdomen and pelvis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Spleen is enlarged, measuring up to 16.6 cm in the craniocaudal\ndimension, without focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is an unchanged,\nhyperdense lesion in the lower pole of the left kidney, which measures\napproximately 1.0 cm and may represent hemorrhagic cyst. However, this is\nincompletely characterized. Otherwise, no concerning focal renal lesions\nwithin limitations of a noncontrast examination. There is no hydronephrosis. \nThere is a nonobstructing 2 mm renal calculus in the lower pole the right\nkidney. No left-sided nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Incidentally noted is a\nmoderately sized duodenal diverticulum. Small bowel loops demonstrate normal\ncaliber and wall thickness throughout. There is extensive diverticulosis\nwithout surrounding inflammation to suggest diverticulitis. The appendix is\nnormal.\n\nPELVIS: Urinary bladder is mostly decompressed with Foley catheter in situ.\n\nREPRODUCTIVE ORGANS: Prostate is mildly enlarged. Seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There are multiple prominent retroperitoneal and mesenteric lymph\nnodes, none of which are pathologically enlarged, likely reactive. There are\nprominent inguinal lymph nodes, which are also likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse soft tissue anasarca, likely due to patient's\nfluid status.", "output": "1. No acute findings identified within the abdomen or pelvis to explain\nobtundation and rising lactate.\n2. Mildly shrunken liver morphology, which may suggest underlying cirrhosis. \nNo focal liver lesions. Splenomegaly, measuring up to 16.6 cm. Moderate to\nlarge volume, nonhemorrhagic ascites, most notable in the right hemi abdomen\nand pelvis.\n3. Bibasilar atelectasis without concerning focal consolidation. Small left\npleural effusion.\n4. Mild cardiomegaly.\n5. Right upper extremity PICC tip terminates in the region of the tricuspid\nvalve, as on previous radiograph.\n6. Unchanged hyperdense lesion in the lower pole of the left kidney, measuring\napproximately 1.0 cm. This likely represents hemorrhagic cyst and can be\nfollowed on future imaging.\n7. Nonobstructing, 2 mm renal calculus in the lower pole the right kidney." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic in morphology, with nodular contour. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is moderate volume ascites. The gallbladder is collapsed,\nwith wall edema likely reflective of liver disease or ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows is enlarged, measuring 17.2 cm, with attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic bilaterally. A 1.0 cm hyperdense lesion in\nthe lower pole of the left kidney, and adjacent subcentimeter hyperdense\nlesion are unchanged. A 4 mm calculus in the lower pole of the right kidney\nis also unchanged. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. An enteric tube terminates in\nthe stomach. There is a duodenal diverticulum in the third portion of\nduodenum (4:78). Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Diverticulosis of the colon is noted, without evidence\nof wall thickening and fat stranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A right mid abdomen percutaneous drain terminates in the left\npelvis.", "output": "1. Cirrhotic liver, with splenomegaly and moderate to large volume ascites.\n2. A right percutaneous drain terminates in the left pelvis.\n3. Please refer to separate report of CT chest performed same day for\ndescription of thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. Of note, there is a moderate\nsized right nonhemorrhagic pleural effusion.\n\nThe visualized portion of the lower right pleura posteriorly demonstrates\nenhancing nodules, concerning for pleural metastases (series 3, image 52). In\nthe anterior right chest wall pleura is a necrotic appearing enhancing nodule\nmeasuring up to 6 x 1.2 cm (series 3, image 60). There is adjacent moderate\nright lower lung relaxation atelectasis. Numerous enhancing lymph nodes in\nthe epicardial fat have increased in number and size compared to the prior\nabdomen CT from ___ (e.g., series 3, image 80, 74, 82, 92).\n\nNo left pleural effusion or a pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous, irregular hypodense hepatic metastases with\nperipheral enhancement demonstrates central necrosis. Compared to ___, these have increased in number and size and some of these have coalesced\nwith adjacent metastases. For example, the largest metastasis in the hepatic\ndome now measures up to 8.3 x 7 cm on axial images, previously 6.1 x 5.9 cm\n(series 3, image 70) and up to 7.9 x 6.1 cm on coronal images, previously 5.9\nx 4.8 cm (series 601b, image 48).\n\nThe main, left, and right portal veins are patent. The left portal vein\nbranch supplying segment 2 is attenuated by an adjacent metastasis but patent\n(series 3, image 106). The hepatic veins are patent, although the middle\nhepatic vein is compressed and therefore attenuated by an adjacent metastasis\n(series 3, image 82).\n\nThere is extensive fat stranding and soft tissue density surrounding the\nceliac trunk, the common hepatic artery and the proximal SMA (e.g., series 3,\nimage 110, 111, 114).\n\nNo evidence of intrahepatic or extrahepatic biliary ductal dilation. The\ngallbladder is decompressed and within normal limits.\n\nPANCREAS: There is a lobulated heterogeneously enhancing pancreatic tail mass\nmeasuring up to 5.5 x 3.4 cm on axial images and 3.5 x 3.1 cm on coronal\nimages (series 3, image 110; series 601b, image 62), larger in size compared\nto the prior exam, previously 4.8 x 3.5 cm on axial images and 2.6 x 2.8 cm on\ncoronal images.\n\nThe pancreatic tail mass extends into the splenic hilum, focally narrowing the\nsplenic vein (series 3, image 105), unchanged. The fat plane between the mass\nand the splenic hilum is also obliterated, unchanged (series 3, image 110,\n114). The mass extends posteriorly into the left retroperitoneum, invading\nthe left anterior pararenal space with loss of the fat plane between the mass\nand the anterior aspect of the left upper renal pole (series 3, image 112 ;\nseries 601b, image 67). In addition, the mass and surrounding fat stranding\nextends into and likely invades the lateral limb of the left adrenal gland\nwhich is slightly thickened and ill-defined (series 601b, image 67 ; series 3,\nimage 112). The fat plane between the mass and the posterior stomach wall\nappears preserved.\n\nThere is a 6 mm hypoenhancing lesion adjacent to the dominant pancreatic tail\nmass, unchanged (series 3, image 117; series 601b, image 60). The remaining\nproximal pancreas including body, head, and uncinate process demonstrate\nnormal enhancement without evidence of a focal mass. No evidence of main\npancreatic ductal dilation. No pancreatic calcifications or peripancreatic\nfluid collections.\n\nThe peripancreatic vessels are patent without focal narrowing or evidence of\nthrombus. As above, the splenic vein at the hepatic hilum is attenuated by\nthe pancreatic tail mass but patent. The splenic artery is also encased by\nthe pancreatic tail mass and soft tissue stranding but is patent.\n\n PANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 5.5 x 3.4 cm\nLocation (head right of SMV, body left of SMV): body/tail\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nabsent\nBiliary tree abrupt cutoff with or without upstream dilatation: absent\n\nArterial evaluation\nSMA involvement: absent\nCeliac Axis involvement: absent\nCommon hepatic artery involvement: absent\n\nVariant anatomy: none\n\nVenous evaluation\nMPV involvement: absent\nSMV involvement: absent\n\nExtrapancreatic evaluation\nLiver lesions: suspicious\nPeritoneal or omental nodules: present\nAscites: present\nSuspicious lymph nodes: Para-aortic, aortocaval, porta hepatis.\nOther extrapancreatic disease (invasion of adjacent structures): present (loss\nof fat plane with the upper pole of the left kidney, probable invasion of the\nlateral limb of the left adrenal gland, loss of fat plane with the adjacent\nspleen at the hilum, potential spleen lesions).\n\nSPLEEN: The spleen is normal in size. A few small subcentimeter hypodensities\nin the spleen are more obvious on today's exam (e.g., series 3, image 107). \nRelative decreased enhancement in the inferior aspect of the spleen is also\nmore conspicuous (series 601b, image 62 ; series 3, image 111, 114).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA left lower pole exophytic simple cyst measures up to 4.8 cm (series 3, image\n143). Several left parapelvic cysts are demonstrated. Other bilateral renal\ncortical hypodensities are too small to accurately characterize on CT but\nstatistically most likely also cysts. As above, the fat plane between the\nanterior right upper renal pole cortex and the pancreatic tail mass and\nassociated fat stranding is obliterated. No evidence of renal stones or\nhydronephrosis. No right perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. No bowel obstruction or free air. No\ndrainable intra- abdominal fluid collections.\n\nPELVIS: The urinary bladder is partially distended and unremarkable. The\ndistal ureters are unremarkable. There is a small amount of free fluid in the\npelvis, minimally changed from the prior exam (series 3, image 20).\n\nREPRODUCTIVE ORGANS: The uterus is retroflexed. The endometrium is\nthickened, likely related to the phase of the patient's premenopausal status. \nNormal follicular activity is seen in the ovaries, including a left corpus\nluteum cyst.\n\nLYMPH NODES. PERITONEUM, OMENTUM:\nSeveral necrotic lymph nodes concerning for metastasis are demonstrated, more\nprominent (new necrosis) compared to the prior exam. Index example the\nlargest node includes a left paracaval necrotic lymph node measuring 1.7 x 1.3\ncm at the level of the left renal hilum, previously 1.5 x 1.2 cm and less more\nsolid (series 3, image 128). Adjacent smaller necrotic lymph nodes are\ndemonstrated, measuring under a cm. Several necrotic lymph nodes are also\nseen in the region of the hiatus. As above, there is nonspecific fat\nstranding at the hiatus as well as the origin of the celiac trunk and proximal\nSMA extending into the hepatic hilum.\n\nThere is diffuse omental fat stranding that is moderate, concerning for\nomental involvement. In addition, several small omental nodules are\nconcerning for omental metastatic soft tissue deposits (e.g. , series 3, image\n197 (measuring up to 9 mm), 193, 166). There is also nodular peritoneal\nenhancement and thickening under the right hemidiaphragm concerning for\nmetastasis ; adjacent necrotic lymph nodes are soft tissue masses are also\nseen in this region (series 601b, image 61, 59, 80).\n\nVASCULAR: No abdominal aortic aneurysm. No calcified atherosclerotic disease\nis noted. Peripancreatic vasculature is described under the pancreas section\nof this report. Hepatic vasculature is described under the hepatobiliary\nsection of this report.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. A\nwell-circumscribed 7-mm sclerotic lesion in the right femoral head is\nunchanged and likely a bone island (series 601b, image 47). Other smaller\nsimilar subcentimeter sclerotic lesions in the right acetabulum are also bone\nislands. Left curvature of the lumbar spine is mild.\n\nSOFT TISSUES: A fat-containing umbilical hernia is mild. A small enhancing\n4-mm nodule in the umbilicus is nonspecific (series 3, image 155; series 602b,\nimage 85).", "output": "1. Interval disease progression as demonstrated by increase in size of the\nhypoenhancing pancreatic tail mass measuring up to 5.5 x 3.4 cm, increased\nsize and number of numerous hepatic metastases, slightly larger and more\nnecrotic lymph nodes particularly in the left para-aortic station, more\nconspicuous omental and peritoneal involvement, probable splenic involvement,\nand new pleural disease as above.\n2. Persistent effacement of the fat plane between the pancreatic tail mass and\nthe splenic hilum as well as upper pole of the left kidney and likely invasion\nof the lateral limb of the left adrenal gland.\n3. Mild focal narrowing of the left splenic vein by the pancreatic tail mass,\nunchanged.\n4. Nonspecific fat stranding surrounding the celiac trunk, proximal SMA,\nextending into the hepatic hilum, overall unchanged.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 18:34 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: There is partially visualized right hilar lymphadenopathy\nmeasuring up to 5.2 x 3.5 cm. Soft tissue nodularity/atelectasis is also seen\nat the right lung base posteriorly. There is moderate background\ncentrilobular emphysema.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 2.3 x 1.3 cm left adrenal nodule which was not seen\npreviously in ___. The right adrenal appears unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fiducial seeds are again visualized within the prostate\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: A 2.3 x 2.0 cm sclerotic lesion in the right femoral head is unchanged\ncompared to previous.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval development of right hilar adenopathy and a left adrenal nodule,\nconcerning for new metastatic disease vs new lung primary malignancy.\n2. Stable sclerotic lesion in the right femoral head.\n\nRECOMMENDATION(S): A CT scan of the chest is recommend further for evaluation\nof hilar lymphadenopathy.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:10 ___, 15 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSmall hypodensity within the left kidney are too small to characterize, likely\na simple cyst (2; 34). There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is marked\nwall thickening of the proximal to mid sigmoid colon surrounding a hyperdense\ninflammed diverticula. Adjacent to the diverticula are a few punctate foci of\nextraluminal gas concerning for microperforation (2; 67, 69). There is\nprominent surrounding pericolonic fat stranding. No evidence of gross\ndrainable fluid collection. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of intermediate-density free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. A corpus luteum is seen in the right ovary.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Sigmoid diverticulitis with concern for microperforation; a few adjacent\npunctate foci of gas concerning for microperforation with surrounding\nmesenteric fat stranding and free fluid in the pelvis. No drainable fluid\ncollection." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Background hepatic morphology is normal. There is no evidence\nof focal liver lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is distended with a small amount of\ngallbladder wall edema, and mild surrounding hyperemia seen in the hepatic\nparenchyma, findings concerning for acute cholecystitis. No radiopaque\ncalculi are seen. No intra or extrahepatic biliary dilatation is present.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the interpolar aspect of the left kidney is too\nsmall to fully characterize, likely a cyst. There is no evidence of\nconcerning focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Scattered\ndiverticulosis is seen in the visualized colon without evidence of acute\ndiverticulitis. Otherwise, the colon and rectum are within normal limits. \nThe appendix is not visualized.\n\nPELVIS: The urinary bladder appears to demonstrate concentric wall thickening,\npossibly due to decompressed state. There is no distal hydroureter. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nsclerotic focus in the L4 vertebrae is likely bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Distended gallbladder with small amount of gallbladder wall edema and\nhyperemia in the adjacent hepatic parenchyma, findings concerning for acute\ncholecystitis. No biliary dilatation." }, { "input": "LOWER CHEST: There is moderate bibasilar atelectasis. Visualized lung fields\nare otherwise within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver parenchyma homogeneous. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas appears atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Mild splenomegaly, measuring approximately 14.0 cm (601:41). The\nspleen shows normal attenuation throughout, without evidence of focal lesions.\nA splenule is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a simple cyst in the left upper pole measuring 2.2 x 2.4 x 3.0 cm, as\nwell as multiple subcentimeter hypodensities throughout the bilateral kidneys,\nwhich are too small to characterize on CT though likely simple renal cysts. \nThere is no evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is diffuse\nthickening of the colonic wall involving the ascending and transverse colon,\nas well as adjacent pericolonic fat stranding most notably in the right upper\nquadrant at the hepatic flexure (02:35, 601:22), suggestive of colitis. There\nis no extraluminal air or focal drainable fluid collection. There are\nscattered diverticula noted throughout the colon. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative changes noted throughout the thoracolumbar\nspine, most notably including narrowed disc space at L5-S1 with anterior\nosteophytosis, disc space narrowing with vacuum disc phenomenon at L2-L3, and\nbridging anterior osteophytosis in the lower thoracic spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Diffuse thickening of the ascending and transverse colonic walls, with\nadjacent inflammatory fat stranding most notable at the hepatic flexure,\nhighly suggestive of colitis. There is no extraluminal air or focal drainable\nfluid collection.\nMild splenomegaly, unchanged.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:45 pm, approximately 5\nminutes after discovery of the findings." }, { "input": "Heart size is enlarged. There is bibasilar atelectasis with mosaic attenuation\nlikely secondary to submaximal inspiration. 7 mm nodule in the right lower\nlobe is stable from the prior study. 4 mm nodule in the left lower lobe is\nstable from the prior exam. Smooth septal thickening is noted diffusely in\nthe lung bases compatible with pulmonary edema.\n\nCT abdomen with contrast: There is a stable 4 mm hypodensity in the right lobe\nof the liver, too small to fully characterize but likely a cyst. The remainder\nof the liver enhances homogeneously without worrisome focal lesion, intra or\nextrahepatic biliary ductal dilatation. The portal vein is patent. The\ngallbladder is unremarkable. The spleen, pancreas and adrenal glands are\nunremarkable. 1.9 cm intermediate density lesion of the left lower pole kidney\nhas increased since the prior examination where it measured 9 mm. A 6 mm\nhypodense lesion of the right lower pole kidney is too small to characterize\nbut likely represents a cyst. The kidneys otherwise present symmetric\nnephrograms and excretion of contrast without hydronephrosis or perinephric\nabnormality.\n\nThe stomach, duodenum and remainder of the small bowel is unremarkable without\nevidence of obstruction. The large bowel is thin-walled and unremarkable.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment.\nThere is no mesenteric or retroperitoneal lymphadenopathy. There is no\nascites, pneumoperitoneum or abdominal wall hernia.\n\nCT pelvis with contrast: The bladder, prostate, seminal vesicles and rectum\nare unremarkable. There is no inguinal or pelvic sidewall lymphadenopathy.\nThere is no free pelvic fluid or air.\n\nOsseous structures: There is no suspicious focal osseous lesion. There is a\nburst type vertebral fracture of the L1 vertebral body mild height loss\ninvolving the anterior and middle columns without retropulsion. There is\nadjacent prevertebral hematoma at this level. The pelvic ring is intact. No\nother fracture is identified.", "output": "1. Burst fracture of the L1 vertebral body involving the anterior and middle\ncolumns without significant retropulsion.\n2. No solid organ injuries.\n3. Stable bilateral lower low lung nodules measuring up to 7 mm on the right.\n4. 1.9 cm intermediate density cystic lesion of the left lower pole kidney may\nrepresent a proteinaceous or hemorrhagic cyst but should be further evaluated\nby non urgent ultrasound.\n5. Pulmonary edema." }, { "input": "LOWER CHEST: A 5 mm pulmonary nodule in right lower lobe (series 2, image 5)\nis unchanged from prior exam on ___ and is compatible with a\nbenign etiology. There is no evidence of pleural or pericardial effusion. \nPatient is status post mitral valvular replacement.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Punctate foci of calcifications/nonobstructive calculi are seen in\nthe upper pole of the left kidney (series 2, image 26). There is no\nhydronephrosis. A 2.4 cm simple cyst is seen in lower pole of the left\nkidney.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Again seen is compression fracture deformity of L1, unchanged. There\nare new compression fracture deformity of L2 and L3, of indeterminate age.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Punctate foci of calcifications/nonobstructive calculi are seen in the\nupper pole of the left kidney with no hydronephrosis.\n2. Compression fracture deformities of the L2 and L3 vertebral bodies are new\nfrom prior exam but are of indeterminate age. Unchanged compression deformity\nof the L1 vertebral body.\n3. No acute fracture or dislocation of either hip.\n4. No hematoma in the abdomen or pelvis." }, { "input": "LOWER THORAX: The lung bases are clear. No pleural or pericardial effusion.\n\nHEPATOBILIARY: 16 mm hemangioma in segment 7. Again noted is dilatation of the\nextrahepatic common bile duct measuring up to 14 mm. The gallbladder is\ncollapsed but appears grossly unremarkable.\n\nPANCREAS: Hypodense lesion within the pancreatic head adjacent to the second\nstage of the duodenum measuring 8 mm (axial series 3, image 66), which may\nhave a linear connection to the main pancreatic duct and possible T2\nhyperintense correlate on prior MRCP. 13 mm hypodense lesion in the\npancreatic head, corresponding to cystic lesion on MRCP. No pancreatic\ncalcification, duct dilatation, or parenchymal atrophy.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis. Subcentimeter cyst\narising from the upper pole of the right kidney. Unremarkable bladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are\nnormal in caliber. Normal appendix.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Periportal lymph node measuring 15 mm. Asymmetric left inguinal\nand pelvic adenopathy measuring up to 10 mm.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Unremarkable.\n\nVASCULAR: There is abnormal early filling with contrast of the left femoral\nand common femoral vein, suggestive of arteriovenous fistula, likely at the\nlevel of small tributary branches (axial series 3, image 181; coronal series\n601, image 47). There is soft tissue stranding and expansion of the greater\nsaphenous vein as well as within the imaged portions of the femoral and common\nfemoral vein consistent with known DVT. No abdominal aortic aneurysm. No\natherosclerotic calcification.\n\nBONES: Spinal fixation hardware is noted from L4-S1 with grade 1\nanterolisthesis of L4 on L5. No suspicious osseous lesion.\n\nSOFT TISSUES: There is edema involving the soft tissues of the left thigh. \nFoci of gas within the right anterior soft tissues of the abdominal wall,\nlikely sites of subcutaneous injection.", "output": "1. 8 mm hypodense lesion within the head of the pancreas adjacent to the\nsecond stage of the duodenum with possible T2 hyperintense correlate on prior\nMRCP. This may represent a small side branch IPMN or sequelae of prior\npancreatitis, however given ill definition and lack of definite discrete MRI\ncorrelate, further evaluation with endoscopic ultrasound is recommended.\n2. 13 mm hypodense lesion within the head of the pancreas, as identified on\nprior MRCP and may represent a small side branch IPMN or walled-off necrosis.\n3. Early contrast filling of the left femoral and common femoral vein\nsuggestive of arteriovenous fistula, likely between small tributary arterial\nand venous branches. Persistent filling defect within the left greater\nsaphenous, left femoral, and left common femoral veins consistent with known\nDVT, with associated soft tissue swelling and left inguinal/pelvic adenopathy.\n4. Dilated extrahepatic common bile duct, unchanged from MRCP.\n\nRECOMMENDATION(S): Further evaluation with endoscopic ultrasound is\nrecommended to evaluate 8 mm ill-defined lesion within the head of the\npancreas." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Diffuse hypoattenuation liver is consistent with steatosis. \nUnchanged 1.6 cm hemangioma in segment 7. No intrahepatic biliary dilation. \nMild extrahepatic biliary dilation is similar prior. Gallbladder is within\nnormal limits.\n\nPANCREAS: Pancreas is normal attenuation throughout. Unchanged 0.9 cm and 1.2\ncm hypodense lesions in the pancreatic head. No peripancreatic stranding or\nmain pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic lymphadenopathy. Prominent left inguinal nodes are not\npathologically enlarged.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted. Early filling of the left common femoral\nvein is again noted and suggestive of an arteriovenous fistula.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPosterior spinal fusion hardware extending from L4 through S1 is noted. \nUnchanged grade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: Subcutaneous areas of soft tissue attenuation with foci gas in\nthe adjacent fat stranding likely reflect sites of subcutaneous injections.", "output": "1. No acute intra-abdominal process. No CT evidence of acute pancreatitis.\n2. 2 hypodense lesions within pancreatic head are unchanged from prior exam\nand may represent sequela of prior pancreatitis and/or side-branch IPMN.\n3. Hepatic steatosis.\n4. Unchanged hepatic hemangioma.\n5. Redemonstration of early filling of the left common femoral vein suggestive\nof an arteriovenous fistula." }, { "input": "LOWER CHEST: Mild dependent subsegmental atelectasis. Visualized lungs and\npleural spaces are otherwise clear.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There has been interval development of a complex cystic lesion\nwithin the head of the pancreas measuring 6.1 x 5.7 x 5.7 cm. There is\nincreased density along the right wall is likely hemorrhage though enhancing\ntissue cannot be completely excluded.. The lesion is primarily exophytic from\nthe head of the pancreas, with mass effect displacing some pancreatic tissue\nposteriorly in the uncinate process medially. It displaces the duodenum\nslightly to the right. There is slight peripancreatic stranding about the\nlesion and duodenal wall edema. It contacts the antrum and pylorus.. The\npancreatic duct is again at the upper limits of normal and only minimally\nincreased from ___. The duct within the neck is seen immediately\nadjacent to the lesion and it is possible that the duct is communicating with\nit, though this is not certain. The pancreatic parenchyma within the upstream\nneck, body, and tail appear normal. There are multiple small surrounding\nlymph nodes.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is increased in diameter up to\n8 mm where as on prior it was 6 mm. Does not fill with contrast and there is\nfluid within the appendix with borderline appendiceal wall thickening and\nslight indistinctness of the serosa of the appendix though no clear\nperiappendiceal stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. There is a stent noted within the left common iliac vein with a\nsmall amount of surrounding fluid and gas compatible with recent procedure\nwith stent placement.\n\nBONES: Stable postsurgical change related to spinal fusion L4 through S1\nwithout hardware complication. No fracture or suspicious osseous lesion.\n\nSOFT TISSUES: Mild stranding within the left groin compatible with vascular\naccess. Tiny fat containing right inguinal hernia. Subcutaneous stranding\ninvolving the ventral abdominal wall with a small amount of subcutaneous gas\non the right compatible with subcutaneous medication administration.", "output": "1. 6.1 cm complex cystic lesion within and exophytic from the head of the\npancreas with likely a small amount of hemorrhage and mild surrounding\ninflammatory change. This could represent a subacute collection from recent\npancreatitis developing into a pseudocyst that recently bled. The pancreatic\nduct may be connected to this collection as is not significantly dilated or if\nthe hemorrhage acutely enlarged it the pancreatic duct may not have had time\nto dilate.\n2. Expected postprocedural change related to recent placement of left common\niliac vein stent without gross complication. Patency of the stent cannot be\nevaluated on this study.\n3. Mildly lay dilated appendix up to 8 mm with borderline wall thickening and\nserosal indistinctness but not definite periappendiceal stranding. This could\nrepresent early acute appendicitis and correlation with physical exam is\nrecommended with follow-up imaging as needed.\n\nNOTIFICATION: The findings regarding the appendix were discussed by ___\n___ by telephone with ___ at 16:17 on ___, 15 minutes\nafter they were discovered." }, { "input": "LOWER CHEST: Small bilateral pleural effusions with associated compressive\natelectasis are slightly worsened from prior. Lingular atelectasis is stable.\nNo pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nPortions of the hepatic dome were not imaged. Within this limitation, there\nare no suspicious focal liver lesions. There is no intra-or extra-hepatic\nbiliary ductal dilatation. There is vicarious excretion of contrast media\nwithin the gallbladder. The main portal vein appears patent.\n\nPANCREAS: The pancreas is markedly enlarged and edematous with severe\nperipancreatic stranding. Main duct does not appear dilated on limited\nassessment. These findings have overall progressed in comparison to ___. The gland enhances homogeneously without evidence of necrosis. There\nare no organized peripancreatic fluid collections.\n\nSPLEEN: Spleen demonstrates normal size and attenuation throughout. There are\nno focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the distal stomach. There is\nno small bowel obstruction. There is diffuse colonic wall thickening along\nthe mesenteric aspect of the colon likely secondary to an inflammatory\nresponse related to the patient's underlying pancreatitis (05:30). The\nanti-mesenteric aspect of the large bowel is not involved. The appendix is\nnot visualized. Trace fluid and peritoneal stranding is seen tracking along\nthe left greater than right lateral conal fascia into the pelvis.\n\nPELVIS: The urinary bladder is decompressed around a Foley catheter. Distal\nureters are normal. Simple density fluid seen tracking into the pelvis.\n\nREPRODUCTIVE ORGANS: Endometrial stripe is mildly thickened measuring 6 mm. \nThe uterus is otherwise unremarkable. No adnexal abnormalities are\nidentified.\n\nLYMPH NODES: There are scattered reactive periportal and peripancreatic nodes.\nNo retroperitoneal or mesenteric lymphadenopathy. No pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild to moderate calcified\natherosclerotic plaque.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild body wall edema.", "output": "1. Severe interstitial edematous pancreatitis, markedly progressed in\ncomparison to ___. There is no evidence of necrosis or organizing\nfluid collections.\n2. Diffuse colonic wall edema along the mesenteric aspect of the colon is most\nlikely secondary to inflammation from pancreatitis.\n3. Small volume free fluid tracks along the lateral conal fascia into the\npelvis with peritoneal stranding along the left lateral conal fascia.\n4. Enlarged endometrial stripe measuring 6 mm. This finding should be further\nevaluated with a non-emergent pelvic ultrasound." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Similar to the prior study, there is extensive fat stranding\nsurrounding the pancreas, which appears to enhance uniformly, consistent with\nacute interstitial edematous pancreatitis. There is no organized\nperipancreatic fluid collection. Extensive fat stranding extends through the\nroot of the mesentery and in the left pericolic gutter, similar to the prior\nstudy. There is no evidence of venous thrombosis or arterial pseudoaneurysm.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable, containing a well-positioned\nenteric tube. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Colon is filled with oral contrast from the study\nof ___, otherwise unremarkable. A rectal tube is in place. The\nappendix is not visualized.\n\nPELVIS: Urinary bladder is decompressed around a Foley catheter. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is similar mild thickening of the endometrial\nstripe. The uterus is otherwise unremarkable. There is no adnexal\nabnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous emphysema within the right lower quadrant\nsubcutaneous fat is consistent with post injection changes (305:74). There is\nmild anasarca.", "output": "1. Unchanged severe acute interstitial edematous pancreatitis without evidence\nof parenchymal necrosis, acute peripancreatic fluid collection, or vascular\ncomplication.\n2. Similar mild thickening of the endometrial stripe, which can be further\nevaluated by nonemergent pelvic ultrasound.\n3. Please see the separately submitted report of the same day CT Chest for\nfindings above the diaphragm.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:35 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized however no\nsecondary signs acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted.\n\nSOFT TISSUES: Subtle fat stranding within the left anterior subcutaneous\ntissues are consistent with injection granulomas (20:106). The abdominal and\npelvic wall is otherwise within normal limits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nLUMBAR SPINE:\nNo acute fracture. There is minimal retrolisthesis of L5 on S1. Alignment is\notherwise within normal limits. No acute fracture. Limited evaluation of the\nspinal cord due to CT scanning however no large mass identified. There is\nmultilevel degenerative changes of the lumbar spine with anterior osteophytes,\nendplate sclerosis and disc space narrowing most notable at L3-L4 and L4-L5,\nworst at L4-L5.\n\nT12-L1: Small posterior foraminal disc bulge causing mild right neural\nforaminal narrowing (20:70). No high grade spinal canal narrowing.\nL1-L2: Small posterior disc bulge mild bilateral facet hypertrophy causing\nmild bilateral neural foraminal narrowing and mild spinal canal narrowing at\nthis level. (20:70).\nL2-L3: Small posterior disc bulge with bilateral facet hypertrophy causing\nmild spinal neural foraminal narrowing (20: 76)\nL3-L4:: Severe disc space narrowing with moderate foraminal disc bulge\nbilaterally with moderate right and mild left facet hypertrophy causing\nmoderate right and mild left neural foraminal narrowing. There is mild spinal\ncanal narrowing at this level. (20: 83).\nL4-L5: Severe disc space narrowing with moderate bilateral disc bulge and mild\nbilateral facet hypertrophy causing moderate right and mild left neural\nforaminal narrowing. (20:89).\nL5-S1: No spinal canal or neural foraminal narrowing at this level.", "output": "1. Multilevel degenerative changes of the lumbar spine most notable at L3-L4\nand L4-L5, as described in detail above.\n2. No evidence of malignancy within the abdomen or pelvis.\n3. Please refer to separate CT chest for findings regarding the thorax." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Hypodense lesions in the head of the pancreas (2:63, 2:64) could be\ncysts or IPMNs. Otherwise, the pancreas has normal attenuation throughout,\nwithout evidence of pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: A hypodense lesion of the inferior spleen (2:60) is too small to\ncharacterize. Otherwise, the spleen shows normal size and attenuation\nthroughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A subcentimeter hypodensity of the lower pole of the right kidney is\ntoo small to characterize, but statistically likely a cyst. Unchanged\nperirenal fat stranding. The kidneys are of normal and symmetric size with\nnormal nephrogram. There is no evidence of hydronephrosis.\n\nGASTROINTESTINAL: The NG tube terminates in the stomach. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Sigmoid diverticulosis, without evidence of\ndiverticulitis. Otherwise, the colon and rectum are within normal limits. No\nevidence of bowel obstruction, pneumoperitoneum, or perforation. The appendix\nis not visualized.\n\nPELVIS: A Foley catheter is in place. The urinary bladder and distal ureters\nare unremarkable. Trace pelvic fluid.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Unchanged multilevel degenerative changes of the thoracolumbar spine. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small areas of fat stranding in the anterior abdominal fat,\nprobably sequela of injections. Otherwise, the abdominal and pelvic wall is\nwithin normal limits.", "output": "1. No acute process in the abdomen or pelvis. No evidence of abscess, bowel\nperforation, obstruction, or ileus.\n2. Hypodense lesions in the head of the pancreas could be cysts or IPMNs.\n3. Please refer to the separate report of the chest CT performed on the same\nday for thoracic characterization." }, { "input": "LOWER CHEST: There is a 3 mm pulmonary nodule in the right lower lobe (series\n2, image 4). There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsub cm hypodensity in segment 7 is too small to characterize but likely\nrepresents a simple cyst. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is moderate hydronephrosis on the right. The left kidney is\nsurgically absent. A 3.6 cm hypodensity in the upper pole the right kidney is\nconsistent with a simple cyst. A 2.1 cm hypodensity in the lower pole the\nright kidney is consistent a simple cyst.\n\nGASTROINTESTINAL: The stomach is unremarkable. The visualized small loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncecum and terminal ileum has been surgically separated from the ascending\ncolon and re- purposed as the patient's neobladder. The appendix is not\nvisualized.\n\nPELVIS: The dilated right ureter terminates in the patient's neobladder which\nconsists of a short segment of small bowel and the repositioned cecum. There\nis no free fluid in the pelvis. Periurethral, penile and scrotal soft tissue\nis poorly evaluated on this noncontrast study.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nheterogeneous, largely lucent lesion in the inferior aspect of the L4\nvertebral body is not changed from ___. Severe pubic diastasis is\nunchanged. Bilateral subchondral sclerosis and cystic changes are noted at\nthe sacroiliac joints, bilaterally.\n\nSOFT TISSUES: A ventral hernia in the mid pelvis contains a single loop of\nsmall bowel (series 2, image 52).", "output": "1. Moderate hydronephrosis is unchanged from ___. No radiopaque\nstone is seen.\n2. The patient's neobladder, as well as periurethral, penile and scrotal soft\ntissue are poorly evaluated on this non-contrast study.\n3. Marked pubic diastasis is unchanged." }, { "input": "LOWER CHEST: Small bilateral pleural effusions are noted, slightly larger on\nthe left, with associated passive atelectatic change.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and dysmorphic in nature compatible with\nthe known underlying cirrhosis. In segment 4B of the liver, adjacent to the\nfalciform ligament there is a 1.4 cm arterially enhancing lesion with subtle\nwashout seen on more delayed images. No definite pseudo capsule is seen. It\ndoes not meet OPTN criteria for HCC, but is highly suspicious, and close\nevaluation on follow-up is recommended.\n\nThere are numerous hypodensities seen within the liver. The largest is in\nsegment ___ measuring 6.5 x 5.7 cm and measures fluid density with partial\nperipheral calcification. This is compatible with a rim calcified cyst, query\nprior treated echinococcal disease or complicated cyst. The other lesions are\ntoo small to confidently characterize on the current examination, however had\nbeen previously thought to represent cysts on recent ultrasound. Given the\nunderlying chronic liver disease, continued follow-up is recommended, which\nshould initially be performed with MRI for additional characterization of\nthese lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.\n\nThe gallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nSmall to moderate amount of ascites is noted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged measuring up to 16.4 cm. A 5 mm hypodensity is\nnoted at the posterior aspect of the spleen, nonspecific but likely\nrepresenting a small hemangioma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are three renal arteries bilaterally. There are bilateral millimetric\nhypodensities seen too small to confidently characterize but statistically\nrepresenting small cysts. There are no suspicious renal lesions identified. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is prominent arterial enhancement in the region of the\nmucosa noted at the level of the gastric antrum, query mucosal\nhyperenhancement versus tortuous arterial vessels. This may correspond to the\nprovided clinical history of GAVE. Please correlate with recent endoscopic\nfindings.\n\n9 x 4 mm focus of vascular enhancement noted at the mid left jejunal loop(3a: \n84) which persists throughout all post contrast phases and is most prominant\non portovenous phase. This likely represents focal vascular anomaly, possibly\na small varix given is portal venous phase prominence.\n\nWithin 5 cm of this first lesion there is an equivocal smaller focus of\nenhancement with similar characteristics measuring 3-4 mm. This may represent\na second smaller vascular anomaly of the same nature, again possibly small\nvarix.\n\nNo other definite areas of small bowel vascular abnormalities or malformations\nare identified on the current examination. Remainder of the visualized small\nand large bowel loops are unremarkable.\n\nPELVIS: Patient is status post prostatectomy. Remnant seminal vesicles are\nunremarkable. The bladder is well distended with soft tissue thickening at\nthe posterior aspect of the bladder, near the insertion of the ureters. There\nis bilateral prominence and mild hydroureter seen.\n\nThere is a small amount free fluid noted in the pelvis.\n\nSOFT TISSUES: There are bilateral fat containing inguinal hernia seen, with\nsmall amount of fluid tracking into the hernia sac on the left. Small fat\ncontaining umbilical hernia is noted.\n\nLYMPH NODES: There are few prominent porta hepatis and peripancreatic lymph\nnodes seen, likely reactive. No definite pathologic lymphadenopathy is seen. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.", "output": "1. Prominent arterial enhancement noted at the level of the gastric antrum,\nquery mucosal hyperenhancement versus arterial vessels. This may correspond to\nthe provided clinical history of GAVE. Please correlate with recent\nendoscopic findings.\n\n2. Additional smaller foci of vascular enhancement noted at the mid left\njejunal loops as detailed above, with persistent enhancement throughout all\npost contrast phases and appearing most conspicuous on portovenous phases. \nThese likely represent small vascular anomalies, possibly small varices.\n\n3. 1.4 cm arterially enhancing lesion with washout in segment 4 B of the\nliver, with no definite pseudo capsule. It does not currently meet OPTN\ncriteria but will require close follow-up. In addition, multiple hypodense\nhepatic lesions are seen, most of which are incompletely characterized. They\nshould be reassessed at the time of the patient's further follow-up\nexamination which should be performed with MRI for additional characterization\nof these hepatic lesions.\n\n4. Asymmetric posterior bladder and trigone wall thickening with associated\nmild bilateral hydroureter. The patient is status post prostatectomy in these\nchanges may be post treatment in nature or secondary to over distension of the\nbladder, however correlation with cystoscopy should be considered to exclude\nany underlying bladder mass lesion at this level.\n\nRECOMMENDATION(S): 1. Follow up with Abdominal MRI for hepatic lesions\ndetailed above. 2. Consider correlation with cystoscopy for further\nevaluation of the posterior bladder and trigone area as above given bilateral\nureteral dilation." }, { "input": "LOWER CHEST: There is motion artifact limiting evaluation of the lungs. \nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion. The patient is status post median\nsternotomy, aortic valve replacement, and pacemaker placement.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThere is a nonobstructing gallstone within the gallbladder measuring 7 x 12\nmm, which has increased in size in comparison to the prior examination.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 1 x 1.2 cm right adrenal nodule, and a 1.3 x 1.8 cm left\nadrenal nodule, both of which are compatible with adrenal adenomas and are\nunchanged in comparison to the prior examination.\n\nURINARY: There are multiple cysts throughout the kidneys bilaterally. There\nare also multiple homogeneous hyperdensities bilaterally, the largest on the\nleft measuring approximately 2 x 3.3 cm with an average ___ density of\n74. There is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is a moderate amount of\ndiverticulosis without any evidence of diverticulitis. The colon and rectum\nare within normal limits. The appendix is not visualized.\n\nPELVIS: There is moderate bladder wall thickening, which is chronic and\nunchanged in comparison to the prior examination. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are bilateral hydroceles, left larger than right,\nthere are noted on the prior examination.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild degenerative changes throughout the thoracolumbar spine. The\npatient is status post laminectomy of L4 and L5 with grade 1 retrolisthesis of\nL5 on S1. The patient is status post left hip replacement causing streak\nartifact throughout the lower pelvis, but no evidence of hardware\ncomplication.\n\nSOFT TISSUES: There are bilateral fat containing inguinal hernias.", "output": "1. 2 x 3.3 cm hyperdense lesion in the left kidney within a background of\nmultiple bilateral renal cysts, which could represent a hemorrhagic or\nproteinaceous cyst versus a recurrence of renal cell carcinoma.\n2. Stable bilateral adrenal adenomas.\n3. Nonobstructing gallstone.\n4. Diverticulosis without diverticulitis.\n5. Stable chronic bladder wall thickening.\n6. Status post laminectomy of L4 and L5 with grade 1 retrolisthesis of L5 on\nS1.\n\nRECOMMENDATION(S): Ultrasound is recommended for further evaluation of the\nkidneys bilaterally.\n\nNOTIFICATION: Pertinent critical findings were posted by Dr. ___\n___ on ___ at 17:54 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The rim enhancing, centrally necrotic mass within hepatic\nsegment IV has significantly increased in size, currently measuring 7.3 x 4.8\nx 9.0 cm, previously measuring up to 4.9 cm. There is a new rim enhancing,\ncentrally necrotic metastatic lesion within segment VII measuring 2.3 cm\n(series 5, image 49). An additional new metastatic lesion is seen along the\nhepatic capsule in the medial right hepatic lobe (series 5, image 56). There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: Note is made of pancreas divisum. The pancreas has normal\nattenuation throughout, without evidence of focal lesions or pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The patient is status post right adrenalectomy. The left adrenal\ngland is normal in size and shape.\n\nURINARY: The patient is status post right nephrectomy. A 5 mm nodule within\nthe resection bed is unchanged compared to prior (series 5, image 75), either\npostsurgical or small lymph node. Multiple subcentimeter hypodensities are\nseen within the left kidney, too small to characterize, but unchanged and\nlikely representing cysts. There is no concerning lesions or hydronephrosis\nwithin the left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Radiodense\nstructures seen within the colon likely represent ingested pills. The colon\nand rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged. The seminal vesicles are\nsymmetric.\n\nLYMPH NODES AND PERITONEUM: There is a 1.8 cm rim enhancing peritoneal implant\nin the right anterior hemiabdomen, new compared to prior (series 5, image 72),\ncompatible with metastasis. There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted in the left iliac vessels.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\n1.3 cm well-marginated sclerotic lesion in the left ilium adjacent to the\nsacroiliac joint (series 5, image 96) is unchanged and likely represents a\nbone island.\n\nSOFT TISSUES: There are incisional changes along the right anterior\nhemiabdomen. Otherwise, the abdominal and pelvic wall is within normal\nlimits.", "output": "1. Interval progression of metastatic disease. Rim enhancing, centrally\nnecrotic mass within hepatic segment IV has significantly increased in size,\nnow measuring up to 9 cm. Two new metastases in segment VII and along the\nmedial capsule the right hepatic lobe.\n2. New metastatic peritoneal implant along the right anterior hemiabdomen.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen is an appearance of scalloping along the dome of the liver,\nslightly less prominent compared to prior exam. . A hypoenhancing lesion\nwithin or along the caudate lobe measures 3.8 x 2.4 cm previously 3.9 x 3.0 cm\n(3:43). The soft tissue lesion adjacent to the porta hepatis also appears\ndecreased in size measuring approximately 3.1 x 3.2 cm, previously 4.5 x 3.7\ncm (3:52). The hypoenhancing lesion adjacent to the falciform ligament now\nmeasures 1.5 x 1.9 cm, previously 1.5 x 2.2 cm (3:49). No new lesions are\nseen. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits. There is trace ascites\naround the liver, decreased from prior exam. The portal vein and its major\nbranches appear patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized. Omental\nthickening is less prominent compared to prior exam measuring up to 1.5 cm,\npreviously up to 3 cm (3:67). Soft tissue nodule along the anterior\nperitoneal surface (3:85) L smaller compared prior exam measuring\napproximately 1.15 0.4 cm, previously 1.1 x 1.0 cm.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis. The soft tissue mass surrounding\nthe uterus appears less prominent compared to prior exam. Measured in a\nsimilar location to the prior exam it now measures 5.7 x 3.3 cm, previously\n7.2 x 3.9 cm (3:96).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in size of dominant ill-defined pelvic mass.\n2. Interval decrease in size of multiple hypoenhancing lesions around the\nliver.\n3. Interval decrease in omental thickening and volume of ascites.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion. Central venous catheter is noted with the\ntip terminating in the right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is fatty and demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\nPANCREAS: Expected postoperative appearance status post Whipple, including a\nmild mesenteric stranding and prominent mesenteric lymph nodes, with interval\nremoval of the prior intra-abdominal surgical drains. The residual pancreas is\natrophic. No evidence of peripancreatic fluid collection.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Oral contrast extends to the level of the rectum without\nevidence of obstruction. Mild apparent wall thickening within several loops of\nsmall bowel may be reactive in the setting of recent abdominal surgery.\nAppendix is not visualized.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries. The mid portion of the\nSMV appears somewhat narrowed, though evaluation is limited secondary to an\nadjacent surgical clip.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions. Abdominal\nand pelvic wall is within normal limits.", "output": "1. No evidence of obstruction or other acute intra-abdominal process.\nNonvisualized appendix.\n2. Expected postoperative appearance of the abdomen status post Whipple\nprocedure.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged appearance of the segment 6 radiofrequency ablation\nzone. No residual enhancement is seen at this level. No evidence of tumor\nrecurrence.\n\nSimilarly, unchanged appearance of the segment 8 peripheral radiofrequency\nablation zone. Again, no residual enhancement or evidence of tumoral\nrecurrence is identified.\n\nThere are no new or suspicious hepatic lesions which demonstrate arterial\nenhancement and washout. There are multiple hepatic hypodensities compatible\nwith hepatic cysts.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 6 mm accessory splenule is seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cysts are seen. The largest on the right measures 4.5 cm. \nLargest on the left measures 3.4 cm. There are no suspicious renal lesions.\n\nGASTROINTESTINAL: The visualized small and large bowel loops are within normal\nlimits. There is no free fluid noted.\n\nLYMPH NODES: There is no size significant lymphadenopathy identified.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. S/p radiofrequency ablation of segment 8 and segment 6 as detailed above,\nwith no evidence of tumor recurrence at these levels.\n2. No new or suspicious hepatic lesions identified." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Two sites of prior RFA ablation in the posterior aspect of\nsegment VI (series 3A, image 47) and the periphery of segment VIII (series 3,\nimage 18) appear unchanged from ___ and without evidence of\nrecurrence. Geographic perfusion abnormalities on arterial phase imaging in\nsegment II and ___ appear unchanged from ___.\n\nA previously seen 2.0 x 1.6 cm arterially hyperenhancing lesion in the\nperiphery of segment VIII/IV does not have correlates on other phases of\nimaging and likely represents a perfusion abnormality (series 3A, image 22).\n\nAdditional arterially hyperenhancing lesions adjacent to the patient's site of\nprior ablation in segment VI (series 3A, image 43) and in segment V (series 3,\nimage 45) also do not have correlates on other phases of imaging and likely\nrepresent perfusion abnormalities.\n\nNumerous additional hypodensities measuring up to 4.0 cm in diameter are\nconsistent with simple hepatic cysts. A small peripherally calcified lesion in\nthe subdiaphragmatic space (601 B, image 59) likely represents a torsed\nepiploic appendage and is unchanged from ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A splenule is noted anterior to the spleen (Series\n3a, image 19).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Bilateral renal\nhypodensities measuring up to 4.8 cm are consistent with simple hepatic cysts.\nThere is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia, otherwise the stomach is unremarkable.\nVisualized small bowel loops demonstrate normal caliber and wall thickness. \nThe visualized colon is unremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes are noted in the visualized spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable appearance of RFA ablation zones without evidence of recurrence.\n2. Several foci of arterial hyperenhancement, as detailed above, do not\nappear to washout or have definite correlates on delayed phases of imaging and\nlikely represent perfusion abnormalities, however attention on followup is\nrecommended." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Bilateral breast implants,\npartially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodense lesion in segment VII (2; 12) is incompletely\ncharacterized, statistically likely a cyst or hemangioma. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Multiple surgical clips and sutures are noted\nadjacent to the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. 1.5 x 1.5 cm cyst is noted in the\nleft upper pole. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post ___ fundoplication. Evaluation of\nthe bowel loops is limited by motion. Within this limitation, small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. The appendix is not visualized\nbut no secondary signs of inflammation were noted in the right lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and bilateral\noophorectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of small-bowel obstruction. No fluid collection. No acute\nfindings to explain patient's abdominal pain." }, { "input": "The lung bases are clear. The included heart and pericardium are normal. \nThere are Bochdalek hernias bilaterally.\n\nThe liver enhances homogeneously. There is sub-cm hypodensity in the dome of\nthe liver, which is too small to characterize (2:12). The gallbladder is\nunremarkable and without radiopaque gallstones. There is no intra or\nextrahepatic biliary duct dilation. The portal vein is patent. The adrenal\nglands, pancreas, and spleen are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. The\nureters are normal in caliber along their course to the bladder. There are\nmultiple simple cysts in the right and left kidney. The largest is in the\nupper pole of the left kidney measuring 5.1 cm (2:70).\n\nAdditionally, there is a indeterminate 1.9 cm lesion in the midpole of the\nleft kidney which measures 90 ___ on this single phase CT (2:39).\n\nThe distal esophagus is normal without hiatal hernia. Oral contrast extends\nthroughout the large bowel. The small bowel is without wall thickening or mass\nlesion.\n\nThere is wall thickening of the sigmoid colon and mild pericolonic fat\nstranding in the region of multiple diverticula, consistent with\ndiverticulitis. There is no drainable fluid collection or extraluminal air.\n\nThere is minimal atherosclerotic disease of the abdominal or aorta, which is\nwithout aneurysmal dilation. The abdominal aorta and its major branches are\npatent. There are small retroperitoneal periaortic lymph nodes, but none that\nare pathologically enlarged. There is no abdominal free fluid. There is a\nsmall fat containing umbilical hernia.\n\nPELVIS:\n\nThe bladder is well distended and normal in appearance. There are 4.5 cm and\n1.9 cm right and left simple adnexal cysts, respectively. The uterus and left\novary are unremarkable. There is no pelvic sidewall or inguinal\nlymphadenopathy. There are prominent gonadal veins bilaterally.\n\nOsseous structures: There are degenerative changes of the lumbar spine with\ndisc space narrowing and endplate sclerosis most pronounced at the L4-5 level.\nThere are no concerning lytic or sclerotic bone lesions.", "output": "1. Uncomplicated sigmoid diverticulitis. No drainable fluid collection.\nColonoscopy is recommended after the acute episode of diverticulitis has\nresolved to ensure no underlying lesion.\n\n2. 4.5 cm and 1.9 cm simple right and left simple adnexal cysts which are\nabnormal in a postmenopausal woman, pelvic ultrasound is recommended for\nfurther evaluation.\n\n3. 1.9 cm worrisome exophytic lesion in the midpole of the left kidney which\ncannot be fully characterized on this single phase CT, MRI is recommended for\nfurther evaluation.\n\nNOTIFICATION: A preliminary report was provided by Dr. ___ the\ntelephone on ___ at 19:40 and ___, 40 minutes after findings\nwere made. Additional findings were emailed to Dr. ___ by Dr. ___ on\n___ at 1700, 3 hours after findings were made." }, { "input": "LOWER CHEST: Lingular atelectasis. There are trace pleural effusions. \nCoronary artery calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Vicarious excretion of contrast within\nthe gallbladder lumen is related to recent contrast-enhanced CT from ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There are areas of peripheral capsular surface\nsplenic calcifications. Linear area of high attenuation along the capsular\nsurface of the spleen may represent blood products or soft tissue, better seen\non CT ___, similar, measuring 0.9 cm in maximum thickness.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral renal parenchymal atrophy. A 7.8 cm simple cyst arises\nfrom the lower pole the left kidney. Small right renal cyst. No\nhydronephrosis. . There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mildly dilated\nascending, transverse colon, measuring 7.5 cm in maximum diameter, with\ngradual transition to normal caliber descending colon. Rectosigmoid are or\nnormal caliber. Distal, terminal ileum are normal caliber. There is no free\nair\n\nPELVIS: A Foley catheter is identified within the urinary bladder. Small\nvolume free pelvic fluid.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Patient is status EVAR of the infrarenal abdominal aortic aneurysm. \nThere is a periaortic abnormality measuring approximately 19 x 32 mm (03:49)\nat, similar. Moderate to severe atherosclerotic disease is noted. \nPostoperative changes right groin, with small volume blood products,\npostsurgical.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPaget's disease of left innominate bone, left sacral ala, involving\nacetabulum, pubic bone, superior, inferior pubic rami, iliac bone. Multilevel\ndegenerative changes of the visualized spine.\n\nSOFT TISSUES: There is a small fat containing periumbilical hernia. Bilateral\nfat only containing inguinal hernias, with small volume fluid within right\ninguinal hernia.", "output": "1. Mildly dilated ascending, transverse colon, measuring 7.5 cm in maximum\ndiameter, with gradual transition to normal caliber descending colon about\nsplenic flexure, consistent with adynamic ileus. No small bowel dilatation.\n2. No secondary signs of bowel ischemia.\n3. Stable periaortic abnormality consistent with hematoma." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Mild bilateral\npleural effusions, partially loculated on the left, has increased since prior\non both sides. There is minimal dependent atelectasis. Coronary artery\ncalcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Scattered peripheral calcifications are unchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 6.1 cm\nexophytic simple cyst at the lower pole of the left kidney. Subcentimeter\nhypodensities in both kidneys are too small to accurately characterize but\nlikely represent cysts. There is no hydronephrosis or nephrolithiasis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal. Multiple round hyperdense structures\nscattered throughout the colon likely represent ingested material.\n\nPELVIS: Small amount of air within the dependent portion of the urinary\nbladder. There is no free fluid in the pelvis. The prostate gland is\nenlarged and impresses upon the dome of the urinary bladder.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Again seen a distal aortic stent graft in place as well as a stent\nthat extends into the right common iliac artery. There is slight interval\nincrease in size of the rounded abnormality along the left lateral aspect of\nthe distal aorta, now measuring 6.3 cm x 5.6 cm x 5.5 cm, compared with 6.0 cm\nx 5.7 cm x 5.5 cm on ___. It extends beyond the aorta, and there\nis 2.2 cm separation between the spine and aorta. This is been gradually\nincreasing in size since ___. Abnormality is well-circumscribed,\nand while it may represent low-grade aortic leak, lymphoma should be\nconsidered. Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nPaget's disease of left left hemipelvis stable.\n Multilevel\ndegenerative changes of the visualized spine.\n\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias, right greater than\nleft.There is a small fat containing periumbilical hernia.", "output": "1. Slight interval increase in size of left para-aortic, retroaortic\nwell-circumscribed abnormality of intermediate density, located at the distal\naortic stent graft. While finding may represent slow aortic leak, lymphoma\nshould be considered.\n2. Small bilateral pleural effusions, increased since prior.\n3. Small amount of intravesicular air may be related to prior instrumentation.\nIf bladder instrumentation was not performed, consider infection, bladder\nenteric fistula." }, { "input": "VASCULAR: There is extensive calcified and noncalcified thrombus in the\nvisualized aorta with a focal outpouching of contrast material (measuring\napproximately 8 mm AP x 10 mm craniocaudal x 8 mm transverse in the lower\nabdominal aorta (___), with surrounding hypodensity and stranding\nposteriorly, spanning an area of 4.3 x 1.6 cm concerning for a contained\nrupture. Extensive atherosclerotic disease is noted with severe narrowing of\nthe bilateral common femoral arteries. Atherosclerotic changes at the origin\nof the bilateral renal arteries. Narrowing at the origin celiac artery, which\nis patent.\n\nLUNG BASES: Respiratory motion limits evaluation of fine pulmonary nodules. \nNo pleural effusion. No pericardial effusion. Heart size is normal. \nExtensive atherosclerotic calcification of the RCA.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: Fatty atrophy of the pancreas. No evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: There are few punctate calcifications in the posterior aspect of the\nspleen (___). There is soft tissue density layering along the lateral and\nposterior aspects of the spleen, indeterminate.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The bilateral kidneys are atrophic with multiple subcentimeter\nhypodense lesions, too small to characterize. There is a large simple cyst\narising from the lower pole of the left kidney, and which measures\napproximately 8 cm. The kidneys are of normal and symmetric size with normal\nnephrogram. No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Multiple layering rounded calcific\ndensities in the colon, likely pills or food contents. The colon and rectum\nare otherwise within normal limits. The appendix is normal.\n\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nBONES: Pagetoid change of the osseous left hemipelvis, likely representing\nPaget's disease. Extensive multilevel degenerative changes of the imaged\nspine. No acute fractures. Unchanged 1.2 cm lytic focus in the right ilium\n(___).\n\nSOFT TISSUES: Small fat containing bilateral, right greater than left,\ninguinal hernias. Small umbilical hernia. The abdominal and pelvic wall is\notherwise within normal limits.", "output": "1. There is extensive calcified and the irregular noncalcified thrombus in the\nvisualized aorta with a focal outpouching of contrast material in the lower\nabdominal aorta, with surrounding hypodensity, measuring up to 4.3 x 1.6 cm\nconcerning for a contained rupture.\n2. Extensive atherosclerotic disease is noted with severe narrowing of the\nbilateral common femoral arteries.\n3. Unchanged extensive mixed lytic and sclerotic foci of the right ilium and\nacetabulum, indeterminate.\n4. There is indeterminate perisplenic soft tissue density layering along the\nlateral and posterior aspects of the spleen, unclear whether hematoma or soft\ntissue.\n5. Pagetoid change of the osseous left hemipelvis, likely representing Paget's\ndisease.\n\nNOTIFICATION: The above findings were communicated to the vascular surgery\nteam by ___, moments after the scan was acquired." }, { "input": "LOWER CHEST: There is a moderate right pleural effusion and small left pleural\neffusion with consolidation at the bases.\n\nABDOMEN: The unenhanced liver, spleen, adrenal glands and pancreas are\nunremarkable. Gallbladder is surgically absent.\n2.6 cm exophytic cyst is again noted arising from the upper pole of the right\nkidney. There is no renal parenchymal calculus. Note is made of a 4 mm\nhyperdensity along the left posterior urinary bladder at the left UVJ\ncorresponding to the echogenic focus seen on ultrasound. There is no\nhydroureter or hydronephrosis.\n\nGASTROINTESTINAL: There is no intestinal obstruction. There is small volume\nascites. Moderate diffuse retroperitoneal edema and mesenteric induration.\n\nPELVIS: The uterus and adnexa are unremarkable on CT for age.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes are visualized.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are\ndemonstrated. There is diffuse soft tissue edema.", "output": "1. 4 mm calcification at the left UVJ likely a small calculus. No significant\nhydronephrosis.\n2. Bilateral pleural effusions, small volume ascites and diffuse edema,\npossibly related to third spacing." }, { "input": "LOWER CHEST: Please see dedicated chest CT dictation for further evaluation of\nthe chest.\n\nABDOMEN: The study is limited for evaluation of the parenchyma and visceral\norgans due to lack of IV contrast.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly with the spleen measuring 13 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Right upper\npole renal cyst measures 2.5 cm. Right peripelvic cysts are re-demonstrated\nmeasuring up to 1.6 cm. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Splenomegaly.\n3. Renal cysts.\n4. Additional findings above.\n Please see dedicated chest CT dictation for further evaluation of the chest." }, { "input": "LOWER CHEST: Partially visualized ill-defined nodular consolidation in the\nright middle lobe and a nodular focal consolidation in the anterior left lower\nlobe are concerning for pneumonia. Moderate bilateral pleural effusions,\nright greater than left, are noted. The heart is enlarged. There is a small\npericardial effusion. Extensive coronary artery calcifications are partially\nvisualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent. Trace ascites is likely\nsecondary to fluid overload.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is top normal in size and there is an unchanged nonspecific\n14 mm hypodense lesion at the inferior splenic tip, unchanged from prior\nexamination, and could represent a cyst or hemangioma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Multiple renal\nhypodensities bilaterally measure up to 2.4 cm in the upper pole of the right\nkidney compatible with simple cysts. A 7 mm hyperdense lesion in the right\nkidney likely reflects a hemorrhagic cyst and was seen previously. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are\nunremarkable. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Trace free\nfluid in the pelvis is likely due to fluid overload. No evidence of\nretroperitoneal bleed.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Concentric calcifications of the splenic artery is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative changes of the spine a bilateral hips noted.\n\nSOFT TISSUES: Diffuse anasarca is noted.", "output": "1. Partially visualized nodular opacities in the right middle lobe and\nconsolidation in the left lower lobe concerning for multifocal pneumonia.\n2. Partially visualized moderate pleural effusions, right greater than left.\n3. No evidence of abdominopelvic hemorrhage.\n4. Findings suggestive of anemia.\n5. Diffuse anasarca.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:17 pm, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions, larger on the left,\nand adjacent bibasilar atelectasis. There is moderate cardiomegaly. Dense\nmitral annular calcifications are partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild central intrahepatic biliary\nductal prominence is noted without common bile duct dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreatic neck and head appear normal in attenuation without\nfocal lesion. The pancreatic body and tail are markedly atrophic, as seen\npreviously. Main pancreatic duct does not appear dilated There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post left nephrectomy. The right kidney is of\nnormal size and displays normal nephrogram. A subcentimeter cortical\nhypodensity is too small to characterize, however likely represents a simple\ncyst. There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are fluid-filled loops\nof mildly prominent small bowel in the left upper quadrant suggestive of a\nnonspecific enteritis. The cecum, while not well distended, demonstrates mild\nmucosal hyper enhancement and wall thickening, also suggestive of inflammation\nor infection (2:40). Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding. There is marked fecal\nimpaction in the rectum which is massively dilated without evidence for wall\nthickening (2:62). The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: A partially visualized marked compression deformity of the T11\nvertebral body with approximately 5 mm retropulsion of the posterior aspect of\nthe vertebral body into the canal is new compared with ___, of\nindeterminate age. There is mild grade 1 anterolisthesis of L3 on L4, stable.\nThere is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Calcifications in the bilateral posterior soft tissues\noverlying the gluteal regions are similar to prior and likely represent\ninjection site granulomas. The abdominal and pelvic wall is otherwise within\nnormal limits.", "output": "1. Prominent, fluid-filled loops of small bowel in the left upper quadrant and\nmild wall thickening and mucosal hyperemia involving the cecum, suggestive of\nan inflammatory or infectious enterocolitis.\n2. Massively dilated rectum due to fecal impaction.\n3. Diverticulosis, with no evidence of acute diverticulitis.\n4. Small bilateral pleural effusions, larger on the left, with compressive\nbibasilar atelectasis.\n5. Age indeterminate marked compression deformity of the T11 vertebral body\nwith approximately 5 mm retropulsion of the posterior aspect of the vertebral\nbody into the central canal, new compared with ___. Recommend\ncorrelation with pain and neurologic symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Right adrenal nodule is unchanged from ___ and has\nbeen previously characterized as an adenoma. The left adrenal gland is\nnormal.\n\nURINARY: Cortical thinning and hypodensity in the inferior aspect of the left\nkidney (03:28) is grossly unchanged from ___ compatible with\nchronic infarct. There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: Evaluation of bowel loops in the pelvis is severely limited\nby beam artifact. The stomach is unremarkable. There is no gross abnormality\nin the small or large bowel. The appendix not\n\nPELVIS: Diagnostic evaluation of the bladder and distal ureters is very\nlimited due to metal artifact.\n\nREPRODUCTIVE ORGANS: Evaluation of the prostate is limited due to metal\nartifact.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Bilateral hip prosthesis are noted. Multilevel degenerative changes\nare noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Limited evaluation of the pelvis due to the beam hardening artifact from\nbilateral hip prosthesis, bu there is no evidence of acute abnormality in the\nabdomen and pelvis to explain patient's reported symptoms." }, { "input": "LOWER CHEST: Trace left greater than right dependent atelectasis is noted. \nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a tiny hypodense lesion in the dome of segment VII\n(02:11) which is too small to characterize. The liver otherwise demonstrates\nhomogenous attenuation throughout. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Cortical thinning of the bilateral kidneys again noted as well as a\nwedge-shaped hypodensity in the inferior aspect of the left kidney measuring\nup to 1.5 cm (02:27) is unchanged dating back to CT ___ and\nlikely represents a chronic infarct. There is no hydronephrosis or\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is colonic\ndiverticulosis without evidence of diverticulitis. . The appendix is normal.\n\nPELVIS: There is limited evaluation of the bladder and pelvis due to beam\nhardening artifact from bilateral hip prosthesis.\n\nREPRODUCTIVE ORGANS: There is limited evaluation of the prostate due to beam\nhardening artifact, but the prostate does not look enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Stents are noted in the bilateral common and external iliac\narteries. The bilateral internal iliac arteries appear diminutive.\n\nBONES: Multilevel degenerative changes are noted. Bilateral hip prosthesis\nare noted.\n\nSOFT TISSUES: There are bilateral fat containing inguinal hernias.", "output": "1. No acute abnormality in the abdomen or pelvis.\n2. Extensive atherosclerotic disease.\n3. Chronic infarct of the inferior left kidney is unchanged.\n4. Colonic diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nFixation hardware noted from L4-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No imaging findings to explain the patient's hematocrit drop." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged appearance of cirrhotic liver morphology. A 1.8 x\n1.6 cm segment II/III lesion demonstrates arterial hyper enhancement and\nwashout on portal venous and delayed phases (06:23). This is unchanged from\nfindings on most recent MR liver performed ___ and meets OPTN 5A\ncriteria for hepatocellular carcinoma.\n\nAn indeterminate 8 mm segment V lesion demonstrates arterial hyper enhancement\nwithout evidence of washout or pseudo capsule formation on delayed or portal\nvenous imaging (06:33). This is unchanged in size compared to prior MR\nperformed ___.\n\n___ additional suspicious hepatic lesions are identified. There is ___ evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is ___ peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple small bilateral renal hypodensities are most consistent with renal\ncysts as seen on prior MR. ___ hydronephrosis. There is ___ perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is ___\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are within normal\nlimits.\n\nLYMPH NODES: There is ___ retroperitoneal or mesenteric lymphadenopathy. There\nis ___ pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is ___ abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. There is early bifurcation of the common hepatic artery\napproximately 3 cm from its takeoff from the aorta (06:40). The right hepatic\nartery courses posterior to the portal vein. The left hepatic artery is of\nnormal configuration coursing anterior to the portal vein and supplying the\nleft hepatic lobe. Accessory right hepatic vein measures 4 mm and supplies\nsegment ___ (9:178).\n\nBONES: Mild degenerative changes of the bilateral acetabulofemoral joints,\nright greater than left. There is ___ evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 1.8 cm segment II/III lesion is unchanged compared to MR dated ___\nand meets OPTN 5A criteria for hepatocellular carcinoma.\n2. Indeterminate 8 mm segment V lesion is unchanged compared to prior MR. ___\nother suspicious hepatic lesions are identified.\n3. ___ evidence of metastatic disease in the abdomen or pelvis.\n4. Variant vascular anatomy with early bifurcation of the common hepatic\nartery and coursing of the replaced right hepatic artery posterior to the\nportal vein. Accessory hepatic vein measuring 4 mm\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "There is mild linear left basilar atelectasis/ scarring. No pleural effusion\nis seen.\n\nAbdomen: The unenhanced appearance of the liver, spleen, pancreas, and adrenal\nglands is normal. There is no hydronephrosis or renal stone. Along the medial\nedge of the liver, there is a 2.8 x 1.0 cm ovoid structure with internal\ncalcification most consistent with a collapsed gallbladder with stones within.\nThe common bile duct is top-normal in diameter. Correlate with LFTs. The\nabdominal aorta appears normal in course and caliber. The stomach is\nrelatively collapsed. No bowel obstruction or bowel wall thickening is seen.\nThere is colonic diverticulosis.\n\nPelvis: The appendix is seen in the right lower quadrant and is normal no\nbowel obstruction or bowel wall thickening is seen. No calculus is seen along\nthe expected course of the ureters or within the bladder. The bladder is\nunremarkable and thin-walled. No free fluid or free air is seen. No\nlymphadenopathy is identified.\n\nBones: No concerning osteoblastic or lytic lesion is seen.", "output": "No hydronephrosis or renal/ureteral stone.\n\nCollapsed gallbladder containing gallstones. Top-normal common bile duct\ndiameter. Correlate with LFTs .\n\nColonic diverticulosis without evidence of acute diverticulitis on this\nnoncontrast enhanced study." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable. Mild nodularity of the\nleft adrenal gland is unchanged from prior.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically. No\nobstructing radiopaque stones are identified. Compared to prior, there has\nbeen resolution of right-sided hydronephrosis. There is mild dilation of the\nmid left ureter with adjacent stranding (series 5, image 46). There are no\nsuspicious renal masses. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Focal dilation and stranding surrounding the mid left ureter, possibly\nrepresenting focal ureteritis. If symptoms persist an MR ___ can be\nconsidered to further characterize of this region.\n2. No obstructing renal stones. Resolution of right hydronephrosis.\n3. No evidence of intra-abdominal abscess.\n\nRECOMMENDATION(S): Please see discussion above regarding MR ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThere is a irregular gallbladder wall thickening, pericholecystic stranding,\nmucosal hyper enhancement, distention, and 2 large, peripherally calcified\ngallstones, likely corresponding to the palpated right upper quadrant mass.\n\nAdjacent hypo enhancing liver parenchyma is likely related to reactive edema. \nNo focal liver lesions or intrahepatic biliary ductal dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes are seen from prior inguinal hernia repair.", "output": "Large stones in a distended gallbladder with irregular wall thickening,\nmucosal hyper enhancement, and pericholecystic stranding. Irregular wall\nthickening and adjacent liver parenchymal changes are concerning for\ngallbladder carcinoma. Given the patient's abdominal pain and fever, chronic\ncholecystitis is an additional differential consideration.\n\nRECOMMENDATION(S): Surgical consultation for cholecystectomy is recommended.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 4:46 ___, 20 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Lung bases appear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrate diffuse hepatic steatosis with regions of\nsparing. The liver is otherwise unremarkable. No biliary dilatation. The\ngallbladder is surgically absent. Stable appearance of fat necrosis\nat the surgical resection bed.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable.\n\nGASTROINTESTINAL: No bowel obstruction or ascites.\n\nPELVIS: The uterus and bilateral adnexae are within normal limits. An\nurethral diverticulum is noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: No aggressive osseous lesions.\n\nSOFT TISSUES: Rectus diastasis is again noted. Similar minimal nodularity\nalong the right upper quadrant incision scar.", "output": "The etiology of pain is not elucidated. No findings of metastatic disease in\nthe abdomen or pelvis." }, { "input": "Lung bases are clear. The heart is normal in size without\npericardial effusion.\n\nCT OF THE ABDOMEN: Probable focal fat in the medial left liver near the\nfissure for the ligamentum teres. No intrahepatic or extrahepatic biliary\nductal dilatation. No focal liver masses. The gallbladder is collapsed,\nquestion postprandial state. The portal vein and branches are patent. The\nhepatic veins appear patent as well. No upper abdominal ascites. The spleen\nis normal in size and opacification. The pancreas is unremarkable. No\nperipancreatic inflammatory changes or main pancreatic ductal dilatation. The\nadrenal glands are unremarkable bilaterally. Preserved enhancement and\nexcretion of both kidneys without hydronephrosis or hydroureter. No focal\nrenal masses are seen. No significant retroperitoneal fluid collections or\nadenopathy. The abdominal aorta is normal in caliber and opacification. \nProximal branch vessels normally opacify. Single bilateral renal arteries are\npatent.\n\nThe stomach, duodenum, small bowel loops are normal in caliber and wall\nthickness. No mesenteric edema, significant adenopathy, or free air. No\npneumatosis. Portions of the left colon are collapsed. Normal air-filled\nappendix in the right lower quadrant measuring up to 5.5 mm. No adjacent\ninflammatory changes.\n\nCT OF THE PELVIS WITH CONTRAST: Urinary bladder is unremarkable. Ureteral\njets are seen bilaterally. Distal ureters are normal in opacification. \nSeminal vesicles are symmetric. The prostate gland contains coarse\ncalcifications centrally. Rectosigmoid is underdistended with suggestion of\nfocal diverticula. No evidence of diverticulitis. No significant pelvic or\ninguinal adenopathy. Overlying soft tissues appear preserved.\n\nNo destructive osseous lesions.", "output": "No acute pathology to account for patient's symptomatology. Few sigmoid\ndiverticula without diverticulitis." }, { "input": "THORAX: The lung bases are clear. The visualized heart and pericardium are\nwithin normal limits.\n\nLIVER: The liver is normal in size and attenuation. The portal vein is\npatent. There is no intra or extrahepatic biliary ductal dilatation. No focal\nhepatic lesions are identified.\n\nGALLBLADDER: The patient is status post cholecystectomy with clips in the\ngallbladder fossa.\n\nSPLEEN: The spleen is normal in size and attenuation.\n\nPANCREAS: The pancreas is normal with no evidence of peripancreatic fat\nstranding or pancreatic lesion.\n\nADRENALS: The adrenal glands are normal bilaterally.\n\nKIDNEYS: The kidneys are normal in short no evidence of hydronephrosis or\nsuspicious mass lesion. Note is made of a 2.7 x 3.2 cm simple cyst in the\nlower pole of the left kidney.\n\nBOWEL: Visualized loops of large and small bowel are within normal limits.\n\nVESSELS: The visualized abdominal aorta is not aneurysmal and its major\nbranches appear patent. Of note, the common hepatic artery arises directly\nfrom the aorta.\n\nLYMPH NODES: Note is made of a few prominent aortocaval lymph nodes without\npathologic enlargement. There is no pathologic mesenteric lymphadenopathy.\n\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: Suspicious lytic or sclerotic lesions\nidentified. Note is made of soft tissue calcifications along the right\nbuttocks (series 5, image 45.) there is moderate degenerative change of the\nthoracolumbar spine.", "output": "No evidence of viscus perforation, pancreatitis or biliary ductal dilation.\n\nProminent aortocaval lymph nodes without pathologic enlargement." }, { "input": "Please see separate report for findings within the chest.\n\nABDOMEN:\n\nAssessment of the solid visceral structures of the abdomen and pelvis is\nlimited without IV contrast.\n\nAllowing for the non-contrast-enhanced technique, the liver demonstrates\nhomogeneous attenuation without focal lesion. There is no intra or\nextrahepatic bile duct dilation. The gallbladder has a thin wall, and is\nwithout radiopaque stones. The pancreas demonstrates normal bulk without\nductal dilation. There is no focal splenic lesion or splenomegaly. There is\ncalcification of the splenic capsule (2:63).\n\nThe right adrenal gland is not well seen, and may have been surgically\nremoved. The left adrenal gland is normal. The patient is status post right\nnephrectomy. There is no mass in the surgical bed. The left kidney is without\nstones or hydronephrosis. There is a stable simple cyst. No solid lesions\nare identified, however evaluation is limited by lack of intravenous contrast.\n\nThere is no abnormal small bowel dilation. The large bowel is normal in\ncaliber. There is diffuse diverticulosis without evidence of acute\ninflammation. The appendix is normal.\n\nPELVIS:\n\nProstate and seminal vesicles are grossly unremarkable, allowing for limits of\nassessment by CT technique.\n\nThe bladder is nondistended, limiting assessment for mass.\n\nMUSCULOSKELETAL:\n\nThere is no concerning destructive osseous lesion.", "output": "Evaluation limited by lack of intravenous contrast. No evidence of local\nrecurrence or metastatic disease. Please see separate report for findings\nwithin the chest." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nNumerous small hepatic hypodensities are incompletely characterize, but\nunchanged from the prior examination and likely represent cysts versus biliary\nhamartomas. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Calcifications are noted within the prostate gland. The urinary\nbladder and distal ureters are unremarkable. There is no free fluid in the\npelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. A venous collateral vessel is noted in subcutaneous tissues\nalong the right trunk. The abdominal and pelvic wall is otherwise within\nnormal limits.", "output": "No evidence for nodal or distant/osseous metastatic disease within the imaged\nabdomen and pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: IUD appears in appropriate position within the uterus. \nNo adnexal abnormalities.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process. Appendix is normal." }, { "input": "The lung bases are clear. Limited imaging of the heart reveals no pericardial\neffusion or cardiomegaly.\n\nCT ABDOMEN: The liver enhances homogeneously. There are no focal liver\nlesions. The portal and hepatic veins are patent. There is no intra or\nextrahepatic biliary dilatation. The gallbladder shows slightly hyperdense\nlayering potentially stones or sludge. The pancreas enhances homogeneously.\nThe spleen and adrenal glands are normal.\n\nOn the unenhanced study, there at least 4 punctate calculi in the mid to lower\npole of the right kidney measuring 1-2 mm. A hyperdense pyramid in the\ninterpolar region of the right kidney (601b:29) may represent medullary\ncalcinosis. The kidneys enhance and excrete contrast promptly. There are no\nconcerning renal lesions. There is mild fullness of the left renal pelvis\nwithout hydroureteronephrosis. A punctate density at the left ureterovesicular\njunction measures 2 mm.\n\nThere is no retroperitoneal or abdominal adenopathy. No free air or free fluid\nis present. The aorta and its major branches are patent and not dilated. The\nstomach and intra-abdominal loops of bowel are normal caliber and appearance. \nThe appendix is visualized in the right lower quadrant, which appears normal.\n\nCT PELVIS: The remainder of the bowel is normal. The bladder is normal. An\nIUD is within the retroflexed uterus. The bilateral adnexa are within normal\nlimits. There is no free pelvic fluid. There is no inguinal or pelvic\nadenopathy.\n\n OSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesion\nidentified.", "output": "1. 2 mm left ureterovesicular junction calculus with no hydroureteronephrosis\nbut minimal fullness of the left renal pelvis.\n2. Nonobstructing bilateral nephrolithiasis.\n3. Normal appendix." }, { "input": "LOWER CHEST: There is severe emphysema. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is mild thickening of the left adrenal gland. The right\nadrenal gland is not well visualized.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder is decompressed. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post bilateral salpingo\noophorectomy. The uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of acute fracture. Sclerotic lesions are seen in\nthe pelvis. In the left iliac bone a spiculated lesion is seen measuring up\nto 1 cm, and in the left ischium a rounded lesion is seen measuring 0.6 cm (3;\n82, 107).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Sclerotic lesions in the pelvis may represent foci of metastatic disease,\nrecommend comparison to prior CT if available or a bone scan can be considered\nfor further evaluation.\n2. No other evidence of acute abnormality in the abdomen or pelvis.\n3. Please see the separate report for the same day CT chest for intrathoracic\nfindings.\n\nRECOMMENDATION(S): Sclerotic lesions in the pelvis may represent foci of\nmetastatic disease, recommend comparison to prior CT if available or a bone\nscan can be considered for further evaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:55 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "CHEST: Limited assessment of the lung bases demonstrates bilateral lung\natelectasis. Visualized heart is mildly enlarged. No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening. The hepatic veins, and main\nportal vein are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: Bilateral stable hypodense lesions measuring 0.8 (3: 51) (previously\n0.8 cm) and 1.3 cm (3: 43) (previously 1.2 cm) within the right and left upper\nrenal poles bilaterally. Additional subcentimeter hypodense lesions\nbilaterally are too small to characterize. Symmetric nephrograms and size. No\nhydronephrosis or obstructing renal calculi. No perinephric stranding or fluid\ncollection.\n\nGI: A small hiatal hernia seen. The stomach is decompressed. The small\nbowel, and colon are within normal limits without mucosal hyper enhancement,\nfat stranding, focal mass lesion, or obstruction. Few sigmoid diverticula seen\nwithout evidence of acute diverticulitis. The appendix is not visualized\nhowever no evidence of acute appendicitis. No ascites or free intraperitoneal\nair. A small right greater than left fat containing inguinal hernias are seen\nbilaterally. No additional abdominal wall hernias.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric lymph\nnode enlargement.\n\nPELVIS: A small left anterior bladder diverticulum is unchanged since ___ (3: 121) The urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.. There is\nno free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: No focal lytic or sclerotic lesions concerning for\nmalignancy. Stable mild anterolisthesis of L5 on S1. Diffuse osteopenia and\ndegenerative changes noted throughout the thoracolumbar spine.\n\nCTA: Patient is status post aortobiiliac stent graft placement. The large\nthrombosed infrarenal aortic aneurysm has mildly decreased is size now\nmeasuring 4.5 cm x 4.8 cm (453:2) with a maximal diameter of 4.9 cm (453:3)\n(previously 5.4 cm). Peripheral rim calcifications are again seen in the\nwall. No evidence of dissection, rupture, or endoleak. Hyperdense focus\nwithin the anterior right and inferior left excluded sac is also seen on\nnoncontrast images and represents calcification (3: 76, 92 respectively). \nThe SMA and renal arteries are patent. Stenosis at the origin of the patent\nceliac trunk without post stenotic dilatation is unchanged since previous\nexamination (602b:41). Heavy calcifications seen throughout the common iliac\narteries. The common femoral arteries, external iliac, and internal iliac\narteries are patent.", "output": "1. Status post aortobiiliac stent graft for a 4.9 cm infrarenal abdominal\naortic aneurysm without evidence of dissection, rupture, or endoleak. The\naneurysm sac has slightly decreased in size compared to prior study. Please\nrefer to imaging lab for previous comparisons and additional measurements.\n2. Moderate to severe atherosclerotic disease involving the aorta.\n3. No change in stenosis of the proximal segment of the patent celiac axis\nwithout post stenotic dilatation." }, { "input": "LOWER CHEST: There are small, simple appearing bilateral pleural effusions. \nThere is no pericardial effusion. There is multifocal consolidation in the\nright lower lobe and left lower lobe, which is consistent with multifocal\npneumonia. There is bronchiectasis and focal scarring in the partially\nvisualized right middle lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. Layering hyperdense material within the\ngallbladder may represent sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There are multiple areas of peripheral hypoattenuation in the spleen,\nwhich are consistent with splenic infarcts.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a small peripheral wedge-shaped hypodensity in the\ninterpolar region of the right kidney, which is concerning for a renal\ninfarct. The left kidney demonstrates a 4 mm hypodense lesion in inferior\npole, which is too small to characterize. The bladder is decompressed around\na Foley catheter. Several foci of air within the bladder are most likely\nsecondary to catheterization.\n\nGASTROINTESTINAL: The enteric tube terminates in the antrum of the stomach. \nSmall and bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding. Small areas of hyperdense\nmaterial in the colon most likely represent oral contrast or ingested\nmaterial. The appendix is normal. There is a small amount of ascites in the\nabdomen.\n\nOTHER: There is no free fluid or air in the abdomen or pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. A right femoral arterial line is noted.\n\nBONES: There are mild multilevel degenerative changes of the visualized\nthoracolumbar spine, mild anterior wedging of L3 is likely chronic.\n\nSOFT TISSUES: There is moderate anasarca.", "output": "1. Multiple peripheral hypodensities in the spleen, which are consistent with\nsplenic infarcts.\n2. Small right renal infarct.\n3. Volume overload with small bilateral pleural effusions, small amount of\nascites, and moderate anasarca.\n4. Multifocal pneumonia in the bilateral lower lobes, which has progressed\ncompared to prior CT study.\n5. No evidence of ischemic colitis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 11:25 pm, 5 minutes after discovery of\nthe findings." }, { "input": "Exam is limited due to motion degradation.\n\nLOWER CHEST: Vis there is dependent atelectasis in the bilateral lower lobes..\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a splenule.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are left-sided parapelvic cysts. There are bilateral subcentimeter\nhypoattenuated lesions which are too small to characterize. There is a\nright-sided extrarenal pelvis. There is no hydronephrosis or perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is not visualized but there are no secondary signs of acute\nappendicitis.\n\nPELVIS: There is a Foley in bladder. There is diffuse wall thickening of the\nbladder likely due to bladder outlet obstruction. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: There are fiducials in the prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES there is grade 1 retrolisthesis of L3 over L4 and grade 1\nanterolisthesis of L5 over S1 and bilateral pars defects of L5. There are\nmoderate to severe degenerative changes of the thoracolumbar spine. \nAnterolisthesis of L4 over: There is no evidence of worrisome osseous lesions\nor acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abnormality in the abdomen or pelvis. No evidence of obstruction,\nbowel ischemia, or inflammation." }, { "input": "LOWER CHEST: Aside from bibasilar atelectasis, the visualized lung fields are\nwithin normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is a punctate, 4 mm focus of hyperdensity in the\nleft interpolar kidney which may represent a small nonobstructing stone. \nMultiple parapelvic cysts are noted in the left kidney. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. There is a large\ncolonic stool burden. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is not well\nvisualized but there is no definite secondary evidence of appendicitis.\n\nPELVIS: A suprapubic catheter is in place within the bladder. The bladder\nwall appears thickened likely secondary to chronic inflammation. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fiducial markers are seen within the prostate. The\nseminal vesicles are grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There are dense calcifications at the origin of the celiac artery.\n\nBONES: A few scattered lucencies are noted within the pelvic bones and lower\nlumbar spine a punctate focus of sclerosis in the left femoral head may\nrepresent a bone island note is made of a 1.2 cm intra-articular loose body in\nthe right femoroacetabular joint. Additional punctate loose bodies are noted\nwithin the left femoroacetabular joint. There are severe degenerative changes\nin the lumbar spine including loss of intervertebral disc space height, vacuum\nphenomena, endplate sclerosis, facet arthropathy and large anterior\nosteophytes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic pathology to explain the patient's\npain.\n2. 4 mm nonobstructing left interpolar renal calculus.\n3. A few scattered lucencies are noted within the pelvic bones and lower\nlumbar spine. Correlate with clinical markers to determine if there is\nsuggestion of malignancy and consider SPEP/UPEP." }, { "input": "There is patchy atelectasis at each lung base, left greater than right. \nCoronary calcification is detected.\n\nAbdomen:\nNo focal liver lesions are identified within the limitations of a non-contrast\nexamination. The gall bladder appears normal. There is no biliary\ndilatation. Large periampullary duodenal diverticulum, although the\npossibility that the common duct may empty into it cannot be excluded. The\nspleen is normal in size and appearance. Each adrenal appears thickened and\nnodular suggesting hyperplasia and/or adenomas measuring up to perhaps at most\n18 mm (on the right). No evidence for stones, solid masses, perfusion defects\nor hydronephrosis involving either kidney, only a few vascular calcifications.\n\nThe stomach appears normal. There is a sigmoid-sigmoid anastomosis. Mild\nscattered diverticulosis along the large bowel, most prominent in the sigmoid,\nbut not severe.\n\nThere is a broad based ventral hernia with a very wide neck.\n\nPelvis:\nProstate is moderately enlarged with central hypertrophy. Distal ureters,\nbladder and seminal vesicles are unremarkable. No lymph nodes that are\nenlarged by size criteria. No free fluid.\n\nBones:\nThere are no suspicious bone lesions. Soft tissue structures are\nunremarkable.\n\nVascular:\nThere is widely patent accessory renal artery feeding the right lower pole. \nMain renal arteries are widely patent. Origins of the celiac trunk and\nsuperior mesenteric artery are widely patent. There may be some narrowing at\nthe origin of the inferior mesenteric artery but the vessel is patent from its\norigin.\n\nThe distal infrarenal abdominal aorta shows mild ectasia with mixed type\natherosclerotic disease. Maximum axial ___ measure up to 27 x 26 mm in\naxial ___.\n\nThe right common and external iliac arteries are patent without substantial\nnarrowing, only showing mild narrowing of the due to a atherosclerotic plaque.\nThe right internal iliac artery is occluded at its origin although more distal\nbranches opacify.\n\nOn the right, although the common femoral artery is patent and gives rise to\npatent deep femoral artery. However, the superficial femoral artery is\noccluded from shortly beyond its origin. A patent femoropopliteal graft is\npatent. Distal run-off vessels are patent below the calf.\n\nFrom its origin, the left common iliac artery is occluded. The left external\niliac artery is fully occluded and shrunken. Left internal iliac artery is\nalso occluded.\n\nOn the left, there is postoperative change including air and stranding in the\nleft groin. The common femoral artery is briefly patent due to collateral\nretrograde flow from an enlarged left external iliac artery interconnecting\nwith small left abdominal wall collaterals (in addition to collateral flow\nfrom posterior internal iliac division branches to a lesser extent). However\nthis is followed by a short occlusion, in turn followed by a patent narrowed\ncommon femoral artery that divides into patent superficial and deep venous\nbranches that proceed into the more distal extremity without any significant\nnarrowing. However, popliteal artery is shrunken and occluded. Nevertheless,\nvia small geniculate CT collaterals, the anterior tibial, posterior tibial and\nperoneal veins all opacify nearly to the foot. The posterior tibial has the\nmost robust opacification along foot. All of the arteries are small, and even\non the delayed images, the peroneal does not enhance very much distally. \nContrast passage is much faster on the right, noting venous return even on the\nearlier phase images.", "output": "1. Occlusions of the left common and external iliac veins. Patent left\nsuperficial and deep femoral arteries via small collaterals but occlusion of\nthe popliteal artery, again with distal flow views small collaterals. Visible\nopen three-vessel runoff to the foot on the left but with diminutive delayed\nflow.\n\n2. Mildly dilated infrarenal aorta to 27 mm. It may be appropriate to\nconsider follow-up surveillance, which could be performed with ultrasound.\n\n3. Nodular bilateral adrenals with low attenuation lesions suggesting\nhyperplasia or adenomas. Largest discrete area measures up to 18 mm in the\nright adrenal, possible adenoma." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 0.9 x 1.0 cm attenuating, oval lesion within hepatic\nsegment VIII, demonstrating peripheral enhancement and centripetal filling,\nmost likely representing a benign hemangioma, unchanged since ___. The\nliver demonstrates homogenous attenuation throughout. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A heterogeneously enhancing mass along the right wall of the bladder\nmeasures 4.4 x 3.2 x 4.0 cm, from 3.5 x 3.8 x 3.1 cm in ___. A\npreviously seen satellite lesion appears to now be continuous with the primary\nmass, with intravesical extension along the anterior wall of bladder. The mass\nhas an irregular serosal margin representing expansion beyond the bladder\nwall, slightly increased from prior (6:74,77; 601:26). There is mild\nperivesical fat stranding along the anterior aspect of the bladder. Of note,\nthe posterior aspect of the mass lies adjacent to the right ureterovesical\njunction.\n\nThe kidneys are of normal and symmetric size with normal nephrogram. Multiple\nsmall bilateral parapelvic cysts are unchanged. A subcentimeter hypodensity\nwithin the upper pole of the right kidney is stable. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a small\nduodenal diverticula. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Multiple intra-abdominal lymph nodes are prominent but not\nenlarged by size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the right hip and the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 4.4 x 3.2 x 4.0 cm heterogeneously enhancing right lateral bladder mass may\nbe mildly increased in size with minimally worsened lateral expansion beyond\nthe bladder wall and perivesical fat stranding along the anterior aspect of\nthe bladder. The posterior aspect of the mass is adjacent to the right\nureterovesical junction.\n2. Unremarkable appearance of the kidneys and ureters. No definitive\nintra-abdominal lymph node involvement.\n3. Benign hepatic hemangioma, duodenal diverticula and bilateral parapelvic\nrenal cysts as described above.\n4. Please see same day CT chest report for full description of intrathoracic\nfindings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Diverticulosis is noted in the descending\nand sigmoid colon, with no evidence of diverticulitis. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diverticulosis of the descending and sigmoid colon, with no evidence of\ndiverticulitis." }, { "input": "A non-contrast study limits the assessment of solid organs.\n\nLOWER CHEST: The lung bases are clear.\n\nHEPATOBILIARY: The liver surface contour is smooth. The liver demonstrates\nhomogenous attenuation throughout. There is no evidence of focal lesions on\nthis non-contrast study. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is non-distended and normal-appearing,\nwithout stones or wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions on this non-contrast study. There is no pancreatic ductal\ndilatation or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nconcerning focal renal masses on this non-contrast study. There is no stone or\nhydronephrosis. There is no perinephric abnormality. The ureters and urinary\nbladder are grossly unremarkable.\n\nGASTROINTESTINAL: The small bowel loops, colon, and rectum are within normal\nlimits. There is no intra-abdominal free air.\n\nLYMPHATICS: There is no evidence of retroperitoneal, mesenteric, pelvic, or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or calcification.\n\nREPRODUCTIVE ORGANS: The patient has had a total hysterectomy and bilateral\nsalpingo-oophorectomy. The vaginal cuff is demonstrated and appears within\nnormal limits. There is minimal free fluid in the pelvis. There is no evidence\nof a loculated fluid collection. There is no evidence of a fistula or sinus\ntract. There is no pre-sacral fluid.\n\nBONES: There is no suspicious bony lesion.\n\nSOFT TISSUES: A small amount of sub-cutaneous emphysema is demonstrated\ncorresponding to the probable sites of laparoscopic port insertion\nbilaterally. There is no evidence of a hernia.", "output": "1. No abscess.\n\n2. Post-surgical changes including subcutaneous emphysema at surgical incision\nsites. No evidence of left abdominal wall hernia.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___,\nthe referring provider requesting ___ wet read, on the telephone on ___\nat 4:45 ___, 5 minutes after discovery of the findings." }, { "input": "Heart size is normal without significant pericardial fluid. Imaged lung bases\nare clear.\n\nCT abdomen without contrast: Note made of uneven lipomatosis of the\npancreatic head. Liver, gallbladder, spleen, pancreas and adrenal glands are\notherwise unremarkable in the context of a noncontrast examination.\n\nMild fullness of the right collecting system with double J ureteral stent in\nplace. Kidneys are otherwise unremarkable without stone, obvious mass or frank\nhydronephrosis.\n\nStomach, duodenum and small bowel loops are normal caliber without evidence of\nobstruction. Note of redundant sigmoid colon. Large bowel is thin-walled and\nunremarkable without pericolonic fat stranding or fluid collection. Normal\nappendix right lower quadrant.\n\nAbdominal aorta is normal caliber with trace calcified atherosclerotic plaque\nburden. No ascites or pneumoperitoneum. Mesenteric and retroperitoneal lymph\nnodes are not pathologically enlarged. No abdominal hernia.\n\nCT pelvis without contrast: Bladder is distended but otherwise unremarkable.\nNo stones within the bladder or terminal ureters. Seminal vesicles, prostate\nand rectum are unremarkable. No free pelvic fluid or air. Inguinal and pelvic\nsidewall lymph nodes are not pathologically enlarged.\n\nBones and soft tissues: No suspicious focal bone lesion. Moderate lumbar\ndegenerative change.", "output": "Right double-J ureteral stent in place with mild fullness of the right\ncollecting system without frank hydronephrosis. No renal calculi." }, { "input": "For detailed evaluation of the lungs please refer to report from dedicated CT\nthorax performed the same date. There are bilateral small pleural effusions\nwith compressive atelectasis.\n\nThere is a small hiatal hernia which is filled with oral contrast. Evaluation\nof the abdominal solid organs and intravenous contrast. Within this\nlimitation, the liver and pancreas are unremarkable. The area of previously\nseen splenic infarct is difficult to evaluate on this noncontrast exam. The\nspleen has a mottled appearance consistent with known infarct. The adrenal\nglands are not well seen.\n\nThere is a delayed renal contrast excretion bilaterally from intravenous\ncontrast administered on ___. There is suggestion of\nwedge-shaped hypodensities bilaterally within the left upper pole and right\nlower pole which may be related to phase of contrast or represent ATN versus\ninfarcts. There are additional areas of cortical scarring and defects, likely\nchronic/old infarcts.\n\nOral contrast of different phases likely some related to prior imaging is seen\nin the large and small bowel. There is colonic diverticulosis without\nevidence of diverticulitis. There is suggestion of a small segment of bowel\nwall thickening within the splenic flexure and proximal descending colon,\nwhich may be secondary to ischemia, however evaluation is limited. The\nremaining bowel is unremarkable.\n\nThere is a moderate amount of ascites. No evidence of free air.\n\nThere is extensive atherosclerotic calcification of the abdominal aorta and\nits major branches. There is focal infrarenal aortic aneurysm measuring 3.3 x\n2.8 cm (series 3, image 70).\n\nCalcification seen in the uterus may be related to vascular calcifications\nversus fibroids. A Foley catheter within the decompressed bladder. There is\nnondependent air in the anterior bladder likely from instrumentation.\n\nThere is diffuse large amount of anasarca.\n\nNo suspicious osteolytic or osteoblastic bone lesions. Multilevel\ndegenerative changes are seen throughout the lumbar spine. Degenerative\nchanges are also noted at the bilateral sacroiliac joints and bilateral hip\njoints.", "output": "1. Moderate amount of ascites and diffuse anasarca may be related to volume\nresuscitation and third spacing.\n2. Short segment of bowel wall thickening in the proximal descending colon and\nsplenic flexure may represent ischemia in the setting of DIC and shock,\nhowever, evaluation is limited by lack of distension.\n3. Bilateral delayed contrast excretion from the kidneys likely represents\nacute on chronic kidney injury with probable ATN. More focal areas of\nwedge-shaped hypo attenuation may also represent a combination of chronic and\npossible acute infarcts.\n4. Previously seen splenic infarct is better evaluated on prior imaging." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Small hiatus hernia is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. Mild prominence of the distal common bile duct may be\nrelated to post cholecystectomy state and is not significantly changed\ncompared to the prior study. The gallbladder surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged with homogeneous enhancement.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Patient is status post Roux-en-Y\ngastric bypass. The Roux limb is opacified by contrast and the jejuno jejunal\nanastomosis is noted to be just to the right of midline, just slightly more\nlateral in location compared to the prior CT from ___. Contrast does not\npass beyond the anastomosis, however fecalization of the jejunum just distal\nto the anastomosis is suggestive of slow transit and this portion of bowel is\nalso mildly thickened, suggestive of chronic changes. There are mildly\ndilated air and fluid-filled loops of small bowel with fluid fluid levels\nassociated with this anastomosis which are also more lateral in location\ncompared to the prior study (02:53). The colon and rectum are within normal\nlimits. The appendix is normal. There is a small amount of free fluid\nwithout drainable collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus. No adnexal mass. Trace FF.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild rectus diastasis. There are no herniated loops of\nbowel through the abdominal wall. Small fascial defects containing omental\nfat are seen within the midline ventral abdominal wall.", "output": "Compared to the prior CT of the abdomen and pelvis from ___, the\njejuno jejunal anastomosis of the Roux-en-Y gastric bypass is now located in\nthe right hemiabdomen, previously in the midline, and is now associated with\nmildly dilated loops of small bowel with fluid fluid levels concerning for\nearly or partial obstruction related to internal hernia." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneously decreased attenuation\nthroughout suggestive of hepatic steatosis. There is no evidence of focal\nlesions however sensitivity is limited due to lack of intravenous contrast. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no nephrolithiasis. There is\nno perinephric abnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Colon and rectum are within normal limits. Suture\nmaterial in the inferior aspect of the cecum is consistent with appendectomy.\nThere is a surgical drain coursing from the left abdomen across the midline\nabdomen into the right lower quadrant. There is no abdominal fluid collection.\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is mild calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder is decompressed by indwelling catheter. The distal\nureters are unremarkable. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. Postsurgical changes consistent with history of appendectomy.\n2. No intra-abdominal or pelvic fluid collection. No evidence of abscess.\n3. Diffuse hepatic steatosis." }, { "input": "Chest: The bases of the lungs are clear bilaterally. The visualized heart\nand pericardium are unremarkable.\n\nAbdomen: The liver appears homogeneous in attenuation with no focal lesion\nidentified. There is no intrahepatic biliary dilatation. The portal veins are\npatent. There is no radiopaque cholelithiasis. The pancreas and spleen are\nunremarkable.\n\nWithin the left adrenal gland are three discrete nodules demonstrating\nintermediate density, measuring 6mm (2:20), 11mm (2:24), and 7mm. Fusiform\nthickening of the right adrenal gland is seen, thought to reflect cortical\nhypertrophy without a discrete nodule.\n\nBilateral kidneys present symmetric nephrograms and excretion of contrast.\nInnumerable cortical punctate cysts are seen throughout both kidneys.\n\nThe stomach is unremarkable. Oral contrast is seen throughout loops of small\nbowel and reaches the sacrum. Contrast is seen within proximal portions of the\nascending colon. No transition points are identified. Significant fecal load\nis seen throughout the colon.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation. Mild\nto moderate atherosclerotic calcifications are noted. Calcifications at the\norigins of the celiac trunk and superior mesenteric arteries result in mild\nstenosis. There is no retroperitoneal or mesenteric adenopathy.\n\nPelvis: The bladder is moderately well distended, unremarkable in appearance.\nThe uterus is within normal limits in appearance. There is no adnexal mass\nseen. No inguinal or pelvic sidewall adenopathy is identified. There is no\npelvic free fluid.\n\nOsseous structures: No suspicious lytic or blastic lesion is identified.\nMultilevel degenerative changes are identified most prominent at the L5-S1\nlevel with disc space narrowing endplate sclerosis and osteophytosis.", "output": "1. No bowel obstruction. Normal appearance of the small and large bowel. Large\namount of colonic stool.\n2. Three left adrenal nodules are statistically likely adrenal adenomas, but\nare not completely characterized on this single phase study. An MRI with a\ndedicated adrenal mass protocol could be performed to further characterize\nthese lesions.\n3. Numerous microcysts throughout the cortex of both kidneys, which may\nreflect exposure to lithium. Correlate with medication history; if the patient\nis actively taking lithium, surveillance of renal function is recommended, as\nthis finding can correlate with nephrotoxicity." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is collapsed\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Bilateral adrenal lesions, most likely representing adenomas,\nappears stable.\n\nURINARY: There are innumerable tiny cysts in the kidneys consistent with the\nprovided diagnosis of lithium nephropathy. The kidneys opacify symmetrically.\nThere is no hydronephrosis. There is no concerning focal lesion. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate\natherosclerotic disease as demonstrated previously.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "No apparent acute cause for the patient's weight loss.\n\nBilateral adrenal lesions appear stable and are most consistent with adrenal\nadenomas. These could be further evaluated by MRI if clinically indicated.\n\nThe appearance of the kidneys is consistent with the provided diagnosis of\nlithium nephrotoxicity. Continued evaluation renal function is suggested.\n\nAtherosclerotic disease." }, { "input": "LOWER CHEST: Small bilateral pleural effusions, left greater than right with\nassociated atelectasis. No pericardial effusion. Hypodense blood pool\nsuggests anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: Subcentimeter hypodensity near the liver dome is too small to\ncharacterize, likely a cyst or biliary hamartoma (series 3, image 18). \nOtherwise, the liver demonstrates homogenous attenuation throughout. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post embolization of the distal left renal\nartery branch. A grade 4 laceration is seen through the superior pole of the\nleft kidney. There is also hypoperfusion affecting the upper pole on the\nleft. There is a large left perinephric hematoma, which is similar compared\nto prior. There is no evidence of active extravasation. Hemorrhagic fluid is\nseen tracking within the left pericolic gutter towards the pelvis. On the\ndelayed images, contrast is seen within the left renal collecting system and\nthroughout the left ureter, however there is no evidence of contrast\nextravasation to suggest collecting system injury. Thrombus within the left\ncollecting system and bladder has significantly improved, near resolved. The\nright kidney is unremarkable in appearance without focal lesion or\nhydronephrosis. A Foley is seen within the bladder. Air within the bladder\nlumen is likely due to catheterization.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: There is a small amount of hemorrhagic fluid within the presacral\nspace.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Narrowing at the origin of the celiac axis may be due to compression\nfrom the median arcuate ligament (series 604, image 89). There is no abdominal\naortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: Acute fractures numerous left rib fractures, some of which appear\ndisplaced, better evaluated on the dedicated chest CT dated ___. \nThere is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Subcutaneous air is seen within the left posterior-lateral chest\nand upper abdominal wall.", "output": "1. Grade 4 laceration through the superior pole of the left kidney status post\nembolization of a distal left renal artery branch. No evidence of active\nextravasation to suggest persistent bleeding or collecting system injury. \nThrombus within the left collecting system and bladder has significantly\nimproved, nearly resolved.\n2. Size of the left perinephric hematoma is unchanged. Small amount of\nhemorrhagic fluid tracking along the left pericolic gutter into the pelvis.\n3. Numerous left rib fractures, better characterized on the prior CT. Small\nbilateral pleural effusions." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. a there is a punctate hyperdense, likely nonobstructing\ncalculus in the midpole of the left kidney (series 6, image 34). There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is post gastric bypass. There is a linear air\nand fluid containing collection with faint rim enhancement located between the\nposterior surface of the left hepatic lobe and the gastrojejunostomy located\nposteriorly (series 7, image 38/series 5, image ___. a this fluid\ncollection measures approximately 3.5 x 0.7 cm in size. There is no oral\ncontrast within this collection to suggest leak from the gastric pouch.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is bilateral L4 pars interarticularis lysis, only partially\nimaged. No worrisome lytic or blastic bone lesions identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Thin linear air and fluid containing collection that appears extraluminal\nlocated between the posterior surface of the left hepatic lobe and the\ngastrojejunostomy without containing oral contrast. A fluoroscopic study with\noral contrast is recommended to look for an ongoing leak.\n2. No other acute process seen in the abdomen to explain patient's pain.\n\nRECOMMENDATION(S): Upper GI study to exclude a leak.\n\nNOTIFICATION: The findings were discussed by Dr. ___, MD with\nDr. ___ on the telephone on ___ at 1.00 Pm, 3 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: The linear opacities within the right lower lobe likely represent\natelectasis. No focal consolidations. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a moderate amount of nonhemorrhagic ascites. The\nliver is cirrhotic in appearance. Gastric and splenic varices are noted. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is a focal enlargement of the main portal vein with\nperipheral calcification (series 2, image 29), which may represent a chronic\nportal vein thrombosis, however this is difficult to assess on a noncontrast\nenhanced examination. Layering hyperdense material within the gallbladder\nlumen may reflect small stones or sludge, however there is no wall thickening\nto suggest acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring up to 17 cm. No evidence of focal\nlesions within the limitations of a nonenhanced examination.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. A small bowel anastomosis is\nseen within the right lower quadrant. Small bowel loops demonstrate normal\ncaliber and wall thickness throughout. There is low-density wall thickening\nof the ascending colon, which is likely related to portal colopathy. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nmoderate amount of nonhemorrhagic ascites within the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a chronic fracture of the left lateral ninth rib. There is mild\ncompression deformity of the T11 vertebral body, which is of indeterminate\nage, but does not appear to be acute.\n\nSOFT TISSUES: There is a moderate amount of stranding within the subcutaneous\nsoft tissues, likely due to volume overload. There is a moderate sized fat\ncontaining umbilical hernia, also with a small amount of stranding.", "output": "1. No evidence of intra-abdominal hemorrhage.\n2. Cirrhotic liver with ascites, splenomegaly, and varices. Thickening of the\nascending colonic wall is likely due to portal colopathy.\n3. Focal enlargement of the main portal vein with peripheral calcification,\nwhich may represent a chronic portal vein thrombosis, however this is\ndifficult to assess on an unenhanced examination. Correlation with ultrasound\nor contrast-enhanced CT is recommended, if not done previously.\n\nRECOMMENDATION(S):\nFocal enlargement of the main portal vein with peripheral calcification, which\nmay represent a chronic portal vein thrombosis, however this is difficult to\nassess on an unenhanced examination. Correlation with ultrasound or\ncontrast-enhanced CT is recommended, if not done previously." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.A peripherally calcified lesion within the liver adjacent to the IVC is\nstable since prior exam and likely represents a small calcified cyst. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality. Several small calcifications within the kidneys bilaterally are\nlikely vascular.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder is well distended. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No large adnexal mass is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Mild multilevel degenerative changes are seen throughout the lower\nthoracolumbar spine including endplate sclerosis, disc space narrowing and\nanterior osteophytes. A 4 mm densely sclerotic lesion within the L5 vertebral\nbody is stable and most consistent with a bone island. There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small fat containing umbilical hernia is noted. Multiple soft\ntissue nodules within the subcutaneous tissue anteriorly are most consistent\nwith injection granulomas. The abdominal and pelvic wall is otherwise within\nnormal limits.", "output": "1. No CT evidence to explain patient's symptoms on this noncontrast study.\n2. Diverticulosis without evidence of acute diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic in appearance, with a nodular surface,\nlarge left and caudate lobes, and small right lobe. In segment ___, a 0.8 x\n0.8 cm focus which is hypodense throughout arterial, portal venous and\nequilibrium phases appears unchanged from MRI ___ and is consistent with\npost-treatment changes following TACE (4:18). In segment VIII, there is a 1.6\nx 1.6 cm lesion which is enhancing in the arterial phase, and become isodense\nin the equilibrium phase, similar to prior (4:10). In segment VII, there is a\n1.0 x 1.2 cm lesion which is enhancing in the arterial phase, and becomes\nisodense in the equilibrium phase, similar to prior (4:13). In segment III, a\npreviously seen 0.9 x 0.9 cm lesion is enhancing in the arterial phase, and\nbecomes isodense with the equilibrium phase (4:22). In segment VI, there is\nan additional peripheral wedge shaped lesion, not identified on previous\nimages, measuring 0.9 x 1.1 cm, which is hyperdense on arterial phase, and\nisodense on equilibrium phase (4:40). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The portal vein and SMV are patent. The\ngallbladder is within normal limits.\n\nPANCREAS: There is a 1.5 x 1.1 cm hypodense cyst in the tail of the pancreas,\nsimilar to recent MRI, which likely represents a side branch IPMN. An\nadditional cyst in the pancreatic body seen on MRI ___ is not\ndefinitely identified on this exam. The remainder of the pancreas has normal\nattenuation throughout, without evidence of pancreatic ductal dilatation. \nThere is no peripancreatic stranding.\n\nSPLEEN: There is borderline splenomegaly, measuring 14 cm in the caudocranial\ndirection. The spleen shows normal attenuation throughout, without evidence\nof focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again seen are adjacent simple cysts in the lower pole of the left\nkidney, similar to recent MRI (12: 101-107). The kidneys are of normal and\nsymmetric size with normal nephrogram. There is no evidence of suspicious\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis in the descending colon. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is a small vessel arising from the celiac artery which\nsupplies the right lung lower lobe, previously seen on arteriogram ___, and likely represents pulmonary sequestration. There is variant hepatic\nanatomy with the common hepatic artery arising from the superior mesenteric\nartery. There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Post TACE treatment changes segment ___ lesion.\n2. Three previously seen hepatic foci in segments VIII, VII, and III appear\nunchanged from prior and do not display typical characteristics of HCC.\n3. Additional 0.9 x 1.1 cm lesion in Segment VI, not identified on previous\nMRI, does not display typical features of HCC.\n4. Pancreatic tail cyst is stable from prior and likely represents a side\nbranch IPMN.\n5. Cirrhosis with borderline splenomegaly.\n6. Descending colonic Diverticulosis.\n7. Incidental note of small vessel arising from the celiac axis supplying the\nright lower lobe, likely representing pulmonary sequestration, as well as\nvariant hepatic anatomy with the common hepatic artery arising from the SMA." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a macronodular contour of the liver consistent with\npatient's known cirrhosis.\n\nThere are post treatment changes in hepatic segment 4A with residual\nhypodensity without residual or recurrent enhancement consistent with treated\nlesion.\n\nThere is a 2.2 cm arterially enhancing lesion with equivocal washout with but\nwith pseudocapsule in hepatic segment 8 consistent with OPTN 5B hepatic\ncellular carcinoma. Series 4 image 10, series 6 image 9.\n\nThere is a 1.8 cm and hand seen lesion with washout on delayed imaging which\ndisplays growth compared to prior examination where it measured up to 12 mm on\n___ consistent with OPTN 5a-g HCC.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The cystic lesion in the tail of pancreas measuring up to 1.5 x 0.9\ncm on today's examination likely representing side-branch IPMN is not\nsignificantly changed. Previously noted cyst in the body of the pancreas seen\non prior MR is not well seen on this examination. There is no peripancreatic\nstranding.\n\nSPLEEN: Borderline splenomegaly up to 13.5 cm is again noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimple cyst in the left kidney again noted measuring up to 2.2 cm. There is\nno evidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Aberrant vessel extending from the celiac trunk to the right lower\nlobe on again noted likely representing a pulmonary sequestration.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the spine are again noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of recurrent or residual enhancement e within the treated\nsegment 4A lesion.\n2. The lesion in hepatic segment 8 now displays arterial enhancement and\npseudo capsule measuring up to 2.2 cm consistent with OPTN 5B hepatocellular\ncarcinoma.\n3. The lesion in hepatic segment 3 measuring 1.8 cm has demonstrated arterial\nenhancement with washout and interval growth of 50% consistent with OPTN 5a-g\nhepatocellular carcinoma.\n4. Celiac trunk artery supplying the right lower lobe likely represents a\npulmonary sequestration though incompletely evaluated.\n5. Cirrhosis with borderline splenomegaly.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:17 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular in contour, consistent with history of\ncirrhosis. A 3.2 x 3.1 cm hypodensity in segment VIII at prior ablation site,\nis slightly decreased in size from prior, with no evidence of enhancement to\nsuggest recurrence (5:60). An arterioportal fistula adjacent to the segment 8\nablation zone, with surrounding hyperemia in the arterial phase, is similar to\nprior (4:23, 41). A 3.6 x 3.2 cm hypodensity in segment III at prior ablation\nsite, is slightly decreased in size from prior, with no evidence of\nenhancement to suggest recurrence (5:83). Two peripheral foci of arterial\nenhancement with no correlate on delayed images are consistent with transient\nhepatic intensity differences (4:36, 57). There are no new lesions suspicious\nfor ___. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: A 1.4 cm cystic lesion in the pancreatic tail is unchanged since at\nleast MRI abdomen in ___, and consistent with a side branch IPMN\n(5:106). The pancreas otherwise has normal attenuation throughout, without\npancreatic ductal dilatation. There is mild peripancreatic stranding around\nthe tail, and thickening of the fascial planes, unchanged and likely reflects\nscarring given chronicity and absence of symptoms.\n\nSPLEEN: The spleen is enlarged, measuring 16 cm, with normal attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimple cysts in the left kidney are unchanged. There is no evidence of focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are colonic\ndiverticula, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Incidental note is made of a replaced common hepatic artery arising\noff the SMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Post treatment changes in segment III and VIII, with no evidence of\nrecurrence. No new focal lesions suspicious for ___.\n2. Unchanged hepatic arterioportal fistula with surrounding perfusion change.\n3. Cirrhosis with splenomegaly.\n4. 1.4 cm cystic lesion the tail the pancreas is unchanged since at least ___ and consistent with a side branch IPMN.\n5. Diverticulosis, with no evidence of acute diverticulitis.\n6. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nThere is a small amount of ascites in the upper abdomen.\n\nHEPATOBILIARY: The liver is nodular in contour, consistent with history of\ncirrhosis.\n\nA 3.1 x 3.1 cm hypodensity in segment VIII at prior ablation site is similar\nin size (3b:99) without evidence of recurrence.\n\nAn arterioportal fistula adjacent to the segment 8 ablation zone, with\nsurrounding hyperemia in the arterial phase, is similar to the prior study\n(3a:25).\n\nA 3.6 x 3.2 cm hypodensity in segment III at prior ablation site is stable in\nsize without evidence of recurrence (3b:124).\n\nOn 3a:48 in segment 5, there is an arterially enhancing 1.8 x 1.6 lesion with\nwashout on delayed images without a pseudocapsule which does not meet OPTN\ncriteria although is suspicious.\n\nOn 3a:63 in segment 5, there is an arterially enhancing 1.6 cm lesion with\nminimal washout on delayed images without a pseudocapsule which does not meet\nOPTN criteria although is suspicious. This previously measured up to 1.0 cm.\n\nTwo peripheral foci of arterial enhancement with no correlate on delayed\nimages are consistent with transient hepatic intensity difference (3a:29,\n3a:28). The area on 3a:28 is more conspicuous on today's study.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: There is a 1.4 cm side-branch IPMN in the tail of the pancreas that\nis stable since at least ___. The pancreas otherwise has normal\nattenuation throughout, without pancreatic ductal dilatation. There is mild\nperipancreatic stranding around the tail, and thickening of the fascial\nplanes, unchanged and likely reflects scarring given chronicity and absence of\nsymptoms.\n\nSPLEEN: The spleen is enlarged, measuring 15.7 cm, with normal attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The left adrenal gland is normal in size and shape. There is a 0.8\ncm right adrenal adenoma. This lesion measures higher than 10 ___\nunits on precontrast imaging but demonstrates dropout on out of phase imaging\nand is compatible with a lipid poor adrenal adenoma. On the outside MR of the\nabdomen from ___, this was reported to be stable dating back to ___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimple cysts in the left kidney are unchanged. There is no evidence of focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are colonic\ndiverticula, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Incidental note is made of a replaced common hepatic artery arising\nfrom the SMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cirrhotic morphology of the liver with the sequela of portal hypertension\nincluding splenomegaly and trace abdominal ascites.\n2. Stable appearance of the segment 8 and segment 3 ablation sites without\nevidence for recurrence.\n3. Arterially enhancing 1.8 cm lesion in segment V with washout and no pseudo\ncapsule does not meet OPTN criteria although is suspicious for ___. \nAdditionally, also in segment 5 more inferiorly, there is an arterially\nenhancing 1.6 cm lesion which is increased in size which demonstrates minimal\nwashout on delayed images without a pseudo capsule. This is also suspicious\nbut does not meet OPTN criteria. Continued follow-up is recommended of these\nnodules.\n4. Unchanged hepatic arterial portal fistula with surrounding perfusion\nchange.\n5. 1.4 cm side-branch IPMN in the tail of the pancreas is stable since at\nleast ___. This can be reassessed on follow-up imaging.\n6. Stable 0.8 cm right adrenal adenoma.\n7. Please refer to the separate report of the CT chest performed on the same\nday for description of the thoracic findings." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis, left greater than right. \nSmall bilateral pleural effusions are present. There is no pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular in contour compatible with\ncirrhosis. Patient is status post tace with post treatment changes are noted.\nLipiodol is predominantly concentrated segment ___. Hypodensities in segment\n3, 8, and segment ___ are re-demonstrated consistent with prior treatment\nsites. Coiled portal arterial fistula is again noted. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder contains\nvicariously excreted contrast from prior administration. Moderate ascites\ndemonstrates intermediate density which may be secondary to delayed\nenhancement of ascites from prior contrast administration.\n\nPANCREAS: The pancreas is atrophic. A 2.0 cm hypodensity in the tail of the\npancreas (02:35) is unchanged since ___, compatible with side\nbranch IPMN. There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Stable 0.8 cm right adrenal nodule previously characterized as an\nadenoma. The left adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are atrophic with previously administered contrast\nretained within the renal cortices bilaterally. A 3.3 cm cyst is seen in the\nlower pole of the left kidney. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the distal stomach. \nVisualized small bowel loops demonstrate normal caliber and wall thickness. \nDiffuse colonic diverticulosis is partially imaged.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Mild atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse anasarca is noted.", "output": "1. Post TACE changes as demonstrated by lipiodol uptake in the right hepatic\nlobe concentrated in segment ___.\n2. Stable 0.8 cm right adrenal nodule previously characterized as an adenoma.\n3. Stable 2.0 cm pancreatic cystic lesion compatible with a side branch IPMN." }, { "input": "LOWER CHEST: Re-demonstration of unchanged bibasilar atelectatic changes with\ntrace of left-sided pleural effusion.\n\nHEPATOBILIARY: There is re-demonstration of cirrhotic liver morphology. \nLipoidal uptake is again noted within the right hepatic lobe mainly segment 6\nand 7. Hypodensity within segment 3 of the liver represents an area of\nprevious RFA. Please note that the evaluation of the liver is somewhat\nlimited with the absence of IV contrast.\n\nPANCREAS: Stable 2 cm pancreatic tail side-branch IPMN. The remainder of the\npancreas appears unremarkable changed.\n\nSPLEEN: Stable splenomegaly measuring 15 cm.\n\nADRENALS: Left adrenal gland is unremarkable subcentimeter right adrenal\nnodule has not changed.\n\nURINARY:There is no hydronephrosis or nephrolithiasis. There are unchanged\nrenal cortical cysts.\n\nGASTROINTESTINAL: There is no bowel obstruction. There are scattered colonic\ndiverticulosis. NG tube is coiled within the body of the stomach.\n\nPERITONEUM: There has been interval development of moderate amount of\nintra-abdominal simple fluid ascites.\n\nLYMPH NODES: There are prominent mesenteric lymph nodes, unchanged. There is\nno retroperitoneal adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber. There is mild atherosclerotic\nchanges.\n\nPELVIS: Urinary bladder is under distended due to the presence of a Foley\ncatheter. Rectum is unremarkable. There are central prostatic\ncalcifications. There are no pelvic adenopathy.\n\nBONES:There is an expansile osseous lucent lesion along the right iliac wing\nwith overlying cortical disruption (3:77). This is concerning for a\npathologic fracture within underlying osseous metastatic lesion. Although, it\nmay represent an incomplete fracture of a osteopenic right iliac bone. There\nare 2 minimally displaced fractures of the left lateral seventh and sixth ribs\nrelated to the recent CPR.\n\nSOFT TISSUES: There is subcutaneous soft tissue stranding consistent with\nanasarca.", "output": "1. Worsening simple fluid ascites in the abdomen as well as anasarca in the\nsubcutaneous soft tissues.\n2. Evaluation of the liver is limited by this noncontrast study.\n3. Unchanged left lateral rib fractures.\n4. Right iliac wing osseous lucent lesion with overlying cortical disruption\nconcerning for a pathologic fracture. Although, osteopenic fracture is a\npossibility. Consider outpatient bone scan as part of metastatic workup.\n\nNOTIFICATION: Findings were conveyed to Dr. ___ medicine intern at\n15:49 on ___ by Dr. ___ fellow." }, { "input": "There is colonic diverticulosis without evidence for diverticulitis. No site\nof active extravasation is identified. Retained contrast from a recently\nperformed CT abdomen/pelvis remains within the colon, somewhat limiting\nassessment. The appendix is normal. There is no bowel obstruction or\ninflammation.\n\nThe liver, spleen, pancreas, adrenal glands, kidneys and gallbladder are\nunremarkable.\nThe abdominal aorta is normal caliber. There is no abdominal, pelvic or\ninguinal lymphadenopathy.\n\nThe urinary bladder, prostate gland and seminal vesicles are unremarkable.\n\nMultilevel spinal degenerative changes are stable.\n\nThe visualized heart and lung bases are unremarkable.", "output": "Somewhat limited exam secondary to retained antral contrast from recently\nperformed outside CT scan. However, there is colonic diverticulosis with no\nsite of active extravasation identified.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 4:41 ___, 60 minutes after discovery of the\nfindings." }, { "input": "There is a small dependent left pleural effusion with overlying atelectasis.\nRefluxed oral contrast material is noted within a small hiatal hernia.\n\nThe liver, spleen, and pancreas are normally enhancing without focal lesion.\nThe gallbladder and biliary tree are unremarkable. The adrenal glands are\nnormal bilaterally. The kidneys appear normal apart from a 2 cm parapelvic\ncyst at the lower pole left kidney.\n\nSince the previous exam there has been right hemicolectomy with anastomosis of\nsmall bowel to colon at the splenic flexure. Additional sutures in the mid to\ndistal small bowel (02:47) are consistent with Meckel's diverticulectomy.\nCompared with the prior exam, there is now diffuse bowel wall thickening\nthroughout the small bowel, as well as mild, diffuse small bowel dilatation.\nThere is no transition point to suggest obstruction. The enterocolic\nanastomosis appears widely patent.\n\nMild to moderate ascites in the lower abdomen is new in the interval. No\nloculated fluid or mature abscess is identified. There is no free air.\nScattered diverticula are noted in the remnant descending colon. Otherwise,\nthe distal sigmoid colon and rectum are within normal limits. The urinary\nbladder is unremarkable.\n\nSubcutaneous edema along the midline laparotomy incision is most likely\npostoperative. There is also mild, generalized body wall edema. Mild\ninflammatory change around the right common femoral artery and vein is likely\nrelated to recent vascular intervention. No concerning skeletal lesion is\nidentified.", "output": "1. Interval development of diffuse bowel wall thickening and mild dilatation\nof the small bowel, status post right hemicolectomy and Meckel\ndiverticulectomy. This appearance of the bowel is nonspecific, with\ndifferential including third spacing, infection, postoperative inflammation,\nor ischemia, likely superimposed on postoperative ileus.\n2. Evidence of third spacing including mild ascites, anasarca, and small left\npleural effusion.\n3. Colonic diverticulosis.\n4. Small hiatal hernia with suggestion of reflux. An EGD performed ___ did not show concerning abnormality." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffuse hypoattenuation reflective of\nsteatosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is mildly fatty replaced without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral hypodensities are present in both kidneys, the largest\nmeasuring 1.4 cm in the right kidney, some of which are compatible with simple\ncysts, others of which are. Too small to characterize however likely simple\ncysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post fundoplication. Stomach appears\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is not visualized however no secondary signs of appendicitis are\nnoted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic compression deformities of T10, L1, L4, and L5 are unchanged from MR\nenterography from ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal abnormality.\n2. Chronic multilevel compression fractures are stable.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: There is increased patchy right basal airspace opacity with\nvolume loss, likely predominantly atelectasis, though a minor component of\nconsolidation is no entirely excluded. There is mild left basal atelectasis. \nTrace right pleural effusion noted.\n\nABDOMEN:\n\nHEPATOBILIARY: There is cirrhotic liver morphology. Evaluation of the liver\nparenchyma is limited by metal artifact from EKG hardware along the patient's\nright flank. There is no obvious biliary dilation. The gallbladder contains\ngallstones without wall thickening or evidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is borderline enlarged at 13.7 cm. The parenchyma is\nhomogeneous.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is bilateral\nrenal contrast retention, presumably from CT 2 days ago in keeping with renal\ndysfunction. There is no hydronephrosis. There is no nephrolithiasis. There\nis new mild bilateral perinephric stranding.\n\nGASTROINTESTINAL:\n\nThe stomach is filled with contrast and contains an NG tube. There are\ndiffuse intramural gas lucencies along the greater curvature, indicating\npneumatosis (02:17). There is no significant perigastric stranding and there\nis no pneumoperitoneum.\n\nThere is no evidence of pneumatosis involving the small bowel or colon. There\nmultiple dilated proximal to mid small bowel loops measuring up to 4 cm. \nThere is gradual tapering of small bowel caliber as well as the contrast\ncolumn through the mid small bowel without a discrete transition point, most\nlikely reflecting ileus.\n\nThere are a few partially contrast filled, thickened small bowel loops in the\nright abdomen associated with mesenteric edema, new from prior CT (02:54). \nThere is a swirled appearance of the mesentery in the right abdomen (___:53)\ninvolving the terminal ileum with approximately 180 degree twist, which could\npotentially be causing low-grade obstruction. However, there is no evidence\nof closed loop obstruction. Rectal anastomosis appears grossly intact.\n\nThere is new trace ascites in the pelvis and right flank. There is diffuse\nmild intraperitoneal stranding.\n\nPELVIS: The urinary bladder is contrast opacified.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic calcification in the abdominal\naorta. There is mild infrarenal ectasia measuring up to 2.2 cm. There\nextensive portosystemic collaterals in keeping with portal hypertension.\n\nBONES: Multilevel lumbar and lower thoracic compression fractures and old\nbilateral rib fractures are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Gastric wall pneumatosis, of uncertain etiology. Surgical consultation\nsuggested.\n2. Small bowel thickening in the right abdomen associated with mesenteric\nedema is new compared to prior CT and could be related to radiation or\ninflammatory enteritis. Ongoing dilation of the proximal to mid small bowel\nwithout a focal transition to point to suggest high-grade obstruction. \nFindings may represent ileus or low-grade obstruction in the right mid\nabdomen, as described above.\n3. Cirrhotic liver morphology with sequelae of portal hypertension.\n4. Increased patchy right basal airspace opacity with volume loss, likely\npredominantly atelectasis, though a minor component of consolidation is no\nentirely excluded.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:15 pm, 15 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Limited evaluation of the lung bases are notable for bibasilar\natelectasis. No pleural effusion or large pneumothorax.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: No interval change in a 3.2 x 2 cm heterogeneously hypodense mass\narising from the anterior left upper pole, worrisome for renal cell carcinoma\n(03:26). No hydronephrosis or perinephric fat stranding. The kidneys are\notherwise of normal and symmetric size. No nephrolithiasis.\n\nGASTROINTESTINAL: Moderate fluid-filled hiatal hernia noted. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Few subcentimeter paraesophageal lymph nodes have slightly\nincreased in size since ___ largest measuring 0.8 cm (03:10) (previously\n0.5 cm). Few subcentimeter pelvic sidewall lymph nodes do not meet size\ncriteria for enlargement. There is no retroperitoneal or mesenteric\nlymphadenopathy. No inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nWell corticated 1.8 cm lucency within the right iliac wing is unchanged since\n___, consistent with a benign entity. Degenerative changes of the right\nsacroiliac joint noted.\n\nSOFT TISSUES: Previously noted right rectus sheath hematoma has resolved. The\nabdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence to explain patient's symptoms. Specifically, no collection.\n2. Moderate hiatal hernia with retained oral contrast\n3. Interval increase in subcentimeter para paraesophageal lymph nodes, likely\nreactive due to reflux.\n4. Persistent 3.2 cm left upper pole mass worrisome for renal cell carcinoma." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate mild subsegmental atelectasis\nbilaterally. There is no evidence of pleural effusion.\n\nABDOMEN: Motion artifact and streak artifact from adjacent arms degrade image\nquality.\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is grossly unremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Streak artifact limits\nvisualization of the known mass in the interpolar region of the left kidney;\nthis has been biopsy proven to represent a clear cell RCC. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Again seen is a large hiatus hernia containing oral\ncontrast. Partially imaged feeding tube is seen terminating in the gastric\nbody. The small and large bowel loops are normal in caliber. Oral contrast\nis seen up till the rectum which shows a rectal tube. There is no evidence of\nbowel obstruction. There is no abnormal wall thickening.\n\nPELVIS: The urinary bladder shows a Foley bulb in situ. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. The\npreviously seen prominent gastroesophageal nodes are not well seen on this\nstudy due to motion artifact.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable appearance of the benign-appearing lucency in the right iliac wing.\nDegenerative disc disease in involving the visualized thoracic and lumbar\nspine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Study technically limited by motion and streak artifact. Stable findings. \nNo evidence of intra-abdominal abscess. No evidence of bowel obstruction or\nabnormal colonic wall thickening.\n2. Limited assessment of the known RCC in the left kidney due to streak\nartifact." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are 6 mm hypodense lesions in the superior pole of the right kidney and\ninterpolar region of the left kidney, which are too small to characterize. \nThere is no hydronephrosis. There is minimal left perinephric stranding.\n\nGASTROINTESTINAL: The stomach is unremarkable. Proximal small bowel loops\ncontain oral contrast and are mildly dilated, without transition point to\nsuggest obstruction. The walls enhance normally throughout. Postoperative\nchanges of sigmoid colectomy with left lower quadrant end colostomy and\n___ pouch creation are present. The previous recto-uterine complex\ncollection is no longer present. ___ pouch suture appears intact. No\norganized collections are identified. There is no pneumoperitoneum.\n\nPELVIS: The urinary bladder is moderately distended and contains a small\nvolume of intraluminal air, which may be iatrogenic from prior indwelling\ncatheter. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Several prominent retroperitoneal and mesenteric lymph nodes not\nmeeting CT criteria for lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Compression deformity of the L5 vertebral body with irregularities of\nthe superior endplate are similar to the prior study. Multilevel degenerative\nchanges of the thoracolumbar spine are again noted. There are healing\nfractures through the right superior and inferior pubic rami and left-side of\nthe sacrum.\n\nSOFT TISSUES: As noted above, an end-colostomy is present in the left lower\nquadrant. There is trace fluid and enhancement within the gluteal muscles and\nsubcutaneous tissues in the right posterolateral pelvis, at the location of\nthe previous right enhancing collection (series 2, image 102). Small air\nlocule is also noted.", "output": "1. Postoperative changes of sigmoid colectomy with end-colostomy and\n___ pouch, with resolution of previous recto-uterine complex collection.\n2. Trace fluid and hyperenhancement within right posterolateral pelvic soft\ntissues consistent with a nearly resolved abscess.\n3. Mildly dilated small bowel loops likely reflecting ileus.\n4. Small volume air within the urinary bladder, likely iatrogenic from\nprevious indwelling catheter." }, { "input": "Chest is reported separately.\n\nWithin the limitations of a non-contrast examination, no focal liver lesions\nare identified. There is no biliary dilatation. Pancreas is moderately\natrophic. Spleen is normal in size. Adrenals appear normal. There is no\nevidence for stones or hydronephrosis involving either kidney. A left hilar\ncalcification is thought to be vascular. There are also vascular\ncalcifications along the splenic artery, hilar vessels and more diffusely\namong medium and large arteries.\n Stomach and small bowel appear normal. Sigmoid diverticulosis is moderate to\nsevere.\n\nFoley catheter terminates in a collapsed bladder. The endometrium appears\nthickened, perhaps measuring up to 14 mm, although not optimally\ncharacterized. There is no indication of adnexal mass. It is noted that\nevaluation of the deep pelvis is partly obscured by streak artifact associated\nwith the right total hip replacement. No enlarged lymph nodes are found or\nascites.\n\nNo substantial hematoma is identified, only a few very small subcutaneous once\nlikely associated with injection sites.\n\nThere are no suspicious bone lesions. L2-L3 interspace is moderately\nnarrowed.", "output": "1. No evidence of hematoma.\n\n2. Possible endometrial thickening.\n\nRECOMMENDATION(S): Follow-up pelvic ultrasound is recommended to assess the\nendometrium when clinically appropriate." }, { "input": "LOWER CHEST: Atelectasis is noted in the left lung base dependently. There is\nno pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple bilateral renal cysts are again noted. There is thinning of\nthe renal cortex bilaterally, as seen on the prior study, including focal\nregions of scarring bilaterally. There is no evidence of hydronephrosis or\nsuspicious focal renal lesion bilaterally. No renal stones are identified.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Prostate gland is enlarged, and protrudes into the\nbladder base.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Aneurysmal dilation of the left aortofemoral bypass graft is\nunchanged in appearance compared to the recent prior CTA from ___. Dense atherosclerotic disease is again noted. Non opacification of the\nSMA is better characterized by prior CTA.\n\nBONES: Severe degenerative changes of the bilateral hips are again noted, with\nsmall effusion on the left. Configuration changes on the right may be in part\ndue to prior avascular necrosis. There is no evidence of acute fracture.\n\nSOFT TISSUES: Several supraumbilical fat containing ventral hernias are noted.\nSmall foci of gas and fat stranding in the subcutaneous tissues of the left\nlower abdominal wall are likely related to injections (02:40).", "output": "1. No acute abdominopelvic pathology.\n2. Severe atherosclerosis, with unchanged aneurysmal dilation of the distal\naspect of the left aortofemoral bypass graft compared to the recent prior CTA\nfrom ___.\n3. Bilateral renal cortical thinning, regions of scarring, and renal cysts,\nunchanged.\n4. Enlarged prostate.\n5. Severe degenerative changes of the bilateral hips, with small left hip\njoint effusion." }, { "input": "LOWER CHEST: There is trace dependent atelectasis bilaterally. There is\nmoderate cardiomegaly.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is mildly distended with\nsmall of sludge in the dependent portions which is grossly unchanged from most\nre- comparison study.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is significant cortical thinning of the bilateral kidneys\ncompatible with prior injury and is grossly unchanged from ___. \nThere are multiple hypodense rounded lesions in the bilateral kidneys, the\nlargest of which is an exophytic rounded lesion contiguous with the interpolar\nregion of the left kidney measuring 3.4 x 3.0 cm (2:41), which is unchanged in\nsize from most recent comparison study and likely represent simple cysts. \nThere is a surgical clip in the infrarenal portion of the right renal artery. \nThere is no evidence of hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The appendix is\nnot visualized. There is small ventral hernia with herniation of an\nantimesenteric portion of the transverse colon (02:27). There is another\nventral hernia which is inferior to the previously described hernia containing\nfatty stranding which extends into the peritoneum (02:41) which may be\ncompatible with omental ischemia.\n\nPELVIS: The bladder is decompressed. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS The calcified prostate is enlarged measuring up to 5.1 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Dilation of the left aortofemoral bypass graft is grossly unchanged\nin size from comparison study.\n\n\nBONES: Severe degenerative changes of bilateral hips, more prominent on left\nthan right are again noted. Multilevel moderate degenerative changes of the\nlumbar spine. Cortical appearance of the right femoral head is unchanged from\nmost recent comparison study.\n\nSOFT TISSUES: Several supraumbilical ventral hernias are again seen. One\nventral hernia contains anti mesenteric portion of the transverse colon as\ndescribed above. There is another ventral hernia containing mild fatty\nstranding which is contiguous with the peritoneum (02:41) which may be\ncompatible with omental anemia or incarceration.", "output": "1. Multiple supraumbilical ventral hernias, one of which contains a portion of\nnonobstructed transverse colon without evidence of strangulation. Another\nmore inferior ventral hernia contains fatty stranding which extends into the\nanterior abdomen which may be compatible with omental incarceration/ischemia\nor strangulation.\n2. No evidence of colitis or abscess." }, { "input": "LOWER CHEST: Bibasilar atelectasis. Bibasilar calcified granulomata. Small\nbilateral pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: Normal contour with no discrete lesion or ductal dilation.\n\nHypodensity within the gallbladder wall at the fundus could represent focal\nadenomyomatosis and/or fundal wall edema (2 : 68). Contrast is seen in the\ndependent portion of the gallbladder from prior examination. Distention of\nthe gallbladder has not changed from previous examinations. No adjacent fat\nstranding within the limitation of adjacent ascites.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: No nodules.\n\nURINARY: Bilateral renal cortical atrophy with cortical scarring. Simple\nbilateral or renal cysts. No nephrolithiasis or hydronephrosis. No\nhydroureter.\n\nGASTROINTESTINAL: Alimentary tube tip in the stomach. Subtotal colectomy with\ndiverting ileostomy and ___ pouch formation. No intestinal\nobstruction. No contrast extravasation. No pneumatosis or pneumoperitoneum. \nNo fluid collection. Increased intraluminal density is noted within the\ndecompressed ___ pouch, likely due to coapted enhancing mucosa rather\nthan enteric contrast.\n\nProgression of ascites, now moderate.\n\nPELVIS: Unremarkable rectum. Decompressed bladder. Mild prostate enlargement\nwith calcifications.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Moderate arteriosclerosis. Chronically occluded SMA origin. Aorto\nbifem bypass with mild circumferential atheromatous plaques. Aneurysmal\ndilation and tortuosity seen proximal to the left femoral anastomosis measures\n3 cm with focal dissection, unchanged. Occluded native iliac arteries. \nMetallic clip around the infrarenal IVC, unchanged.\n\nBONES AND SOFT TISSUES: Open midline abdominal incision with wound vac. \nAnterior abdominal wall postoperative changes. Right lower quadrant\nileostomy. Mild anasarca. Lumbar spine and bilateral hips degenerative\nchanges.", "output": "1. Status post subtotal colectomy with ileostomy and ___ pouch. \nAscites is progressed, but there is no evidence of enteric leak or\nobstruction. No organized fluid collection.\n2. Stably distended gallbladder with possible fundal edema, the significance\nof which is uncertain since third spacing may contribute.\n3. Bibasilar atelectasis. Small bilateral pleural effusions.\n4. Stable chronic focal dissection and aneurysm in the left aortofemoral graft\nproximal to its femoral anastomosis." }, { "input": "LOWER CHEST: See concurrent CT chest for thoracic findings.\n\nABDOMEN:\n\nThere is moderate ascites. There is no organized fluid collection in the\nabdomen or pelvis.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder again demonstrates\nhypodensity within the fundal wall, unchanged from prior exam, which may\nrepresent focal adenomyomatosis or fundal wall edema.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is bilateral renal cortical atrophy with cortical scarring. \nTwo exophytic cysts are seen in the left kidney, unchanged from prior exam.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The patient is status post\nsubtotal colectomy with ileostomy and ___ pouch.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted, better correct characterized on prior CTA abdomen and\npelvis. Stable appearance of chronic focal dissection and aneurysm in the\nleft aortofemoral graft proximal to its femoral anastomosis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post subtotal colectomy with ileostomy and ___ pouch.\n\n2. Moderate ascites. No organized fluid collection.\n\n3. Hypodensity in the fundal wall of the gallbladder, unchanged from prior\nexam, possibly representing focal adenomyomatosis or fundal wall edema." }, { "input": "Lung bases: Lung bases are included are clear. No suspicious pulmonary nodule\npleural effusions are seen. See chest CT report for full evaluation.\n\nAbdomen: The liver and spleen are normal in size. No suspicious focal hepatic\nlesions are present. The gallbladder, pancreas, adrenals, and kidneys are\nunremarkable. There is no evidence for hydronephrosis or nephrolithiasis. No\nsuspicious renal masses. 2 renal cysts are identified in the right kidney\nwhich the largest 1 measures 4.5 x 2.3 cm. There is no retroperitoneal\nmesenteric lymphadenopathy.\n\nThe visualized portion of the GI tract unremarkable. No intra obstruction.\n\nPelvis: The urinary bladder is decompressed but does not show any gross\nabnormalities. The seminal vesicle prostate normal in size for the age of the\npatient. There is no pelvic lymphadenopathy.\n\nReview of the images in bone window does not show any suspicious bony lesions.", "output": "1. No evidence for metastatic disease in the abdomen or pelvis. 2. 2\nright-sided renal cysts." }, { "input": "Chest: The bases of the lungs are clear.\n\nAbdomen: The liver appears homogeneous with no focal lesion identified. The\ngallbladder is without radiopaque cholelithiasis. The pancreas, spleen, and\nbilateral adrenal glands are unremarkable. Kidneys present symmetric\nnephrograms and excretion of contrast. Note is made of a punctate\nnonobstructing stone measuring 1-2 mm within the lower left collecting system\n(2:25). No perinephric fluid collection is identified.\n\nStomach, duodenum, and loops of small bowel are grossly unremarkable. The\nappendix is air-filled and within normal limits. The colon demonstrates no\nabnormality.\n\nThere is no abdominal free fluid or air. The abdominal aorta demonstrates\nmoderate atherosclerotic calcifications without aneurysmal dilatation. Note is\nmade of a highly heavily calcified superior mesenteric artery, though patent.\nThere is no retroperitoneal or mesenteric adenopathy.\n\nPelvis: The bladder is moderately well distended and grossly unremarkable. The\nprostate gland and seminal vesicles are within normal limits. There is no\npelvic free fluid. No pathologically enlarged inguinal or pelvic sidewall\nlymph nodes are identified.\n\nOsseous structures: No suspicious lytic or blastic lesion is identified. A\nnon-aggressive lesion in the right calcaneus with a geographic appearance and\nwell-defined sclerotic margins appears benign; based on fat density it is\nconsistent with an intraosseous lipoma.\n\nCTA: Patient is status post femoral-femoral graft. The major mesenteric\narteries appear widely patent. The aorta is widely patent without dilatation.\n\nLeft Lower extremity: The left common iliac artery appears patent though\nheavily calcified. The external and internal iliac arteries are widely\npatent, but the common femoral artery shows abrupt occlusion shortly above the\ntake-off of the femoral-femoral graft. The graft is entiredly occluded. There\nis re-constitution of the superficial femoral artery at its take-off. Flow in\nthe superficial femoral artery, and its deep branch, stems from collaterals\nwhose origins are obscure, although probably including the obturator artery. \nThe mid to distal superfical femoral artery is patent but irregularly narrowed\nwith predominantly calcified atherosclerotic plaque. The left circumflex\nfemoral artery is occluded. The popliteal artery is occluded with no flow\nseen distally within the posterior tibial, anterior tibial, or peroneal\narteries.\n\nRight Lower Extremity: The right common iliac artery becomes occluded at its\norigin. There is reconstitution of the distal right internal iliac via\ncollaterals. However, the external right iliac artery remains occluded. Just\ndistal to the femoral-femoral graft insertion site, the superficial femoral\nright artery demonstrates patency though severe calcifications results in\nstenosis. Because the graft and inflow are occluded, flow is via collaterals,\nparticularly from the obturator artery. The anterior tibial artery is patent\nas is the dorsalis pedis artery although stenotic at its origin. The posterior\ntibial artery becomes somewhat attenuated distally. The peroneal artery is\neven more attenuated distally.", "output": "1. Patient is status post femoral-femoral graft which appears occluded. The\nright common iliac artery and external iliac artery are completely occluded to\nthe level just past the femoral graft. There is reconstitution with flow\nwithin the anterior, posterior tibial and peroneal arteries via collaterals\nbut with small vessels including attenuated flow in peroneal and posterior\ntibial arteries.\n\n2. The left external iliac artery appears patent as does the superficial\nfemoral artery, but the common femoral artery is occluded. The popliteal\nartery and distal arteries are occluded.\n\n3. Non-obstructing nephrolithiasis." }, { "input": "Heart size is normal. Linear right base atelectasis is mild. Imaged lung bases\nare otherwise clear.\n\nCT abdomen with contrast: Liver enhances homogeneously without focal mass,\nbiliary dilatation. Portal vein is patent. Gallbladder is normal without\nstones. Punctate hyperdense focus on axial views is located within the colon\nrather than the gallbladder.\n\nSpleen, pancreas and adrenal glands are normal. Kidney present symmetric\nnephrograms and excretion of contrast without focal solid mass, hydronephrosis\nor perinephric abnormality. Punctate hypodensity in the left interpolar kidney\nis too small to fully characterize but likely a cyst.\n\nStomach, duodenum and remainder of the small bowel is normal caliber without\nevidence of obstruction. Roughly 10 cm stretch of the distal descending colon\nis thickened with surrounding fat stranding and there are reactive peritoneal\nthickening though no discrete diverticulum is identified and no diverticula\nare noted in the remainder of the colon. The remainder of the colon is\nthin-walled and unremarkable. Normal appendix visualized in the right lower\nquadrant.\n\nAbdominal aorta is normal caliber. New scattered mesenteric and\nretroperitoneal lymph nodes are not enlarged. There is no ascites or\npneumoperitoneum. Trace fat containing umbilical hernia.\n\nCT pelvis with contrast: Bladder is distended but unremarkable. Seminal\nvesicles, prostate and rectum are unremarkable. No free pelvic fluid or air.\nInguinal and pelvic sidewall lymph nodes are not pathologically enlarged.\n\nBones and soft tissues: Well-circumscribed sclerotic focus in the right\nfemoral head is compatible with bone island. No suspicious of bone lesion.", "output": "Descending colitis. No diverticula are seen in the area of colonic wall\nthickening or elsewhere in the colon." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is mildly enlarged with left hydronephrosis and\nperinephric stranding and possible trace perinephric fluid with an obstructing\n4 mm stone noted in the proximal ureter (2; 50). In addition, there are\nmultiple punctate hyperdensities within the left kidney, the largest measuring\n2 mm consistent with nonobstructing nephrolithiasis. Multiple punctate\nnonobstructing stones are also noted in the right kidney, the largest\nmeasuring 2 mm. No right hydronephrosis. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic lesion in bilateral iliac bone adjacent to the SI joint suggest\nprior infarct. A subchondral cyst is noted in the right acetabulum, likely\ndegenerative.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Obstructing 4 mm stone in the left proximal ureter resulting in left\nhydronephrosis and perinephric stranding with possible trace perinephric\nfluid.\n2. Multiple bilateral punctate nonobstructing nephrolithiasis.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 12:22 am, 5 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: There is a 7 mm nodule in the right lower lobe (2:3). Otherwise,\nthe lungs are clear. There is no pleural effusion pericardial effusion. \nSubtle hyperdense appearance of the ventricular wall is suggestive of\nunderlying anemia.\n\nABDOMEN: The liver, spleen, pancreas, adrenal glands and left kidney are\nunremarkable. The intrahepatic bile ducts are mildly dilated. The common\nbile duct is dilated, measuring 1.1 cm. There is subtle hyperdensity at the\nexpected location of sphincter of Oddi measuring 2.3 cm (601:35). The finding\nis nonspecific.\nPatient is status post right nephrectomy. The surgical bed is grossly\nunremarkable, without focal nodularity. Multiple surgical clips are noted\nalong the right psoas muscle. Dropped clips are noted posterior to the liver\nand in the right lower quadrant.\n\nGASTROINTESTINAL: There is no intestinal obstruction or ascites. Hiatal\nhernia is moderate in size.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen.\nPatient is status post posterior fixation and decompression with bilateral\nlaminectomies at L4 and L5. No hardware complication is seen. Low-density\nfluid collection in the surgical bed is likely postsurgical seroma. There is\ngrade 1 anterolisthesis of L4 on L5.", "output": "1. Mildly prominent intrahepatic ducts and dilated common bile duct measuring\nup to 1.1 cm, similar to ultrasound from the same day. Subtle 2.3 cm\nhyperdensity at the sphincter of Oddi. The finding is nonspecific and may\nrepresent a mass at the sphincter versus choledocholithiasis versus ingested\nmaterial. If clinically relevant, further assessment with MRCP can be\nconsidered.\n2. Postsurgical changes from right nephrectomy and posterior decompression\nwith fixation at L4 and L5.\n3. 7 mm nodule in the right lower lobe. Please refer to the recommendation\nsection for further follow up.\n\nRECOMMENDATION(S): Consider MRCP.\n\nFor incidentally detected single solid pulmonary nodule measuring 6 to 8 mm, a\nCT follow-up in 6 to 12 months is recommended in a low-risk patient,\noptionally followed by a CT in ___ months. In a high-risk patient, a CT\nfollow-up in 6 to 12 months, and a CT in ___ months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsub cm hypodensity near the dome of the liver is consistent with a simple\nhepatic cyst. An ill-defined hypodensity in segment 6 (series 2, image 73)\nshows peripheral nodular, centripetal enhancement consistent with a hepatic\nhemangioma, unchanged from ___. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple sub cm peripelvic cysts are noted bilaterally. Additional cortical\nsubcentimeter hypodensities in the lower pole of the right kidney are too\nsmall to characterize, but are consistent with simple renal cysts. There is\nno evidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nLYMPH NODES: Prominent mesenteric and aortocaval lymph nodes are noted. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 on L5 with endplate sclerosis is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. A hypodensity in segment 6 of the liver is consistent with a hepatic\nhemangioma, unchanged. No evidence of malignancy within the abdomen and\npelvis" }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for a description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver is homogeneously attenuated throughout. There is no\nfocal lesion. There is no intrahepatic or extrahepatic biliary dilatation. \nThere is a tiny non-obstructing gallstone (Series 7, Image 22). There is no\nevidence of cholecystitis; the gallbladder is decompressed and without\nwall-thickening or pericholecystic fluid. There is no ascites. The portal\nvein appears patent.\n\nPANCREAS: The pancreas is normal in attenuation throughout, without focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly persists and is unchanged, measuring 13.4 cm in longest\ndimension on axial images. The spleen is homogeneously attenuated throughout.\nThere is no focal splenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal\nnephrograms. The right kidney appears low-lying likely from mass effect of\nthe liver, unchanged from the prior exam. Multiple bilateral cortical renal\ncysts as well as parapelvic cysts are unchanged. The largest is in the lower\npole of the left kidney and now measures 3.1 x 2.9 cm, minimally changed from\nthe previous measure of 2.8 x 2.6 cm (Series 4, Image 82). There is no\nconcerning focal renal lesion. There is no evidence of stones,\nhydronephrosis, or perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is extensive diffuse colonic\ndiverticulosis without evidence of diverticulitis. The appendix contains air\nand is normal in caliber without adjacent fat stranding. There is no bowel\nobstruction, intraperitoneal free air, pneumatosis intestinalis, or\nintraperitoneal fluid collection.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries. The SMA, celiac\naxis, and splenic artery are patent.\n\nLYMPHATICS: The previously described prominent lymph nodes have all since\ndecreased in size. One representative node is in the aortal caval region and\nmeasures 9 mm in short axis, previously measuring 2.8 cm (Series 4, Image 79).\nAnother representative node in the paraduodenal region now measures 2 x 1.6 cm\nand previously measured 5.4 x 5.3 cm (Series 4, Image 76). Another\nrepresentative node anterior to the right inferior renal pole now measures 2.9\nx 0.7 cm, and previously measured 6.6 x 4.5 cm (Series 4, Image 85). There is\npersistent symmetric enlargement of the distal external iliac lymph nodes,\nmeasuring 1.2 cm in short axis (Series 4; Image 103).\n\nPELVIS: There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: There is no suspicious lytic or sclerotic bony\nlesion. Multi-level degenerative changes of the spine are again seen with\nloss of intervertebral disc height and anterior osteophytes. There is stable\nmild anterolisthesis of L5 on S1 and retrolisthesis of L2 on L3. The right\ninguinal canal is distended with fat that has extended from the\nretroperitoneum (Series 4, Images 95-112).", "output": "1. No CT evidence of acute infectious process in the abdomen or pelvis\nincluding no evidence of abscess.\n\n2. Significant interval decrease in all previously described affected lymph\nnodes as above. Stable, persistent splenomegaly.\n\n3. Diverticulosis without evidence of diverticulitis.\n\n4. Please refer to CT chest report for above diaphragm findings.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ from the referring team requesting a wet read on the\ntelephone on ___ at 4:09 ___, 1 minutes after discovery of the findings." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions with areas of\nsubpleural and bandlike atelectasis. There is no pericardial effusion\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. There is reactive bowel wall thickening of the\ndistal sigmoid colon, related to the adjacent inflammatory process. The\nappendix is again distended measuring up to 1.6 cm in diameter with adjacent\nperiappendiceal fat stranding and fluid. There is a complex right pelvic\nabscess, as previously described which has increased mildly in size measuring\n5.0 x 6.3 cm versus 5.0 x 5.5 cm previously on the pre-aspiration CT from ___ (2:68). There is no evidence of mesenteric lymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.\nAbdominal and pelvic wall is within normal limits.", "output": "Persistent right pelvic abscess, now slightly larger in comparison to the\npre-aspiration CT from ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The lower esophagus and stomach are unremarkable in\nappearance. Small bowel loops are normal in caliber and without evidence of\nfocal wall thickening. Mild residual reactive inflammatory changes are noted\ninvolving the distal descending and sigmoid colon, having slightly decreased\nas compared to the prior examination. The appendix has decreased in size now\nmeasuring approximately 1.0 cm in diameter with persistent adjacent\ninflammatory fat stranding. An anterior approach pigtail catheter is noted\ncoiled within a tiny residual fluid collection measuring approximately 2.3 x\n2.0 cm (601b:40), previously measuring 5.0 x 6.3 cm on ___.\n\nRETROPERITONEUM: Multiple prominent mesenteric and retroperitoneal lymph\nnodes are not pathologically enlarged by CT size criteria, and are likely\nreactive in nature.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.\nAbdominal and pelvic wall is within normal limits.", "output": "1. Unchanged position of an intra-abdominal drainage catheter which\nterminates within a tiny residual fluid collection.\n2. Residual although decreased periappendiceal inflammatory stranding with\nreactive inflammation of the sigmoid and distal descending colon.\n3. No evidence of appreciable free intraperitoneal fluid or pneumoperitoneum." }, { "input": "LOWER CHEST: The patient is status post lingular 3, with postsurgical changes.\nThe previously seen consolidation in the inferior left upper lobe and\nperibronchial ground-glass opacity in the left lower lobe are partially\nvisualized, difficult due compared to prior due to differences in lung volume\nand non breath hold technique. There is a small left pleural effusion, new\nfrom prior. Enlarged mediastinal lymph nodes are partially visualized, better\nseen on prior dedicated CT chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.4 cm hypodensity in the upper pole of the right kidney is consistent with\nsimple cyst. An additional subcentimeter hypodensity in the lower pole of the\nright kidney is too small to characterize by CT. There are no suspicious\nrenal lesions. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the colon is noted, without evidence of wall thickening and\nfat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\ntrace amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no acute fracture. There is a new 12 mm lytic lesion with\nthinning of the overlying cortex in the anterior right femoral head (3:84). \nThere is grade 1 retrolisthesis L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New 12 mm lytic lesion in the anterior right femoral head with some\nthinning of the overlying cortex. Osseous metastatic lesion is difficult to\nexclude. Attention on follow-up imaging is advised.\n2. No other frank evidence of metastatic disease in the abdomen and pelvis. \nNo focal liver lesions identified.\n3. The visualized lung bases are notable for new left pleural effusion and\nredemonstration of masslike consolidation in the upper lobe and airspace\ndisease in the left upper and lower lobes, partially imaged difficult to\ncompare to prior. This again likely represents a combination of\npostobstructive pneumonia and disease recurrence. Mediastinal lymphadenopathy\nis also incompletely evaluated on the current study.\n4. Cholelithiasis." }, { "input": "LOWER CHEST: Partially imaged bilateral saline breast implants. Visualized\nlung fields are within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nfocal concerning hepatic lesion identified. Patient is status post\ncholecystectomy with expected mild intrahepatic and extrahepatic biliary\nductal dilatation, with the CBD measuring up to 10 mm (05:30), unchanged since\n___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastric bypass with normal-appearing\nexcluded stomach and gastrojejunal anastomosis. Remaining loops of small\nbowel are unremarkable. There is a hazy, ill-defined short segment of distal\nsigmoid colon with a hyperenhancing diverticulum (5:7, 7:24), wall thickening,\npericolonic fat stranding (5:67-71) and thickening of adjacent lateral conal\nfascia (7:23), consistent with mild acute diverticulitis. There is no\npericolonic abscess. No free intraperitoneal air. No mesenteric free fluid. \nThroughout the remaining sigmoid colon, there are multiple diverticula. \nOtherwise, the colon and rectum are unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Mild degenerative changes of the thoracolumbar spine, worst at L4-L5. \nNo lytic or sclerotic lesions suspicious for malignancy. No acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild acute uncomplicated sigmoid diverticulitis.\n2. Status post cholecystectomy with expected mild intrahepatic and\nextrahepatic biliary ductal dilatation.\n3. Status post gastric bypass with normal-appearing excluded stomach and\ngastrojejunal anastomosis.\n\nRECOMMENDATION(S): The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:14 ___, 1 minute after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix is normal. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nThere is no fracture. Abdominal and pelvic wall is within normal limits.", "output": "No acute findings. Normal appendix." }, { "input": "Chest: The bases of the lungs are clear bilaterally. Visualized heart\ndemonstrates coronary artery calcifications.\n\nAbdomen: The liver enhances homogeneously. Within segment VI of the liver is\na 3.8 x 3.5 cm hemangioma previously characterized on MR dated ___\n(series 4, image 45). There is no intrahepatic biliary dilatation. The portal\nvein appears patent. Best appreciated on sequence 6 image 44 is a thrombus\nwithin the splenic vein, with gastric varices noted. Inferior to the uncinate\nprocess is a 2.4 x 4.5 cm fluid collection. Previously identified walled-off\nnecrosis seen on prior examination dated ___ is significantly\ndecreased in size, now measuring 3.5 x 8.5 cm (4:41) with a gastrocystic drain\nin place, with trace fluid and a small amount of gas within the collection.\nThere is persistent moderate stranding around this area. Several calcific\ndensities are identified throughout the body of the pancreas, the largest\nwhich measures 8 x 9 mm seen best on sequence 3 image 22. Additional punctate\nstones are noted at the tail of the pancreas. There is no pancreatic ductal\ndilatation. An accessory spleen lies adjacent to the inferior aspect of the\nspleen. The spleen is normal in size.\n\nBilateral adrenal glands are normal. The kidneys present symmetric nephrograms\nand excretion of contrast. Several cortical hypodensities are identified\nbilaterally. These appear stable when compared to examination most recently\n___ statistically most compatible with simple cysts. Again seen is\nleft hydroureter without evidence of ureterolithiasis or nephrolithiasis,\nunchanged since prior examination.\n\nThere is a large hiatal hernia. Loops of small bowel are unremarkable.\nVisualized portions of colon demonstrate diverticular disease without\ndiverticulitis. There is no abdominal free air or fluid.\n\nThe abdominal aorta demonstrates moderate atherosclerotic calcifications\nwithout aneurysmal dilatation. Scattered retroperitoneal nodes as well as\nmesenteric nodes, likely reactive, are identified, which do not meet CT size\ncriteria for pathology. Note is made of a replaced left hepatic artery with\nits origin from the left gastric and a replaced right hepatic artery with its\norigin from the superior mesenteric artery.\n\nOsseous structures: Multilevel degenerative changes are noted throughout the\nthoracolumbar spine, most notably at the L1-L2 level and L4-L5 with endplate\nsclerosis and narrowing of disc space. Prominent anterior osteophytes at this\nlevel are additionally seen.", "output": "1. Post drainage of massive walled-off necrosis from the ___ CT. The\ncollection now measures 3.5 x 8.5 cm, containing a gastrocystic catheter.\n2. Separate 4.5 x 2.4 cm fluid collection inferior to the uncinate process.\n3. Persistent left hydroureter without nephrolithiasis or ureterolithiasis.\n4. Stable segment VI hepatic hemangioma." }, { "input": "LOWER CHEST: Subsegmental atelectatic changes at the lung bases. There are no\npleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is re-demonstration of a high-grade mechanical\nsmall-bowel obstruction, with small bowel loops dilated up to 3.6 cm. There\nis a transition point within a large umbilical hernia, containing several\nloops of dilated small bowel, with the efferent loop being the site of\ntransition (2:64). The hernia sac contains multiple dilated and decompressed\nsmall bowel loops, as well as a segment of transverse colon. The distal small\nbowel and colon outside of the hernia sac are decompressed. There is no\npneumatosis or portal venous gas. There is however fat stranding within the\nsmall bowel mesentry, as well as a small volume of ascites within the hernia\nsac extending into the abdomen.\n\nPELVIS: A Foley catheter is present in the urinary bladder, which is\ncollapsed.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. High-grade mechanical small bowel obstruction, secondary to a large\numbilical hernia, with the transition at the level of a small bowel loop\nexiting the hernia sac.\n2. Associated mesenteric inflammatory changes and small volume ascites.\n\nRECOMMENDATION(S): The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:12 pm, 10 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Splenic\nhypodensity measures up to 2.2 x 1.8 cm, slightly increased in size compared\nto ___.\n\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix fluid-filled and dilated measuring up to 9 mm in\ndiameter (02:53). 6 mm hyperdensity seen near the base of the appendix is\nmost in keeping with an appendicolith (602:35). There is moderate volume\nascites. Punctate foci of air are demonstrated along the anterior abdominal\nwall (for example 02:37, 32), likely related to patient's peritoneal dialysis\ncatheter.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Again\ndemonstrated is a percutaneous peritoneal dialysis catheter coursing from the\nleft lower quadrant abdominal wall into the right pelvis. Large volume free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The unenhanced uterus and adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute appendicitis with appendicolith. No evidence to suggest perforation.\n2. Large volume ascites, in the presence of a peritoneal dialysis catheter.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:38 am, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Limited evaluation of the lung bases shows small bilateral\npleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains multiple\ngallstones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are unchanged subcentimeter hypodense lesions in the left kidney, that\nare too small to characterize. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Nasogastric tube has its tip terminating in the gastric\nbody. There is a small hiatal hernia. The patient is status post right\nhemicolectomy with unremarkable anastomotic site. The colon and rectum are\nwithin normal limits. The small bowel is diffusely fluid-filled and mildly\ndilated, with no transition point noted.\nThere is trace ascites, likely postsurgical.\n\nPELVIS: The bladder is decompressed with a Foley catheter within it.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Again noted are severe degenerative changes throughout the lumbar\nspine, with grade 1 anterolisthesis of L3 on L4.\n\nSOFT TISSUES: There is mild subcutaneous emphysema throughout the abdominal\nwall, likely postsurgical.", "output": "1. Diffusely mildly dilated fluid-filled loops of the small bowel with no\ntransition point, likely represents ileus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:34 AM, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions with compressive\natelectasis in the right lower lobe and left lower lobe atelectasis. The\nheart is enlarged but there is no pericardial effusion in the visualized\nportion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Patient is status post recent\ncholecystectomy. There is new mild perihepatic ascites. There is trace fluid\nin the cholecystectomy bed, without any organized fluid collections. Small\nbowel loop has migrated near the cholecystectomy bed well.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. There are few probable small renal cysts. . \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post right hemicolectomy. There are\ndilated loops of small bowel without a distinct transition point likely\nrepresenting an ileus. The stomach is unremarkable and there is oral contrast\nin the remaining large bowel.\n\nFLUID: There is a mild amount of perihepatic free fluid of intermediate\ndensity, although evaluation of the density is somewhat limited by artifact\nand this may represent simple fluid rather than hemorrhagic fluid.\n\nPELVIS: The bladder is collapsed with a Foley catheter. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is a total right hip arthroplasty without evidence of hardware\ncomplication. Multilevel degenerative changes throughout the spine. \nDegenerative changes left hip, sacroiliac joints.\n\nSOFT TISSUES: An incision within the left lower abdominal region is noted.", "output": "1. Dilated loops of small bowel without a distinct transition point likely\nrepresent an ileus.\n2. Mild volume intermediate density perihepatic fluid, though evaluation of\ndensity limited by artifact. While this likely represents simple fluid,\nrecommend correlation with hematocrit to exclude hemorrhagic fluid.\n3. Small bilateral pleural effusions with basilar atelectasis." }, { "input": "Evaluation is markedly limited secondary to motion degradation, streak\nartifact related to positioning of the arms over the abdomen, and patient body\nhabitus.\n\nLOWER CHEST: There are small bilateral pleural effusions with associated\ncompressive atelectasis, unchanged. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation. The gallbladder\nsurgically absent. Fluid in the cholecystectomy bed has decreased since the\nprior CT from ___. Again seen is a small amount of perihepatic\nascites, unchanged.\n\nPANCREAS: The pancreas is homogeneous in attenuation. There is no pancreatic\nmass or main ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and homogeneous in attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There are postsurgical changes of right hemicolectomy. \nSmall bowel loops are normal in caliber. Oral contrast has mostly passed\nsince the prior CT, with a small amount of residual contrast in the rectum. \nThere is retained oral contrast in a few colonic diverticula.\n\nPELVIS: Evaluation of the pelvis is limited by streak artifact from a right\nhip prosthesis. The bladder is decompressed by a Foley catheter. There is a\nsmall amount of gas in the bladder.\n\nREPRODUCTIVE ORGANS: The reproductive organs are able to be assessed secondary\nto streak artifact from a right hip prosthesis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are multilevel spinal degenerative changes. There is a partially\nimaged right hip prosthesis. There is osteoarthritis of the left hip joint\nand bilateral sacroiliac joints.\n\nSOFT TISSUES: There are injection granulomas in the bilateral gluteal\nsubcutaneous fat.", "output": "1. Technically limited study. Status post cholecystectomy. Interval decrease\nin fluid in the cholecystectomy bed since the prior CT from ___.\n2. Small amount of perihepatic ascites, unchanged.\n3. Interval passage of oral contrast since the prior CT, with a small amount\nof residual contrast in the rectum. Normal caliber small bowel loops, without\nevidence of ileus or obstruction.\n4. Small bilateral pleural effusions with associated compressive atelectasis,\nunchanged." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN: The study is limited by large body habitus and metal artifact from\nthe right total hip replacement.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Multiple\nhypodense cortical lesions kidneys likely represent simple renal cysts and are\nunchanged since at least ___. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. A percutaneous gastrostomy\ntube is seen with the bumper inflated within the body of the stomach. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Patient is status post right colectomy. The surgical anastomosis\nis intact. Multiple diverticula are seen near the anastomotic site as well as\nalong the transverse colon without evidence of diverticulitis.\n\nPELVIS: Assessment of intrapelvic now is limited secondary to metal artifact\nfrom right THA. Partially imaged bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: The partially imaged uterus is unremarkable. There is a\nunchanged calcification within the right adnexa.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Diffuse thoracolumbar intervertebral disc space narrowing is again\nnoted. No suspicious osseous lesions.\n\nSOFT TISSUES: A midline ventral hernia contains fat and nonobstructed loops of\nbowel. Fatty density lesions in the anterior abdominal wall likely post\ninjection fat necrosis. Posterior body wall subcutaneous calcifications are\nlikely injection granulomas.", "output": "1. No evidence for recurrence or metastases in the abdomen or pelvis within\nthe limitations of an exam limited by body habitus and metal artifact from a\nright hip THA.\n2. Midline ventral hernia containing fat and nonobstructed loops of bowel.\n3. Please see report from same day CT of the chest full description of\nintrathoracic findings." }, { "input": "Heart size is normal without significant pericardial fluid. The imaged lung\nbases are clear.\n\nCT abdomen with contrast: Liver enhances homogeneously without focal lesion\nor biliary dilatation. Gallbladder is decompressed and unremarkable. Portal\nvein is patent. Mild prominence of the common bile duct is unchanged.\n\nCalcified splenic granuloma is unchanged. Spleen, pancreas and adrenal glands\nare otherwise unremarkable. Kidneys present symmetric nephrograms and\nexcretion of contrast without focal lesion or hydronephrosis.\n\nPostsurgical changes are present from Roux-en-Y gastric bypass without\nevidence of obstruction. The afferent and the afferent loops are\ndecompressed. Small bowel loops are normal caliber without evidence of\nobstruction. Large bowel is decompressed and unremarkable without pericolonic\nfat stranding or fluid collection. A normal air-filled appendix is noted in\nthe right lower quadrant.\n\nA small 8 mm soft tissue nodule with central hyperdensity likely from\ncalcification is noted adjacent to the mid transverse colon (02:30), which was\npresent on the prior examination in ___ and is similar in appearance. \nAdditional adjacent soft tissue lesions, some with calcifications, also seen\ninferior to the liver (2: 20, 22, 27). These have been seen on prior exams\nand could be sequela of prior epiploic appendagitis or fat necrosis.\n\nAbdominal aorta is normal caliber. There is no mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria. There is no ascites or pneumoperitoneum.\nThere is no ventral abdominal hernia.\n\nCT pelvis with contrast: Slight irregular contour of the uterus corresponds\nto fibroids as seen on prior pelvic ultrasound. Bladder, uterus, ovaries and\nrectum are otherwise unremarkable. There is no free pelvic fluid or air. \nThere is no inguinal or pelvic sidewall lymphadenopathy by CT size criteria.\n\nBones and soft tissues: There is no suspicious focal bone lesion.", "output": "No acute findings in the abdomen or pelvis." }, { "input": "LOWER CHEST: Bibasilar atelectasis and mild edema at the lung bases. The\nheart is moderately enlarged. Trace pleural effusions noted. No pericardial\neffusion.\n\nABDOMEN: A peritoneal dialysis catheter terminates within the right lower\nquadrant. Multiple small foci of free intraperitoneal air and small volume\nintraperitoneal fluid are likely related to recent peritoneal dialysis.\n\nHEPATOBILIARY: Noncontrast appearance of the liver is normal. The gallbladder\ncontains gallstones without wall thickening or evidence of inflammation.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys appear atrophic with simple appearing lower pole cysts noted.\nThere is no hydronephrosis or kidney stone.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder is mostly collapsed though mild perivesical fat\nstranding is noted raising potential concern for urinary infection. There is\nno free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild perivesical fat stranding could reflect urinary infection. Please\ncorrelate with UA.\n2. Peritoneal dialysis catheter terminating within the right lower quadrant of\nthe pelvis.\n3. Cardiomegaly, trace bilateral pleural effusions and mild pulmonary edema at\nthe lung bases.\n4. Cholelithiasis without evidence of cholecystitis." }, { "input": "LOWER CHEST: Evaluation of the lower chest demonstrates a small right-sided\npleural effusion and associated compressive atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates cirrhotic morphology. There is\nextensive infiltrative tumor throughout the majority of the right hepatic lobe\nspanning a diameter of approximately 17 cm, compatible with infiltrative\nhepatocellular carcinoma. This is seen to a lesser degree involving most of\nthe medial aspect of the lateral segment. Consequently, there is tumor\nthrombus in the left and right portal veins as well as bland thrombus in the\nright, left and main portal veins. Cavernous transformation of the portal\nvein is seen at the hilum.\n\nGallbladder wall edema is likely secondary to hepatocellular disease.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Moderate splenomegaly measuring 16 cm is noted.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable aside for multiple hypodense lesions are\ntoo small to characterize. No hydronephrosis or solid renal lesions.\n\nGASTROINTESTINAL: No bowel obstruction. There is a small amount of ascites.\n\nPELVIS: No enlarged pelvic lymph nodes.\n\nLYMPH NODES: There are no enlarged abdominal or pelvic lymph nodes. Prominent\nperipancreatic and periportal lymph nodes measuring up to 1.1 cm are most\nlikely reactive.\n\nVASCULAR: No abdominal aortic aneurysm. Numerous portosystemic shunts are\nnoted, evidence of portal hypertension.\n\nBONES: No aggressive osseous lesions.\n\nSOFT TISSUES: Rectus diastasis noted.", "output": "1. Cirrhosis liver withextensive infiltrative hepatocellular carcinoma\ninvolving nearly the entire right hepatic lobe and most of the lateral segment\nwith vascular extension as above.\n2. Bland and tumor thrombus involves the right and left portal veins; the\nbland thrombus extends into the main portal vein with cavernous\ntransformation.\n3. Sequela of portal hypertension, including numerous portosystemic shunts,\nsplenomegaly, and ascites." }, { "input": "LOWER CHEST: There are dependent bilateral lower lobe consolidations and\nadjacent ground-glass opacities concerning for aspiration with possible\naspiration pneumonia and small pleural effusions. Please refer to separate\nreport for same-day CT chest for complete description of the thoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: An 8 mm left adrenal apex nodule is unchanged (series 2, image 61). \nThe right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. Possible punctate nonobstructing nephrolithiasis, though\nmore likely atherosclerotic calcifications. Mild symmetric perinephric fat\nstranding is unchanged, a nonspecific finding.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. A rectal tube is in place. The\nappendix is normal. Trace peritoneal free fluid is noted.\n\nPELVIS: A Foley catheter is in place with intravesicular gas. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Subcentimeter retroperitoneal lymph nodes are unchanged. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Unchanged L1 and L4 burst fractures with 4 mm of osseous retropulsion\nat L4. No evidence of new fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nBilateral subcutaneous edema in the gluteal regions in proximal thighs.", "output": "1. No evidence of abdominopelvic hemorrhage or infection.\n2. Dependent bilateral lower lobe consolidations and adjacent ground-glass\nopacities concerning for aspiration with possible infection are better\nassessed on same day chest CT.\n3. Unchanged L1 and L4 burst fractures with retropulsion at the level of L4.\n4. An 8 mm left adrenal apex nodule is incompletely characterized. This could\nbe further assessed with dedicated adrenal protocol CT or MRI." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 1.4 x 1.0 cm cyst in the lateral left lobe (04:14),\nunchanged since at least ___. There is an additional hypoattenuating lesion\nadjacent to the right anterior portal vein which is too small to completely\ncharacterize, but likely an additional cyst (04:19). There is a 0.9 cm\nhyperenhancing lesion in segment VIII (4:9). The liver otherwise demonstrates\nhomogenous attenuation throughout. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no nephrolithiasis or hydronephrosis. There is a 2.2 x 3.1 cm simple\ncyst in the interpolar left kidney and additional 0.8 x 1.0 cm simple cyst in\nthe lower pole of the left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes at L5-S1 which include bilateral pars\ninterarticularis defects, osteophytosis, endplate sclerosis, disc space\nnarrowing, and vacuum disc phenomenon.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No nephrolithiasis or colitis. No other etiology identified for the\npatient's reported symptoms.\n2. 9 mm hyperenhancing lesion in segment VIII of the liver may represents a\nhemangioma or FNH in the absence of a history of malignancy. However,\nnonurgent dedicated ultrasound recommended for further characterization.\n\nRECOMMENDATION(S): Liver ultrasound for further evaluation of 9mm enhancing\nlesion in the liver." }, { "input": "Lung bases are clear. There is no pleural or pericardial effusion.\n\nCT of the abdomen: The liver demonstrates decreased attenuation, consistent\nwith mild hepatic steatosis. No focal hepatic lesions identified. No intra or\nextrahepatic biliary ductal dilatation. The gallbladder contains a small\namount of stones, with no evidence of acute cholecystitis. The adrenal\nglands, pancreas and spleen are normal. The bilateral kidneys enhance\nsymmetrically and excrete contrast without evidence of hydronephrosis or renal\nmasses.\n\nPatient is status post mobilization of the splenic flexure and\nabdominoperineal resection. The stomach, proximal small bowel as well as\nascending and transverse colon appear grossly intact. There are minimally\ndilated loops of small bowel in the lower abdomen, with no evidence of small\nbowel obstruction. There is an end colostomy seen in the left lower quadrant\nwith surrounding soft tissue stranding, presumed expected postsurgical\nchanges. There is a low-density fluid collection in the subcutaneous tissues\nof the anterior abdominal wall, within the pannus and just below the suture\nline, which measures approximately 3.5 x 1.2 x 14 cm, likely a seroma. There\nis no free air.\n\nThe intra-abdominal aorta contains mild to moderate amount of atherosclerotic\ncalcifications. The celiac axis, SMA, bilateral renal arteries and ___ are\npatent.\n\nCT of the pelvis: The urinary bladder contains small foci of air, likely\nsecondary to recent instrumentation. Postsurgical changes related to recent\ncoccygectomy, APR and flap closure noted within the pelvis and presacral\nspace, including soft tissue stranding, foci of air and probable small amount\nof fluid. There is a poorly marginated collection in the left gluteal region\nwhich extends to the region of the presacral space and measures approximately\n7.3 x3.2 x 5.5 cm (series 4, image 80). Stranding and subcutaneous gas also\nextends into the gluteal region bilaterally. Linear hyperdensity extends from\nthe rectal region into the gluteal region (series 4, image 87). No organized\ndrainable fluid collection is identified. A surgical catheter terminates\nwithin the presacral space. Fiducial markers are also noted.\n\nOsseous structures: There is mild scoliosis of the lumbar spine. Multilevel\ndegenerative changes are noted along the thoracolumbar spine. No blastic or\nlytic lesion concerning for malignancy.", "output": "1. Status post abdominoperineal resection, mobilization of the splenic\nflexure, coccygectomy and flap closure with postsurgical changes seen in the\npresacral, rectal and gluteal region including subcutaneous gas, fat stranding\nand fluid.\n\n2. Left gluteal poorly marginated collection extending to the region of the\npresacral space, no definite organized drainable fluid collection identified\nin this examination.\n\n3. Long strip of intraabdominal fluid within the pannus, right below the\nsuture line, likely a seroma.\n\n4. No evidence of small bowel obstruction.\n\n5. Cholelithiasis, no acute cholecystitis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 11:30 ___, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Multiple hypodense splenic lesions are again visualized not\nsignificantly changed from prior CT likely represent hemangiomas.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nMultiple evidence renal lesions likely represent simple cysts. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate-sized hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: A couple calcified mesenteric lymph nodes are seen. There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the spine are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No significant interval change in appearance of splenic lesions with\ndifferential favoring hemangiomas as per prior MRI.\n2. Please see chest CT report for evaluation of chest findings." }, { "input": "LOWER CHEST: Minimal subsegmental atelectasis is identified in the lingula. \nNo pleural effusions are present.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse fatty change of liver. There is no evidence\nof focal lesions on this unenhanced CT study. . There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is congenitally absent. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed but does not show any gross\nabnormalities. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The seminal vesicle and prostate normal in size for the\nage of the patient.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The left kidney is congenitally absent. 2. Diffuse fatty change of liver.\n3. No explanation for the patient's abdominal pain." }, { "input": "LOWER CHEST: Mild atelectasis in the lung bases without focal consolidation. \nThere is no evidence of pleural or pericardial effusion. Coronary artery\ncalcifications are noted diffusely. Heart size is normal.\n\nABDOMEN:\n\nEvaluation of the upper abdomen is mildly limited due to streak artifact from\npatient's spinal hardware.\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 8 mm obstructing stone is seen in the distal left ureter, measuring\n363 Hounsfield units in density (series 2; image 68). There is moderate\nupstream hydroureteronephrosis with left kidney enlargement and perinephric\nstranding. Additional nonobstructing calculi are seen in the left renal\npelvis (series 2; image 32) and left upper pole.\n\nThere does not appear to be upstream dilatation from this calculus. 3.9 cm\nhypodensity off the upper pole of the right kidney likely represents a simple\ncyst. No right-sided hydroureteronephrosis is present though the mid right\nureter is minimally prominent. Mild nonspecific right perinephric stranding\nis also appreciated.\n\nGASTROINTESTINAL: Small hiatal hernia. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber and wall thickness throughout. There\nis colonic diverticulosis without surrounding inflammation to suggest\ndiverticulitis. The appendix not definitively visualized\n\nPELVIS: The bladder is decompressed with Foley catheter in situ. Radiopaque\ndensities in the bladder measuring up to 5 mm near the left ureterovesicular\njunction consistent with bladder calculi. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not definitively visualized. There is no large\nadnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status post posterior fusion of T11 through L1 without\nevidence of hardware complication. There is compression deformity at T12,\nwhich is of unknown chronicity. No additional compression deformities are\nidentified. There is grade 1 anterolisthesis of L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 8 mm obstructing distal left ureter calculus with moderate upstream\nhydroureteronephrosis, left kidney enlargement and perinephric stranding. \nUnderlying pyelonephritis/urinary tract infection cannot be excluded.\n2. Multiple additional stones are seen in the left renal pelvis, upper pole\nthe left kidney, as well as within the bladder.\n3. Patient is status post T11 through L1 posterior fusion without hardware\ncomplication. Compression deformity at T12 vertebral body is of unknown\nchronicity." }, { "input": "Lungs: Small bilateral pleural effusions, greater on the left, with associated\nsubsegmental atelectasis.\n\nLiver: The liver is homogeneous with a smooth contour. No suspicious liver\nlesion.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\nis unremarkable.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. No pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Hypodensities are seen in both kidneys, the largest seen in the upper\npole of the left kidney measuring up to 6.2 cm in diameter, likely cortical\ncysts. No hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nReproductive organs: The visualized reproductive organs are unremarkable.\n\nGastrointestinal: The bowel is within normal limits. No evidence of\nobstruction.\n\nVascular: Mild atherosclerotic calcifications of the abdominal aorta.\n\nLymph nodes: No size significant lymph nodes.\n\nBone and soft tissues: No suspicious bone lesion. Mild wedge compression\nfracture of L1, with no retropulsion.", "output": "1. No acute intra-abdominal findings.\n\n2. Please see report of the scrotal ultrasound performed on ___\nfor more details.\n\n3. Mild wedge compression fracture of L1, with no retropulsion." }, { "input": "LOWER CHEST: Trace bilateral pleural effusions and bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable hypodensities in the liver are compatible with simple cysts as seen on\nprior MRI. There is minimal prominence of the intrahepatic bile ducts,\nparticularly the right anterior branch, which may be postsurgical in nature. \nThe gallbladder not clearly visualized.\n\nPANCREAS: There is mild pancreatic ductal dilatation measuring up to 5 mm at\nthe junction of the neck and body of the pancreas, likely related to recent PD\nreanastomosis. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Status post gastrojejunostomy and trans duodenal resection\nwith CBD/PD re-anastomosis. The tip of an enteric tube terminates in the body\nof the stomach. There are numerous dilated fluid-filled loops of small bowel,\nsome of which with air-fluid levels, with a suspected transition point in the\nanterior pelvis where there are numerous collapsed loops of small bowel\nadherent to the anterior abdominal wall subjacent to the surgical incision\n(series 4, image 49. Minimal free air is seen just superior to the\nright-sided abdominal wall catheter (05:38) whose tip terminates in the right\nhemiabdomen there is another tiny focus of free air within the anterior\nabdominal wall on 5:61, likely related to recent surgery. Mild\ncircumferential wall thickening of the right colon is more prominent since\nprior, may be reactive, consider infectious or inflammatory enteritis. Normal\ncaliber appendix, 0.7 cm, which trace fluid adjacent to it, likely reactive is\nsecondary to small volume abdominal ascites.\n\nPELVIS: The urinary bladder contains a large amount of nondependent gas,\nlikely related to recent instrumentation. Trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is fibroid uterus. No adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes from midline incision in the anterior\nabdominal wall without evidence for hernia, as clinically questioned.", "output": "1. Status post trans duodenal resection of ampullary mass with\ngastrojejunostomy and CBD/PD reanastomosis. There is minimal prominence of\nthe pancreatic duct and the intrahepatic bile ducts, particularly the right\nanterior branch, which may be postsurgical in nature.\n2. Findings are compatible with small bowel obstruction with a transition\npoint in the anterior pelvis in the region of collapsed loops of small bowel\nadherent to the anterior abdominal wall subjacent to the surgical incision. \nMinimal free air in the abdomen is likely related to recent surgery (postop\nday 5).\n3. No evidence of hernia, as clinically questioned.\n4. Trace bilateral pleural effusions.\n5. Large amount of air within the urinary bladder likely relates to recent\ninstrumentation.\n6. Mild circumferential wall thickening right colon, mildly more prominent,\nmay be reactive, consider inflammatory or infectious colitis." }, { "input": "LOWER CHEST: A right pleural effusion is seen, increased compared to prior\nwith adjacent compressive atelectasis.\n\nABDOMEN: The liver is unremarkable. There is no evidence of biliary\ndilatation. Cholelithiasis is noted.\nThe spleen and adrenal glands are unremarkable.\n\nPANCREAS: There has been interval worsening in increased pancreatic fat\nattenuation and in diffuse peripancreatic stranding consistent with worsening\npancreatic edema and evolving peripancreatic necrosis. No drainable fluid\ncollection is identified. There is no evidence of pancreatic parenchymal\nnecrosis.\n\nURINARY: Stable hypodense renal lesions too small to characterize are noted. \nThe kidneys are otherwise unremarkable. There is no hydronephrosis.\n\nGASTROINTESTINAL: There is mild ascending colon dilatation without evidence of\na transition point, which may represent developing colonic ileus. There is no\nobstruction or free air. Trace ascites is similar to prior.\n\nPELVIS: There is trace free fluid in the pelvis.The patient is status post\nhysterectomy. The adnexal are unremarkable for age.\n\nLYMPH NODES: There is no abdominopelvic lymphadenopathy.\n\nVASCULAR: The splenic vein and splenic artery are patent.\n\nBONES: There is no evidence of aggressive osseous lesions. Lumbar hardware\nagain noted.", "output": "1. Worsening acute pancreatitis evidenced by increased pancreatic edema and\nperipancreatic necrosis. No drainable fluid collection. No evidence of\npancreatic parenchyma necrosis.\n2. Mild ascending colon dilatation without transition point, new compared to\nprior study, likely representing developing colonic ileus.\n3. Increased right pleural effusion." }, { "input": "LOWER CHEST: There has been interval resolution of the previously seen right\npleural effusion. The visualized lungs are clear without evidence of\nconsolidation. There is no pericardial effusion..\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout,\nwithout evidence of concerning focal hepatic lesion. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is contracted\nand likely contains a gallstone or polyp. Portal vein is patent.\n\nPANCREAS: There is a subtle focal heterogeneity at the tail of the pancreas\nwhich may suggest a small region of necrosis and attention on follow up is\nrecommended. The remainder of the pancreatic parenchyma demonstrates\nhomogenous attenuation throughout. There is no pancreatic ductal dilatation.\nThere has been interval organization of previously seen diffuse peripancreatic\nedema into several peripancreatic fluid collections. The largest of these\nmeasures 8 x 4 x 5 cm extending from the anterior aspect of the pancreatic\nbody into the lesser sac (5:25). This fluid collection is seen to exert\nminimal mass effect on the region of the gastric pylorus. The fluid\nattenuation of this collection appears simple. This fluid collection tracks\nposteriorly and laterally along the left anterior renal fascial lines where\nseveral other more focal, simple appearing collections are noted (5:19, 5:31).\nAn additional focal fluid collection is noted along the anterior renal fascia\non the right (5:31). The superior mesenteric vein is patent. The splenic vein\nis patent. The splenic artery is not well assessed on this non-arterial phase\nstudy.\n\nSPLEEN: The spleen demonstrates normal size and attenuation throughout. There\nis no evidence of concerning focal lesion. No perisplenic fluid collection.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: Kidneys are of normal size and are symmetric. There is no evidence of\nconcerning focal renal lesion. Punctate hypodensities are too small to\ncharacterize but are favored to represent a benign etiology such as simple\nrenal cysts. No hydronephrosis. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement. The previously noted mild\ndilatation of the ascending colon is no longer visualized. There are sigmoid\ndiverticula without evidence of diverticulitis. No ascites.\n\nPELVIS: Urinary bladder and distal ureters are unremarkable. No free fluid\nwithin the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.\n\nLYMPH NODES: No evidence of abdominopelvic lymphadenopathy.\n\nVASCULAR: No evidence of abdominal aortic aneurysm.\n\nBONES: No evidence of acute fracture or worrisome osseous lesion. The patient\nis status post placement of posterior fixation hardware at the level of L4-L5\nwith a disk-spacing device.\n\nSOFT TISSUES: Soft tissues of the abdominopelvic wall are unremarkable.", "output": "1. Interval change in morphology and organization of diffuse peripancreatic\nedema into several simple appearing peripancreatic fluid collections. The\nlargest of these measures 8 x 4 x 5 cm extending from the anterior aspect of\nthe pancreatic body into the lesser sac. This fluid collection tracks\nposteriorly and laterally along the left anterior renal fascial lines where\nother more focal, simple appearing collections are noted. An additional focal\nfluid collection is noted along the anterior renal fascia on the right.\n2. There has been interval resolution of the previously seen right pleural\neffusion.\n3. The previously noted mild dilatation of the ascending colon is no longer\nvisualized.\n4. Gallstone or polyp is seen within the gallbladder.\n5. Sigmoid diverticula without evidence of diverticulitis." }, { "input": "LUNG BASES: The imaged lung bases appear clear. The imaged portion of the\nheart is unremarkable. No pleural or pericardial effusion is seen.\n\nABDOMEN: Persistent similar pattern of pneumobilia with mild prominence of the\nintrahepatic biliary tree most notably in the left hepatic lobe, which is\nunchanged. Patient has had a history of hepaticojejunostomy complicated by\nbiliary stricture requiring hepaticojejunostomy revision in ___. The\nhepaticojejunostomy is seen anterior to the porta hepatis and is decompressed.\nEvaluation for cholangitis is limited. No focal concerning liver lesion. \nMain portal vein is patent. The gallbladder is surgically absent. The\npancreas appears normal. The spleen is normal in size. Adrenals are normal\nbilaterally. The kidneys enhance symmetrically. No hydronephrosis or\nworrisome renal lesion. The abdominal aorta is normal in course and caliber\nwithout significant atherosclerotic calcification. No retroperitoneal or\nmesenteric adenopathy. No free air or free fluid. The stomach and duodenum\nappear normal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is normal. The colon contains a moderate fecal load and demonstrates\nno wall thickening or evidence of pericolonic inflammation. Diverticulosis\nalong the sigmoid colon without evidence of diverticulitis is also noted. The\nuterus is surgically absent. There is no adnexal mass. Urinary bladder is\nwell distended and appears normal. There is no pelvic sidewall or inguinal\nadenopathy.\n\nBONES: No worrisome lytic or blastic osseous lesion is seen.", "output": "1. No acute findings to account for abdominal pain.\n2. Postoperative changes related to prior hepaticojejunostomy with similar\npattern of mild intrahepatic biliary ductal dilation most notably in the left\nlobe as on prior, with pneumobilia. Please note, cholangitis is impossible to\nexclude on the basis of this exam." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings. There is minimal bibasilar dependent\natelectasis. There is no pleural effusion.\n\nAbdomen/pelvis:\nThere is normal hepatic parenchymal density. There is no evidence of hepatic\nmass. There is no intrahepatic or extrahepatic biliary ductal dilatation.\nGallbladder is unremarkable. Spleen is not enlarged. There is no evidence of\npancreatic mass or pancreatic ductal dilatation.\n\nAdrenal glands are unremarkable. There is symmetric renal enhancement and\nexcretion of intravenous contrast. 9 x 12 mm fluid attenuation structure\narising from the lower pole of the right kidney is consistent with cyst. There\nis no evidence of hydronephrosis or renal mass. Urinary bladder is moderately\ndistended without gross abnormality.\n\nThere are no dilated loops of bowel. There is no bowel wall thickening. The\nappendix is unremarkable in appearance. There is no intraperitoneal free air\nor free fluid.\n\nThere is moderate atherosclerotic calcification of the abdominal aorta without\nevidence of aneurysmal dilatation. There is no evidence of abdominal aortic\naneurysmal dilatation.\n\nThere are no enlarged inguinal, iliac chain, mesenteric, or retroperitoneal\nlymph nodes. There is no suspicious osseous lesion.", "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. Please see separate dictation for dedicated CT chest report." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Unchanged scattered pancreatic\ncalcifications are noted, and may be a sequelae of chronic pancreatitis. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nA 1.7 cm simple cyst in the right upper pole is unchanged. Additional\nsubcentimeter hypodensities are too small to characterize but most likely\nrepresent cysts. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a moderate hiatus hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nApparent thickening of the wall of transverse, descending and sigmoid colon is\nlikely related to underdistention. The colon and rectum are otherwise\nunremarkable. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Interval increase in the size of a left external iliac node,\nwhich measures 2.2 x 2.8 cm, previously 1.8 x 2.5 cm on ___. A right\nexternal iliac node measures 1.0 cm, grossly unchanged in comparison with ___ (2:103). Multiple left inguinal lymph node measure up to 1.2 cm,\nsimilar to prior (2:121). These nodes were FDG avid on PET CT from ___. Additional small but non pathologically enlarged retroperitoneal lymph\nnodes are grossly unchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Moderate stenosis of the celiac artery with poststenotic\ndilation is unchanged.\n\nBONES: Sclerotic lesion in the left tenth lateral rib is unchanged, most\nlikely a bone island. Extensive degenerative changes of the thoracolumbar\nspine are again seen. Sclerotic endplate changes at L2 and L3 are most likely\ndegenerative.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval increase in the size of a left external iliac lymph node, which\nnow measures 2.2 x 2.8 cm, previously 1.8 x 2.5 cm. Additional left inguinal\nand right external iliac lymph nodes, which were FDG avid on PET CT from ___ are unchanged.\n2. No new metastatic lesions are identified in the abdomen or pelvis.\n3. Please see the separately dictated CT chest report from the same date for a\ndescription of thoracic findings." }, { "input": "LOWER CHEST: Please refer to dedicated chest CT performed on the same date for\ndescription of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypodense lesion in the upper pole of the left kidney measuring 2 cm (5:66) is\nconsistent with a simple cyst, unchanged since the ___ exam. 2 small\nhypodense lesions in the lower pole of the right kidney are too small to\ncharacterize, but statistically likely to be simple cysts. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Re-demonstrated is a moderately sized hiatal hernia. The\nstomach is unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is been interval decrease in size of the left external\niliac node, currently measuring 1.7 x 0.9 cm (5:111), previously 2.8 x 2.2 cm.\nThere has also been interval decrease in size in the right external iliac node\n(5:100), currently 0.7 cm previously 1 cm. Additionally, there has been\ninterval decrease in size of the left inguinal nodes, the largest of which now\nmeasures 0.7 cm (5:122) previously 1.2 cm. A 0.9 cm right external iliac node\n(5:105) is unchanged since ___. Additional retroperitoneal and\nmesenteric lymph nodes are prominent, though not enlarged by CT criteria and\nunchanged since the prior exam.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Moderate stenosis of the celiac artery and poststenotic\ndilatation are unchanged.\n\nBONES: Sclerosis of the left tenth lateral rib is unchanged, likely compatible\nwith a bone island. Re-demonstrated is extensive degenerative change of the\nthoracolumbar spine, most prominent at L2-3. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in size of the left external iliac node, right external\niliac node and left inguinal nodes.\n2. Stable right external iliac node (5:105).\n3. Please refer to dedicated chest CT performed the same day for description\nof intrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings, including new opacities in the\nvisualized bilateral lower lobes.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Calcification predominantly in\nthe head and neck of the pancreas may be related to prior\ninfection/inflammation, unchanged from the prior exam (2:63). There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.0 cm cyst in the upper pole of the left kidney and other subcentimeter\nhypodensities in the right kidney are unchanged from prior exam (2:65, 76). \nThere is no evidence of suspicious renal lesions or hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged. Asymmetric appearance\nof the seminal vesicles, right larger than left, is unchanged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. An 8\nmm aortocaval lymph node is unchanged from the prior exam (2:74). A 6 mm\nshort axis left external iliac lymph node is slightly decreased in size from\nthe prior exam, previously 7 mm (2:110). A 7 mm in short axis right external\niliac lymph node is unchanged (2:105). There is no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm, but tortuous. Extensive\natherosclerotic disease is noted. There is stable narrowing of the celiac\nartery with poststenotic dilation, unchanged from the prior exam.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are moderate to severe with\nmultilevel loss of intervertebral disc height, most notable at L2-3, L3-4 and\nL4-5. Endplate changes are noted at L2 and L3. There is a Schmorl's node at\nL4.\n\nSOFT TISSUES: There are postsurgical changes of prior right inguinal hernia\nrepair. The abdominal and pelvic wall is otherwise within normal limits.", "output": "1. Retroperitoneal and pelvic lymph nodes are not enlarged by size criteria. \nNo evidence of metastatic disease in the abdomen or pelvis.\n2. Please refer to the separate CT chest report from the same day for details\non intrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Coarse calcifications throughout the pancreatic parenchyma,\ncompatible with chronic pancreatitis. There are no focal lesions. There is\nno ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a thin hypodense subcapsular fluid\ncollection along the lateral margin of the spleen (series 8, image 35), which\nis unchanged compared to multiple prior examinations, and may represent a\nchronic subcapsular hematoma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Small simple cyst arising from the upper pole of the left kidney. \nAdditional subcentimeter hypodensities within the lower pole of the right\nkidney are too small to characterize, but likely represent additional cysts. \nOtherwise, the kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of suspicious renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged with coarse central\ncalcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nPunctate calcified retroperitoneal nodule adjacent to the left iliac bone is\nunchanged, nonspecific (series 5, image 86). There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted. No abdominal aortic\naneurysm. However, there is aneurysmal dilatation of the celiac axis\nmeasuring up to 15 mm, similar compared to prior (series 5, image 55).\n\nBONES: Extensive degenerative changes throughout the lumbar spine. Minimal\nretrolisthesis of L2 on L3. There is no evidence of worrisome osseous lesions\nor acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Hypodense subcapsular fluid collection along the lateral margin of the\nspleen, unchanged compared to numerous prior examinations, possibly a chronic\nsubcapsular hematoma.\n3. Aneurysmal dilatation of the celiac axis measuring up to 15 mm.\n4. Other incidental findings include sequela of chronic pancreatitis and mild\nprostatomegaly.\n5. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "CHEST: Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Calcifications in the\npancreatic head are similar to prior exam (5:70).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones or hydronephrosis. A 1.6 x 1.5 cm hypodensity\nwithin the left upper pole appears similar to ___ and likely\nrepresents a cyst (5:69).\n\nBOWEL: A hiatal hernia is again noted. The stomach opacifies with oral\ncontrast and appears unremarkable. The small bowel opacifies with oral\ncontrast evidence of wall thickening or obstruction. The appendix is\nair-filled and unremarkable. The large bowel contains stool and oral contrast\nwithout wall thickening or evidence of obstruction. There is no abdominal free\nair or free fluid.\n\nRETROPERITONEUM: A 1.7 x 1.5 cm right retroperitoneal lymph node is similar\nto ___ (5:72). Prominent retroperitoneal lymph nodes measuring up\nto 9 mm are similar to prior exam (5:69,78).\n\nVASCULAR: The abdominal aorta demonstrates mild atherosclerosis.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.", "output": "1. Retroperitoneal lymphadenopathy, stable compared to ___ with\nthe largest lymph node measuring 1.7 x 1.5 cm.\n\n3. Celiac trunk dissection with aneurysmal dilation, similar to prior exams." }, { "input": "Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nCT abdomen with contrast: The liver enhances homogeneously without focal\nlesion, intra or extrahepatic biliary ductal dilatation. The portal vein is\npatent. The gallbladder is unremarkable.\n\nThe spleen, pancreas and adrenal glands are unremarkable in appearance. The\nkidneys present symmetric nephrograms and excretion of contrast without focal\nsolid mass, hydronephrosis or stone. 1.8 cm left interpolar renal cyst is\nunchanged from the prior study.\n\nThere is a small to moderate hiatal hernia unchanged from the prior study. The\nstomach, duodenum and remainder of the small bowel are otherwise unremarkable\nwithout evidence of obstruction. The large bowel is thin-walled and\nunremarkable. Normal appendix is visualized in the right lower quadrant.\n\nHeavy atherosclerotic calcifications are noted along the abdominal aorta.\nThere is no focal aneurysmal segment. There is severe stenosis at the origin\nof the celiac axis with poststenotic dilatation. There is mild narrowing at\nthe origin of the SMA. There is moderate narrowing at the ostia of the right\nrenal artery. There is minimal narrowing of the left renal artery. Take-off of\nthe ___ is not well visualized. Single enlarged retroperitoneal lymph node\nposterior to the infrarenal IVC is unchanged again measuring 1.8 x 1.6 cm\n(5:69). Remainder of nonenlarged mesenteric and retroperitoneal lymph nodes\nare unchanged. There is no new enlarged lymph node. There is no ascites,\npneumoperitoneum or hernia.\n\nCT pelvis with contrast: The bladder, seminal vesicles and rectum are\nunremarkable. The prostate is mildly enlarged. There is no free pelvic fluid\nor air. Top-normal sized lymph node in the right external iliac station\nmeasuring 1.5 x 0.9 cm is unchanged. There is no inguinal or pelvic sidewall\nlymphadenopathy by CT size criterion.\n\nOsseous structures: There is no suspicious focal osseous lesion. There are\nprominent degenerative changes of the thoracolumbar spine most severe at the\nlevel of L2-L3. At the levels of L2-L3 and L3-L4 there are large posterior\nosteophytes which causes moderate to severe canal stenosis. This appearance is\nstable from the prior study.", "output": "1. Stable 1.8 x 1.6 cm in large retroperitoneal lymph node at the level of the\ninfrarenal IVC. No new focus of disease involvement in the abdomen or pelvis.\n2. Severe stenosis at the origin of the celiac axis with poststenotic\ndilatation.\n3. Stable prominent degenerative changes of the thoracolumbar spine with large\nposterior osteophytes at the level of L2-L3 and L3-L4 causing moderate to\nsevere canal stenosis.\n4. Enlarged prostate.\n5. Refer to the separate report for intrathoracic findings." }, { "input": "PLEASE SEE CHEST CT REPORT FOR FORMAL CHEST FINDINGS.\n\nCT OF THE ABDOMEN: THE LIVER IS HOMOGENEOUS WITHOUT FOCAL MASSES, NO DILATED\nINTRAHEPATIC BILIARY RADICLES, THE PORTAL VEIN AND HEPATIC VEIN BRANCHES ARE\nPATENT, THE GALLBLADDER IS UNREMARKABLE.\n\nTHE SPLEEN, ADRENAL GLANDS AND KIDNEYS APPEAR UNREMARKABLE. NOTE OF A SIMPLE\nCYST WHICH IS UNCHANGED, INVOLVING THE LEFT KIDNEY. THERE IS MILD\nATHEROSCLEROTIC DISEASE AND THERE IS A MODERATE STENOSIS OF THE CELIAC AXIS AT\nITS ORIGIN WITH SOME POST-STENOTIC DILATATION WHICH IS UNCHANGED. AGAIN\nAPPRECIATED ARE MULTIPLE CALCIFICATIONS INVOLVING THE REGION OF THE UNCINATE\nPROCESS AND PANCREATIC HEAD.\n\nAGAIN APPRECIATED ARE RETROPERITONEAL, AORTOCAVAL AND PERIAORTIC LYMPH NODES,\nALL OF WHICH ARE UNCHANGED COMPARED TO THE PRIOR EXAM. THE LARGEST OF THESE\nMEASURES 17 X 15 MM (SERIES 5, IMAGE 71). NO NEW AREAS OF ADENOPATHY.\n\nCT OF THE PELVIS: VISUALIZED LOOPS OF LARGE SMALL BOWEL APPEAR NORMAL. THERE\nIS NO FREE FLUID, NO PATHOLOGICALLY ENLARGED ADENOPATHY. THE PROSTATE SHOWS A\nSINGLE COARSE CALCIFICATION, BLADDER IS UNREMARKABLE. ATHEROSCLEROTIC CHANGES\nOF THE DISTAL AORTA AND ITS BIFURCATION\n\nDEGENERATIVE CHANGES OF THE BONY STRUCTURES ARE AGAIN APPRECIATED.", "output": "1. NO CHANGE WHEN COMPARED TO THE PRIOR EXAM OF ___. THIS INCLUDES\nMULTIPLE SMALL RETROPERITONEAL LYMPH NODES, INCLUDING THE LARGEST NODE WHICH\nMEASURES APPROXIMATELY 17 X 15 MM.\n2. ATHEROSCLEROTIC DISEASE INCLUDING CELIAC AXIS STENOSIS AND POST STENOTIC\nDILATATION." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. Small hiatal hernia is again\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening. Portal caval node measures 0.8\ncm, not significantly changed from previous exam (series 2, image 67).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There are diffuse multiple\ncalcifications within the head and uncinate, which are similar appearing\ncompared to prior exam, most likely from chronic pancreatitis. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAn exophytic stable hypodensity is again noted in the midpole of the left\nkidney, measuring 1.5 x 1.7 cm (series 2, image 69). There is no evidence of\nstones, focal renal lesions, or hydronephrosis. There are no urothelial\nlesions in the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix contains air and has normal caliber without evidence of fat\nstranding. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There are multiple prominent retroperitoneal lymph nodes,\nthe largest measuring 1.5 cm (series 2, image 72), which is unchanged from\nprior exam. Lymph node near external iliac artery on right measuring 1 cm\n(series 2, image 111).\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries. Post stenotic\naneurysm is again noted in the proximal celiac trunk, measuring 1.1 x 2.3 cm\n(series 2, image 16), and appears similar compared to last exam.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are within normal limits. Again\nnoted is a coarse calcification in the prostate.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. The\nabdominal and pelvic wall is within normal limits. There are degenerative\nchanges in the spine.", "output": "1. No evidence of recurrence. Stable retroperitoneal lymph nodes measuring up\nto 1.5 cm.\n2. Similar appearance of celiac axis stenosis and post stenotic dilatation." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Scattered calcifications in\npancreas, most prominent in the head, are unchanged, and may represent sequela\nof chronic pancreatitis There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.8 cm partially exophytic hypodense lesion arising from the upper pole of\nthe left kidney is unchanged, and likely represents a simple cyst. Multiple\nadditional bilateral subcentimeter cortical hypodensities are too small to\ncharacterize, however likely represent cysts. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is otherwise\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Again seen is prominent fat at the ileocecal\nvalve, of no clinical significance (2:97). The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Prominent retroperitoneal lymph nodes, the largest being a 1.0\ncm posterior pericaval lymph node, are unchanged (2:72). There is no new\nretroperitoneal or mesenteric lymphadenopathy. A prominent right external\niliac node measuring 9 mm is not significantly changed from prior (2:109). \nThere is no new pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. There is re- demonstration of narrowing at the takeoff of\nthe celiac artery, with poststenotic dilatation (602b:49-50).\n\nBONES: Severe multilevel degenerative changes in the lumbar spine are not\nsignificantly changed from prior. There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Retroperitoneal and pelvic lymphadenopathy is stable. No new\nlymphadenopathy.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAgain seen is a 1.9 x 1.9 cm intermediate density cyst, unchanged in size and\nappearance from most recent prior. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small paraesophageal hernia. The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Again seen are multiple prominent retroperitoneal lymph nodes. \nThe previously described paracaval node is unchanged in size and appearance,\nmeasuring 1.2 cm (2:75). A rounded left inguinal lymph node with surrounding\nfat stranding is also unchanged in size and appearance, measuring 1.3 cm\n(2:125).\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Again seen is narrowing of the celiac trunk due to\ncalcified atherosclerotic disease with poststenotic dilation, unchanged\n(2:62).\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged size and appearance of retroperitoneal and inguinal lymph nodes.\n2. Please refer to separate report for CT chest performed same day for\ndescription of thoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate bibasilar scarring and\natelectasis, with subpulmonic fibrotic changes at the right lung base. In\naddition, there A 2 cm perifissural pulmonary nodule is noted at the anterior\nleft lung base (2:6), and a 3 mm subpleural nodule is noted within the left\nlower lobe (02:19). There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder demonstrates mildly increased\ndensity material layering dependently, and potentially compatible with sludge.\nThere is no gallbladder wall thickening or pericholecystic fluid to suggest\nacute cholecystitis.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.8 cm simple cyst is noted within the mid portion of the right kidney. \nThere is no hydronephrosis. There is no perinephric abnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix has normal caliber without evidence of fat stranding. There is no\nevidence of mesenteric lymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is heavy calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS: Calcified uterine fibroids are noted. The urinary bladder and distal\nureters are unremarkable. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: Degenerative changes are seen in the lumbar spine. No\nsuspicious osseous lesion is identified. A small fat containing umbilical\nhernia is noted.", "output": "1. No acute intra-abdominal process. Normal appendix.\n2. Sigmoid diverticulosis without evidence of acute diverticulitis.\n3. Probable cholelithiasis without evidence of acute cholecystitis." }, { "input": "LOWER CHEST: Visualized lung fields are notable for bilateral scarring and\nfibrotic changes with emphysema. There is no evidence of pleural or\npericardial effusion. Prominent para-aortic lymph nodes are seen in the lower\nchest, measuring up to 8 mm. Coronary artery and aortic valvular\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic, with normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. A 1.8 cm\nsimple cyst is seen in the upper pole of the right kidney. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe colon is noted, without evidence of wall thickening and fat stranding. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild grade 1 anterolisthesis of L3 on 4 and L4 on 5 with moderate to\nsevere degenerative changes noted at these levels.\n\nSOFT TISSUES: A tiny umbilical hernia containing fat is noted.", "output": "1. No acute intra-abdominal process to explain the patient's symptoms.\n2. Colonic diverticulosis without diverticulitis.\n3. Fibrotic changes are noted in the visualized lower lungs." }, { "input": "LOWER CHEST: The lung bases are clear. The visualized heart and pericardium\nare within normal limits.\n\nHEPATOBILIARY: The liver is normal in size and attenuation on this unenhanced\nscan. There is a gallstone seen adjacent to the neck of the gallbladder\nhowever there is no evidence of gallbladder wall thickening or marked\ndistention.\n\nSPLEEN: The spleen is homogeneous in attenuation and is small measuring 4.2\ncm.\n\nPANCREAS: The pancreas is within normal limits on this unenhanced scan. There\nis no pancreatic ductal dilatation.\n\nADRENALS: The left adrenal gland appears thickened, potentially hyperplastic,\nin the right adrenal gland is grossly unremarkable.\n\nURINARY: The kidneys are normal in size and there is no evidence of\nhydronephrosis. A subcentimeter hypodensity within the interpolar right\nkidney is too small to characterize but statistically represents a small cyst.\nPunctate calcifications in both kidneys may reflect small nonobstructing renal\nstones or vascular calcifications.\n\nGASTROINTESTINAL: The stomach is within normal limits. Small bowel loops are\nnormal in caliber. The large bowel is grossly normal. A 1.4 cm peripherally\ncalcified ovoid lesion in the left anterolateral hemipelvis may reflect prior\nepiploic appendagitis. There is no free air or free fluid in the abdomen or\npelvis. The appendix is normal.\n\nLYMPH NODES: There is no pathologic retroperitoneal or mesenteric\nlymphadenopathy by CT size criteria.\n\nVASCULAR: The abdominal aorta is normal in caliber mild to moderate calcified\natherosclerosis is demonstrated.\n\nPELVIS: The uterus shows multiple calcified fibroids. The bladder is within\nnormal limits. The rectum and sigmoid colon are within normal limits. No\nevidence of diverticulosis or diverticulitis is identified. There is no\npelvic or inguinal adenopathy.\n\nBONES AND SOFT TISSUES: Diffuse lytic and sclerotic lesions throughout the\nimaged axial and appendicular skeleton including the bilateral femurs are\ncompatible with metastatic disease. No pathologic fractures are identified. \nNo large abdominal wall hernias are seen.", "output": "1. No acute intra-abdominal process to account for the patient's symptoms.\n2. Diffuse osseous metastatic disease.\n3. Thickening of the left adrenal gland suggestive of hyperplasia.\n4. Cholelithiasis." }, { "input": "LOWER CHEST: Please refer to concurrent CT Chest for intrathoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 7-mm\nhypodensity in segment 7 of the liver (series 5; image 53) is unchanged from\n___. No new focal liver lesions. There is new, mild intrahepatic biliary\ndilatation. In the region of the common hepatic duct, the bile appears\nreplaced by ill-defined soft tissue for 1-2 cm, concerning for malignancy. \nThe CBD distal to this is normal in diameter. This may also involve the\ncystic duct; the gallbladder is collapsed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Ovoid enlargement of the left adrenal gland is slightly increased in\nsize, measuring 2.9 x 2.0 cm (previously 2.5 x 1.8 cm). This lesion has shown\nto have features of an adenoma on previous magnetic resonance imaging. The\nright adrenal gland is normal in appearance.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n2.5 x 1.8 and 2.3 x 1.9 cm cysts are noted of the interpolar region of the\nleft kidney, both of which are likely simple cysts. Mild-to-moderate\nbilateral hydronephrosis, left greater than right, is noted with transition\npoints at the bilateral ureteropelvic junctions. Heterogeneous enhancement\nwith mild surrounding stranding is noted in the posterior portion of the left\nkidney. This may be related to obstruction, although pyelonephritis cannot be\nexcluded. Recommend correlation with urinary analysis.\n\nGASTROINTESTINAL: There is thickening of the serosa of the stomach with\nincreased enhancement with minor surrounding slight stranding. The small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnot visualized. Haziness and nodularity in the mesentery of the ileum in the\nright lower quadrant is concerning for metastatic disease.\n\nPELVIS: 2 linear areas of increased enhancement are noted anteriorly (series\n8; image 22) and inferiorly (series 8; image 28) along the right bladder wall\nare nonspecific, although may represent additional metastatic disease. There\nis no free fluid in the pelvis.Calcification at the dome of the uterus is\nconsistent with fibroid and unchanged from prior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nHowever, there is symmetric stranding that is noted along the lateral conal as\nwell as the anterior and posterior renal fasciae. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Mild-to-moderate degenerative changes in the thoracolumbar spine, most\nnotable at L5-S1. No evidence of concerning osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New, mild intrahepatic biliary dilation secondary to soft tissue in the\nupper common hepatic duct for a 1-2 cm segment. These findings are concerning\nfor a metastasis or primary cholangiocarcinoma. Recommend ERCP for potential\nstenting and cytology.\n2. Mild-to-moderate, bilateral hydronephrosis, left greater than right. \nHeterogeneous enhancement in the left kidney may be from the obstruction,\nalthough pyelonephritis is possible. Recommend correlation with urine\nanalysis.\n3. Abnormal enhancement and thickening of the outer gastric wall is concerning\nfor metastatic involvement.\n4. Enhancement along the anterior and inferior right urinary bladder walls are\nconcerning for metastatic disease.\n5. Haziness and nodularity in the mesentery of the ileum is suggestive of\nmetastatic disease.\n6. Non-specific stranding in the retroperitoneum.\n\nRECOMMENDATION(S):\n1. ERCP for potential stenting and cytology.\n2. Correlation with UA to determine clinical likelihood of left-sided\npyelonephritis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:18 am, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable subcentimeter hypodensity in segment 7 has been previously\ncharacterized as a simple hepatic cyst.\nThere is minimal prominence of the intrahepatic biliary tree. There is hyper\nenhancement of the CBD wall within area of focal narrowing in the distal third\nmeasuring 5 mm (previously 7 mm). The gallbladder is normally distended and\nshows mild hyper enhancement of its walls.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right gland is normal in size and shape. Left adrenal mass\nmeasuring 2.6 x 1.9 cm (previously 2.7 x 2.2 cm).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMild to moderate bilateral symmetric hydronephrosis is again seen with normal\ncaliber ureters bilaterally. No hyperenhancement of the ureteric walls seen. \nNo nodularity or stranding within the ___ ureteric soft tissues. Stable\ncortical renal cysts. There is minimal perinephric stranding bilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild prominence of the intrahepatic biliary tree with hyperenhancement of\nthe gallbladder wall and the CBD wall.\n2. Stable mild-to-moderate symmetric hydronephrosis involving both kidneys\nwith normal caliber of both ureters, stable since the CT from ___. No\nureteric wall hyperenhancement seen, no obstructive lesions or masses. \nMicroscopic retroperitoneal metastatic involvement cannot be excluded,\nrecommend correlation with renal function tests and imaging follow-up with\nultrasound/CT/MRI.\n3. The gastric wall hyperenhancement seen on the prior MRI is not appreciated\non this study." }, { "input": "LOWER CHEST: Please refer to the separately dictated report of same day CT\nchest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable subcentimeter hypodensity in segment 7, previously characterized as a\ncyst on the prior MRI. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Stable accessory spleen.\n\nADRENALS: The right adrenal gland is normal. Stable appearance of the left\nadrenal nodule measuring 2.6 x 1.9 cm, this has been previously characterized\nas an adenoma on the MRI from ___.\n\nURINARY: The kidneys are of normal size and symmetric parenchymal enhancement.\nStable bilateral hydronephrosis with normal caliber of the ureter. No\nsignificant ureteral wall thickening or stranding. Stable renal cortical\ncysts and parapelvic cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatus hernia, otherwise the stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Stable fibroid uterus, no adnexal abnormality..\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild to moderate\natherosclerotic disease is noted. No evidence of\n\nBONES: Mild levoscoliosis of the lumbar spine. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable findings with no evidence of metastatic disease in the abdomen or\npelvis.\n2. Stable left adrenal adenoma." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild fecal\nloading is noted within the colon. The colon and rectum are within normal\nlimits. The appendix is not identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal abnormality\nidentified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "Suboptimal timing of contrast bolus, however no evidence of acute\nintra-abdominal or intrapelvic process which would correlate with patient's\nreported symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is fatty in attenuation. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is no hiatal hernia. Small bowel is normal in caliber\nwithout focal wall thickening. Large bowel is also normal in caliber without\nfocal wall thickening. No obstruction. No intra-abdominal free fluid or free\nair. Post appendectomy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Hepatic steatosis." }, { "input": "LOWER CHEST: There is trace dependent atelectasis. Otherwise, the visualized\nlung fields are within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Spleen is borderline in size, measuring up to 13 cm in AP dimension\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is no evidence of suspicious focal renal lesion within the\nlimitation on unenhanced study. There is no hydronephrosis. There is\nnonspecific stranding surrounding the left renal parenchyma with subtle\nthickening of lateral conal fascia, as well as periureteral stranding along\nthe proximal to mid left ureter. No renal or ureteral calculus is seen. No\ncalculus is seen within the urinary bladder.\n\nGASTROINTESTINAL: Stomach is relatively collapsed. No bowel obstruction or\nbowel wall thickening is seen. The appendix is top normal in caliber. No\nperiappendiceal stranding is seen.\n\nPELVIS: The urinary bladder is not well distended; apparent diffuse urinary\nbladder wall thickening could relate to underdistention; correlate with\nurinalysis to assess for infection. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Left perinephric, proximal to mid left periureteral stranding, and subtle\nthickening of the left lateral conal fascia. This may be related to acute\npyelonephritis. A recently passed stone could also be in the differential\ndiagnosis. No renal, ureteral, or bladder calculus seen currently. No\nhydronephrosis.\n2. Urinary bladder is not fully distended; apparent diffuse urinary bladder\nwall thickening could relate to underdistention, but correlate with urinalysis\nto assess for infection.\n3. Cholelithiasis." }, { "input": "Heart is mildly enlarged. Lung bases appear clear.\n\nNo focal liver lesions are identified. Morphology of the liver appears\nnormal. There is a small calcified stone in the gallbladder. No biliary\ndilatation. Spleen measures up to 11.3 cm in maximal dimension. Pancreas\nappears normal. Adrenals are unremarkable. There is no evidence for stones,\nsolid masses or hydronephrosis involving either kidney.\n\nStomach and small bowel appear normal. Appendix measures up to 7 mm in\ndiameter with partial enteric contrast filling, probably normal, although\nchronic inflammation is not excluded. Quantity of stool throughout the large\nbowel is mildly prominent.\n\nUterus and adnexa appear normal. Bladder is unremarkable. Major vascular\nstructures are widely patent. No lymphadenopathy, free air or free fluid. \nIll-defined subcutaneous nodules are likely due to injection sites.\n\nThere are no suspicious bone lesions. Vertebral bodies are preserved in\nheight.", "output": "No evidence of acute abnormality." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are bilateral nonobstructing punctate renal stones, one in the\nright upper pole and the other in the left lower pole. In addition, there is\na 3 mm stone in the proximal right ureter (Hounsfield units 360). There is no\nupstream hydroureteronephrosis. No left ureteral stone is seen. There is a\nsubcentimeter simple cyst in the lower pole of the left kidney.\n\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel is normal in\ncaliber without focal wall thickening. There is diverticulosis of the sigmoid\ncolon. Large bowel is normal in caliber without focal wall thickening or\ndilation. The appendix is not visualized but there are no secondary signs of\nappendicitis in the right lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No bladder\nstones are seen. There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nNote is made of sacralized L5 on the left.\n\nSOFT TISSUES: There are small bilateral fat containing inguinal hernias.", "output": "1. 3 mm stone in the proximal right ureter without upstream\nhydroureteronephrosis.\n2. Bilateral non-obstructing renal stones.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:05 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are unremarkable. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Area of hypodensity seen near\nthe pancreatic neck most likely represents interdigitating fat. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of suspicious focal renal lesions or hydronephrosis. A\n2.3 cm simple cyst is again seen in the interpolar region of the right kidney\n(9:38), not significantly changed. A second small subcentimeter hypodensity\nseen in the upper pole the right kidney is too small to characterize, but\nlikely represents a cyst. There is no nephrolithiasis. A 5 mm dependent\nstone is seen in the posterior bladder (3:72). The bladder is otherwise\nunremarkable. There is no evidence of urothelial lesions. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are noted.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "1. 5 mm dependent stone in the posterior bladder.\n2. No evidence of nephrolithiasis.\n3. No evidence of suspicious renal or urothelial lesions.\n4. Cholelithiasis without evidence of cholecystitis." }, { "input": "LOWER CHEST: Trace right lung base and lingular atelectasis. No pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: Again noted, hypodense, heterogeneously hypoenhancing left\nhepatic mass involving segment 2, 3, and 4, measures 9 x 12.8 cm. Part of\nsegment 4 hypo enhancement is related to post Y 90 treatment given the lobar\nleft hepatic treatment. Left hepatic artery remains patent.\n\n1.1 cm segment 7 hemangioma. Subcentimeter hepatic dome hypodense lesion, too\nsmall to characterize, attention on follow up is recommended (08:23).\n\nRemarkable ductal dilation is noted within the involved segments (left hepatic\nlobe), unchanged. Mild right anterior and posterior intrahepatic biliary\nductal dilation secondary to cholangiocarcinoma, unchanged. No fluid\ncollection. Unremarkable gallbladder.\n\nPANCREAS: 0.6 cm cystic lesion in the pancreatic body/tail, likely side\nbranch intraductal papillary mucinous neoplasm. No main ductal dilation.\n\nSPLEEN: No splenomegaly. Accessory spleen adjacent to the pancreatic tail.\n\nADRENALS: Fullness of the medial limb of the left adrenal gland. No adrenal\nnodules.\n\nURINARY: No nephrolithiasis or hydronephrosis.No discrete lesion.\n\nGASTROINTESTINAL: Unremarkable stomach and visualized intestine. Subtle\nscattered omental nodules (8:68, 69), and hazy omentum in the right hemi\nabdomen (8:94) concerning for peritoneal metastasis. No ascites.\n\nLYMPH NODES: Unchanged 1.2 cm right cardiophrenic angle lymph node. Enlarged\nporta hepatis and gastrohepatic lymph nodes measuring 1.1 cm and 1.3 cm,\nrespectively, unchanged. Scattered other prominent mesenteric lymph nodes.\n\nVASCULAR: Patent aorta and major branches with conventional anatomy. Coil\nembolized right gastric artery. Invaded/occluded left portal and hepatic\nveins.\n\nBONES AND SOFT TISSUES: T11 mild anterior compression, unchanged. No soft\ntissue mass.", "output": "1. Left hepatic cholangiocarcinoma status post left hepatic radio embolization\nwith posttreatment changes as described above. Given the extensive post\ntreatment changes, evaluation for residual disease is somewhat challenging.\nRecurrence is less likely on this short interval follow up exam.\n2. Unchanged gastrohepatic and porta hepatis adenopathy.\n3. Subtle omental nodularity suspicious for peritoneal carcinomatosis. Given\nplanned resection, preoperative evaluation of these nodules is recommended.\n4. Indeterminate subcentimeter hypodense lesion in the hepatic dome, can be\nassessed during intraoperative ultrasound or on follow-up examination.\n5. Persistent , unchanged right intrahepatic ductal dilation.\n6. 0.6 cm pancreatic tail likely side branch IPMN. Attention on follow-up is\nrecommended.\nLiver volumes will be attached to this exam once processed by the 3D lab." }, { "input": "LOWER CHEST: A 1.3 x 1.0 cm right cardiophrenic node (09:28) is not\nsignificantly changed in size. There is a new trace right-sided pleural\neffusion. Please refer to dedicated CT chest report for thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post left hepatic radio embolization. \nThe left hepatic artery remains patent. There has been mild decrease in size\nin a 10.2 x 8.1 cm mass involving the left lobe of the liver (04:43) showing\nprogressive enhancement that previously measured 12.2 x 9.0 cm. There has\nbeen interval development of multiple hypoenhancing lesions throughout the\nliver suggestive of metastases, such as a 1.7 x 1.4 cm lesion in segment 8\n(04:24) and a 1.3 x 0.9 cm lesion in segment 6 (4:71). There is an unchanged\n1.0 cm hypervascular lesion in segment 7 of the liver suggestive of a\nhemangioma. There has been interval placement of a CBD stent with its\nextremity in the right hepatic duct. There has been mild interval worsening\nin mild intrahepatic biliary ductal dilatation. Only minimal pneumobilia is\nnoted. The gallbladder is decompressed with diffuse wall edema, likely\nreactive.\n\nPANCREAS: There is an unchanged 5 mm hypodense cystic lesion in the pancreatic\ntail (601:47), likely representing a side-branch IPMN. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Similar appearance of the thickening of the left adrenal gland. \nThe right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is no evidence of bowel\nobstruction. Note is made of stratification of the wall of the rectum,\nsigmoid and descending colon to the level of the splenic flexure of the colon,\nwith mucosal hyperenhancement and marked hypodensity noted associated with\nprominent pericolonic vessels raising concern for some degree of active\ndisease superimposed on chronic inflammatory changes related to inflammatory\nbowel disease, most likely related to ulcerative colitis\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Again noted are multiple enlarged upper abdominal and\nretroperitoneal lymph nodes, that are not significantly changed in size\ncompared to prior, including a 1.3 x 1.1 cm gastrohepatic node (04:50 3), a\n2.1 x 1.1 cm aortocaval node (4:62) and a 1.6 x 0.8 cm left para-aortic node\n(4:81). There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There are new blastic lesions in T12 an L3 vertebral bodies, highly\nconcerning for osseous metastases.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Progression of disease as evidenced by interval development of multiple new\nliver lesion suggestive of metastases.\n2. Interval development of blastic lesions in the spine are also concerning\nfor new osseous metastases.\n3. Enlarged upper abdominal, retroperitoneal and right cardiophrenic\nlymphadenopathy is no significantly changed compared to prior.\n4. Status post left hepatic radio embolization with mild interval decrease\nsize in enlarged left hepatic cholangiocarcinoma, that demonstrates delayed\nenhancement.\n5. Interval placement of a CBD stent with its tip in the right hepatic duct,\nhowever there is increased mild intrahepatic biliary dilatation. Only mild\npneumobilia is noted. These findings are concerning for malfunctioning stent.\n6. Unchanged 5 mm probable pancreatic side-branch IPMN.\n7. Stratification of the bowel wall with marked hypodensity associated with\nmucosal hyperenhancement involving the rectum, sigmoid and descending colon\nraising concern for some degree of active disease superimposed on chronic\ninflammatory changes due to the patient's IBD, most likely related to\nulcerative colitis.\n\nRECOMMENDATION(S): The impression and recommendation above was entered by Dr.\n___ on ___ at 17:00 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: There is new lung moderate nonhemorrhagic layering pleural\neffusion on the right with associated mild basal atelectasis, new since ___. A calcified granuloma is again seen in the right lower lobe. \nThere is mild atelectasis in the right lower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen are numerous hypodensities throughout the liver, not\nsignificantly changed since ___, though new since ___. \nPatient is status post left hepatic lobe Y 90 treatment with ill-defined\nhypodensity of the left lobe, likely a combination of posttreatment changes\nand the tumor burden, similar in appearance compared to ___. \nPreviously described hypervascular lesion in segment VII of the liver is not\nwell demonstrated on today's exam due to the phase of contrast (03:19). There\nhas been interval catheter placement within the CBD stent with the pigtail\ncatheter terminating in the duodenum. There is persistent intrahepatic\nbiliary ductal dilatation, not significantly changed in the decreased compared\nto ___, and increased since ___. There is no pneumobilia. \nThe gallbladder again is decompressed with diffuse wall edema, likely\nreactive. New since ___, there is interval development of small\nvolume perihepatic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout. Specifically, the\npancreas does not appear edematous. A 5 mm hypodensity in the body of the\npancreas is unchanged from prior exam (03:35). Mild prominence of the main\npancreatic duct is minimally decreased compared to ___. There is\nmild peripancreatic stranding, new since ___.\n\nSPLEEN: The spleen is mildly enlarged, measuring up to 13.9 cm. New since ___, there has been interval development of small volume of perisplenic\nascites. There is no evidence of focal lesions within the spleen.\n\nADRENALS: There is stable thickened appearance of the left adrenal gland. The\nright adrenal gland normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA tiny subcentimeter hypodensity in the upper pole of the right kidney is too\nsmall to characterize by CT. There is no evidence of hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There has been interval\nworsening of previously described stratification of the bowel wall, now\naffecting the entire length of the large bowel, the terminal ileum and a\nshorter segment of the distal ileum. The mucosa is hyper enhancing, with\nassociated bowel edema and evidence of fat deposition within the rectum and\nthe sigmoid colon, concerning for acute on chronic inflammatory bowel disease.\nThere has been interval increase in the degree of hyperemia of the mesenteric\nand mesorectal vessels.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Multiple enlarged periportal lymphadenopathy, the largest\nportacaval node measuring 1.2 x 4.1 cm is unchanged since ___.\nMultiple gastrohepatic ligament lymph nodes are grossly unchanged since ___. There is stable retroperitoneal lymphadenopathy, including the\ncavoatrial node (___:52), and a left para-aortic node (___:55). There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: The bilateral common iliac arteries are mildly dilated, measuring up\nto 1.6 cm. No vascular filling defect is seen. Mild atherosclerotic disease\nis noted.\n\nBONES: Focal areas of sclerosis in L3 and T12 are again seen, new since ___, unchanged since ___. No new suspicious lesions are seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval worsening of the acute on chronic inflammatory bowel disease, now\npan colitis with involvement of the terminal ileum and a short segment of the\ndistal ileum.\n2. New small volume ascites.\n3. Interval placement of a pigtail catheter within the CBD stent with\npersistent intrahepatic ductal dilatation. No complications.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:47 AM, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There are partially visualized pulmonary emboli on the right,\nbetter seen on the CT chest performed on the same day. Please see that report\nfor further details.\n\nABDOMEN:\n\nHEPATOBILIARY: Status post coil embolization of the right gastric artery.\nNumerous low-density lesions scattered throughout the liver are increased in\nsize and number compared to ___. For example on 07:19 there is a 1.0\ncm lesion in the dome of the liver which previously measured 6 mm. \nAdditionally on 07:20, the numerous new lesions in the hepatic dome are seen.\n\nPatient is status post left hepatic lobe Y ___ treatment with ill-defined\nhypodensity of the left lobe, likely a combination of posttreatment changes\nand the tumor burden, similar in appearance compared to ___. Left\nhepatic vein is narrowed by tumor. Left portal vein appears to be occluded,\nlikely chronic. Previously described hypervascular lesion in segment VII of\nthe liver is not well demonstrated on today's exam due to the phase of\ncontrast. Again seen is a CBD stent and catheter with the pigtail catheter\nterminating in the duodenum.\n\nThere is persistent intrahepatic biliary ductal dilatation, not significantly\nchanged in the decreased compared to ___, and increased since ___. There is no pneumobilia. The gallbladder again is decompressed with\ndiffuse wall edema, likely reactive. The small amount of perihepatic ascites\nis mildly decreased.\n\nPANCREAS: The pancreas has normal attenuation throughout. Specifically, the\npancreas does not appear edematous. A 5 mm hypodensity in the body of the\npancreas is unchanged from prior exam (07:52) and is compatible with fat as\nseen on prior MRI. A 7 mm hypodensity in the body of the pancreas is also\nunchanged (07:51) and was demonstrated to be a cyst on the recent MRI. Mild\nprominence of the main pancreatic duct is unchanged. Mild peripancreatic\nstranding is again seen a decreased from ___.\n\nSPLEEN: The spleen is mildly enlarged, measuring up to 13.3 cm. There has\nbeen interval resolution of perisplenic ascites. There is no evidence of\nfocal lesions within the spleen.\n\nADRENALS: There is stable thickened appearance of the left adrenal gland. The\nright adrenal gland normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There has been interval\nimprovement in previously described pan colitis. There is no obstruction. \nThe bowel is normal in caliber. There are few segments of bowel which appear\nto demonstrate mild wall thickening which may be related to chronic\ninflammatory bowel disease as well as underdistention (11:115).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Trace free\nfluid in the pelvis, decreased.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Multiple enlarged periportal lymphadenopathy, the largest\nportacaval node measuring 1.2 x 4.1 cm is unchanged since ___. There\nhas been an interval increase in retroperitoneal and mesenteric\nlymphadenopathy as well as omental nodularity and stranding. For example,\nthere are new and increased size of omental nodules as well as increased\nomental and mesenteric stranding on 11:137. A left periaortic lymph node\nmeasuring 1.3 cm on 11:121 previously measured up to 1.0 cm.\n\nVASCULAR: The bilateral common iliac arteries measure 1.3 cm each on coronal\nimaging, within normal limits. No vascular filling defect is seen. Mild\natherosclerotic disease is noted.\n\nBONES: There has been progression of diffuse osseous metastatic disease with\nnumerous new and enlarging lesions.\n\nSOFT TISSUES: Postsurgical changes are seen in the anterior abdominal wall.", "output": "1. Findings are compatible with progression of hepatic, osseous, and omental\nmetastatic disease with increased lymphadenopathy. Similar appearance of the\nleft hepatic lobe cholangiocarcinoma status post radio embolization on ___.\n2. Persistent mild intrahepatic biliary ductal dilatation. The CBD stent and\ncatheter appear stable in position. Status post coil embolization of the\nright gastric artery.\n3. Interval near complete resolution of pan colitis. A few suspected areas of\ncircumferential colonic wall thickening at the splenic flexure and the sigmoid\ncolon may be related to underdistention and/or residual or chronic\ninflammatory changes. There is no evidence of active inflammation of the\nsmall or large bowel.\n4. Stable mild splenomegaly.\n5. 7 mm cystic structure in the body of the pancreas likely represents an IPMN\nor dilated side branch radicle. Attention to this area on follow-up imaging\nis recommended.\n6. There are partially visualized pulmonary emboli on the right, better seen\non the CT chest performed on the same day. Please see that report for further\ndetails." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is mild intrahepatic biliary duct\ndilation, within normal limits for patient's age. There is no extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral subcentimeter cortical hypodensities are too small to\ncharacterize, however likely represent cysts. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube is present in the stomach. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon is unremarkable. There is a large fecal loading in the rectal vault,\nwith thickening of the rectal wall, likely reflects chronic retained fecal\ndebris. The appendix is not visualized.\n\nPELVIS: The bladder is decompressed with a Foley catheter present. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are multilevel degenerative changes in the lumbar spine. There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or pelvic injury.\n2. Multiple subcentimeter bilateral renal cortical hypodensities are too small\nto characterize, however likely represent cysts.\n3. Thickened rectal wall with large fecal load .\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Imaged lung bases are clear. The imaged portion of the heart is\nunremarkable. No pleural or pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a\ndecompressed appearance of the left hemi colon which appears slightly\nthickened concerning for acute colitis. There is minimal surrounding fat\nstranding. The appendix is within normal limits, measuring 7 mm and\ncontaining several foci of air. No free air. Trace free fluid is noted in\nthe pelvis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Probable mild acute Crohn's colitis involving the left colon." }, { "input": "LOWER CHEST: Mild dependent bibasilar atelectasis and a trace right pleural\neffusion are noted. There is no evidence pericardial effusion or left pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is relatively collapsed. Oral contrast is seen\nprogressing to the level of the cecum. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum\ncontain moderate to large stool burden. No evidence of bowel obstruction is\nseen. The appendix is normal (02:52). There is no free intraperitoneal fluid\nor air.\n\nPELVIS: The bladder is collapsed around a Foley balloon. There is no free\nfluid in the pelvis. There is no abscess.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nTrace retrolisthesis of L5 on S1 is noted.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "1. No abscess or drainable fluid collection seen.\n2. Moderate to large stool burden seen throughout the rectum and colon. No\nbowel obstruction.\n3. Trace right pleural effusion with overlying atelectasis." }, { "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 2.3 x 2.3 cm\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent\nBiliary tree abrupt cutoff with or without upstream dilatation: absent. CBD\nstent in place.\n\nArterial evaluation\n\nSMA involvement: absent\nSolid soft-tissue contact: ?180\u00b0\nIncreased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: absent\nSolid soft-tissue contact: ?180\u00b0\nIncreased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: absent\nSolid soft-tissue contact: ?180\u00b0\nIncreased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to celiac axis: absent\nExtension to bifurcation of right/left hepatic artery: Absent\n\nVariant anatomy: none\n\nVenous evaluation\n\nMPV involvement: present\nDegree of solid soft-tissue contact: ?180\u00b0\nDegree of increased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\npresent at the portal confluence.\n\nSMV involvement: present\nDegree of solid soft-tissue contact: ?180\u00b0\nDegree of increased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\npresent\nExtension to first draining vein: absent\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The background liver is heterogeneous. In segment V, there are\nareas of perfusion anomaly (04:32, 43). Associated lesions seen on prior MRI\nare not appreciated on this exam. In segment 7, there is a large area of\nincreased perfusion without discrete lesions. Other areas of perfusion\nanomaly with rim enhancing lesions seen on prior MRI are not well seen on\ntoday's exam. Patient is status post CBD placement, which is patent with left\nworse than right pneumobilia, not significantly changed compared to prior. \nThe gallbladder is contains stones, without evidence of gallbladder wall\nthickening or pericholecystic fluid. Numerous periportal, non necrotic\nenlarged lymph nodes appear grossly similar compared to prior. The largest\nperiportal node conglomerate measure 1.8 x 1.0 cm (04:33).\n\nPANCREAS: In the head of the pancreas, there is a hypodensity measuring 2.2 x\n2.2 cm, minimally increased compared to prior. There is severe atrophy of the\nbody and tail of the pancreas and dilation of the main pancreatic duct,\nunchanged compared to prior. There are no enlarged peripancreatic nodes.\nFiducial seeds are in place. Gastroduodenal artery is seen coursing through\nthe hypodensity, completely encased within it (04:43). However, the vessel\nappears patent. The portal vein at the portal confluence appear slightly\nattenuated in demonstrate tear drop deformity. There is no involvement of the\nceliac, SMA and common hepatic artery.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.4 cm simple cyst in the posterior lower pole of the left kidney appear\nunchanged compared to prior. There is no evidence of stones or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: While there is no pathologic retroperitoneal lymphadenopathy,\nnumerous subcentimeter chain of lymph nodes are seen in the para-aortic\nstation.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nThere is a bone island in the right femoral neck.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Overall unchanged appearance of pancreatic head mass with involvement of\nthe main portal vein and SMV at the confluence.\n2. Stable periportal lymphadenopathy." }, { "input": "VASCULAR:\nThere is no abdominal aortic aneurysm. There is near complete or complete\nocclusion of the medial portion of the splenic vein at the confluence with the\nportal vein (series 3, image 137). There is mild narrowing of the portal vein\nand proximal superior mesenteric vein, as before (series 3, image 141). As\nbefore, there has been resection of the splenic artery just beyond its origin\nwith reconstitution distally.\n\nLOWER CHEST: Please see CT chest from the same date.\n\nABDOMEN:\nHEPATOBILIARY: There is mild intrahepatic biliary ductal dilation, with trace\npneumobilia, mildly increased from prior examination. There is heterogeneous\nenhancement of the liver, some of which is peribiliary along with clear\nincreased enhancement of the bile ducts walls consistent with changes of\ncholangitis. The liver is homogeneously low in attenuation from fatty\ndeposition. A 3.0 x 0.6 cm hypodense, lesion in segment 2 of the liver\n(series 3, image 119) is unchanged from prior examination and likely\nrepresents a small subcapsular fluid collection with adjacent perfusion\nabnormality. The gallbladder is absent.\n\nPANCREAS: The patient status post Whipple procedure with pancreaticojejunal\nanastomosis as before. There is again a hypoattenuating lesion posterior and\nslightly to the right of the pancreaticojejunal anastomosis measuring 41 x 23\nmm, increased in extent compared to the prior study with increased soft tissue\ninterposed between the portal vein and common hepatic artery (3, 133) and\nsurrounding the stump of the splenic artery and around the splenic vein at the\nconfluence. There is atrophy of the distal pancreas, as before. Small cystic\nlesions in the body and tail likely represent dilated pancreatic duct or\nside-branches (series 6, image 135, 132).\n\nSPLEEN: The spleen is increased in size and borderline enlarged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 23 mm hypodensity arising from the posterior aspect of the left kidney is\nconsistent with a simple renal cyst. Additional millimetric hypodensities are\ntoo small to characterize but likely represent simple renal cysts. There are\nno urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post Whipple procedure. The\nhepaticojejunostomy appears unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement throughout. Colon and rectum\nare within normal limits. Appendix contains air, has normal caliber without\nevidence of fat stranding. There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: There is moderate enlargement of the prostate.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Increased soft tissue posterior and slightly to the right of the\npancreaticojejunal anastomosis post Whipple extends about several vessels\nslightly further than before and results in marked attenuation of the medial\naspect of the splenic vein with possible occlusion. Findings are highly\nsuspicious for recurrence.\n2. Increased peribiliary enhancement is similar to multiple prior examinations\nlikely from chronic cholangitis. Intrahepatic biliary ductal dilatation is\nsimilar in comparisons priors studies.\n3. Moderate prostatomegaly.\n4. Increased size of the spleen from prior, which measures at the upper limits\nof normal." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is similar appearance near\ncomplete or complete occlusion of the medial portion of the splenic vein at\nthe portal venous confluence. Narrowing of the portal vein and proximal\nsuperior mesenteric vein appears slightly progressed (6:116). As before,\nthere has been resection of the splenic artery just beyond its origin with\nreconstitution distally.\n\nLOWER CHEST: Please see CT chest from the same date.\n\nABDOMEN:\n\nHEPATOBILIARY: Mild intrahepatic biliary ductal dilatation appears overall\nsimilar in degree compared to the prior study with an interval decrease in\npneumobilia. Again noted is heterogeneous enhancement of the liver, some of\nwhich is peribiliary, along with clear increased enhancement of the bile duct\nwalls consistent with changes of cholangitis. The degree of abnormal\nenhancement is slightly increased compared to ___ especially in\nthe dome and in segment IV B (6:112). The liver is diffusely low in\nattenuation related to hepatic steatosis. A peripherally located hypodense\nlesion in segment 2 of the liver (09:18) appears more linear in nature today\nand is favored to represent a small subcapsular fluid collection with adjacent\nperfusional abnormality. The gallbladder is surgically absent.\n\nPANCREAS: The patient status post Whipple procedure with pancreaticojejunal\nanastomosis as before. There is again a hypoattenuating lesion posterior and\nslightly to the right of the pancreaticojejunal anastomosis measuring 4.1 x\n2.1 cm (6:111), similar compared to the prior study when measured similarly on\nseries 3, image 133 of that examination. There is a similar degree of soft\ntissue interposed between the portal vein and the common hepatic artery and\nsurrounding the stump of the splenic artery and around the splenic vein at the\nconfluence. There has been a mild interval increase in the degree of\nperipancreatic stranding particularly along the posterior aspect near the\nsuperior mesenteric artery origin (6:110).\n\nThere is atrophy of the distal pancreas, as before. There is increased\nill-defined hypodense soft tissue in the region of the pancreatic tail (6:112\nand 6:111). There is an ill-defined hypodense lesion in this region measuring\n1.4 x 0.7 cm on 6:112. Previously, there is noted to be a 7 mm hypodense\nlesion in this region. Small cystic lesions in the body and tail likely\nrepresent dilated pancreatic duct or side-branches.\n\nSPLEEN: The spleen is increased in size and borderline enlarged at 13.1 cm. \nThere is new hypoattenuation in the medial superior aspect of the spleen\n(09:48, 6:93, 6:107).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a stable left renal cyst. Additional subcentimeter hypodensities in\nboth kidneys are too small to characterize but likely represent additional\nsimple cysts. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post Whipple procedure. The\nhepaticojejunostomy appears unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement throughout. Colon and rectum\nare within normal limits. Appendix contains air, has normal caliber without\nevidence of fat stranding. There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: Prominent left para-aortic lymph nodes which are not enlarged\nby CT size criteria are stable in size and number (6:122).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is a 1.4 x 1.0 cm fluid\ndensity lesion adjacent to the right common femoral vein (6:108) which is\nslightly increased in size but is overall similar in appearance compared to ___. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is moderate enlargement of the prostate.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nfew subcentimeter scattered sclerotic foci in the proximal femurs are\nunchanged dating back to ___ and most likely represent small bone\nislands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable appearance of soft tissue posterior to and slightly to the right of\nthe pancreatico jejunal anastomosis status post Whipple procedure extending\nabout several vessels resulting in stable marked attenuation of the medial\naspect of the splenic vein with possible occlusion. These findings are again\nhighly suspicious for recurrence.\n2. There is increased ill-defined hypodense soft tissue seen in the pancreatic\ntail, suspicious for a second site of disease.\n3. Peribiliary and heterogeneous hepatic enhancement is more prominent\ncompared to prior studies and is suspicious for cholangitis. There is a\nsimilar degree of intrahepatic biliary ductal dilatation with an interval\ndecrease in pneumobilia.\n4. New abnormal hypodense wedge-shaped peripheral low-attenuation within the\nposterior and superior aspect of the spleen which is indeterminate and may\nrepresent infarcts or metastases. This could be further evaluated with MRI.\n5. Please see the separately dictated report for the CT of the chest\nperformed on the same day for description of intrathoracic findings." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Mild dependent subsegmental atelectasis particularly in the right\nlung base. No pleural effusion. Interval decrease in the size of the\npericardial fluid.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is similar appearance of the hypodense lesion within segment ___ which\nmeasures 1.4 cm. There is an ill-defined hypodensity within segment 5\nmeasuring 1.1 cm, which may represent perfusional anomaly (4: 110). There is\npneumobilia. CBD stent in situ, which appears patent. The gallbladder is not\ndistended, and contains gallstones. Prominent periportal lymph nodes\nmeasuring up to 1.4 cm, unchanged.\n\nPANCREAS: Interval decrease in the size of the pancreatic head mass, now\nmeasuring 1.8 x 2.1 cm compared to prior measurement of 1.7 x 2.4 cm though\nassessment is limited by fiducial markers in situ. There is persistent\natrophy of the distal pancreas, with dilatation of the pancreatic duct,\nmeasuring up to 1.0 cm. There is persistent contact approximating 180 degrees\nof the GDA. There is also persistent contact of 180 degrees with deformity of\nthe portal confluence, similar to previous.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.0 cm simple cyst in the left mid kidney. No evidence of\nhydronephrosis. The bladder is not distended, and the wall appears thickened.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colonic diverticulosis. Appendix contains air,\nhas normal caliber without evidence of fat stranding. There is no evidence of\nmesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 1.8 x 2.1 cm\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent\nBiliary tree abrupt cutoff with or without upstream dilatation: present, CBD\nstent in situ\n\nArterial evaluation\n\nSMA involvement: absent\nCeliac Axis involvement: absent\nCommon hepatic artery involvement: absent\nVariant anatomy: none\nVariant vessel contact: absent\n\nGDA involvement: Present\nDegree of solid soft tissue contact: Greater than 180 degrees.\nDegree of increased easy attenuation/stranding contact: Greater than 180\ndegrees\nFocal vessel narrowing or contour irregularity: Present\n\nVenous evaluation\n\nMPV involvement: present\nDegree of solid soft-tissue contact: ?180\u00b0\nDegree of increased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop): \nPresent, at confluence/portal vein origin\n\nSMV involvement: present\nDegree of solid soft-tissue contact: ?180\u00b0\nDegree of increased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\npresent\nExtension to first draining vein: absent\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: Similar appearance of a hypodense lesion in segment ___\nmeasuring 1.4 cm, incompletely characterized.\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: absent. Similar appearance of borderline enlarged\nperiportal lymph nodes, without necrosis.\nOther extrapancreatic disease (invasion of adjacent structures): absent", "output": "1. Interval decrease in the size of the dominant pancreatic head mass. There\nis persistent encasement of the GDA. Persistent contact and deformity of the\nmain portal vein at the portal confluence and SMV.\n2. Borderline enlarged periportal lymph nodes are unchanged.\n3. Similar appearance of a hypodense lesion within the left hepatic lobe,\nwhich is incompletely characterized. Ill-defined hypodensity in the right\nhepatic lobe. These can be further assessed on MRI, for which patient is\nscheduled on ___.\n4. CBD stent in situ, with pneumobilia, suggestive of patency, unchanged.\n5. Cholelithiasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\nlargely decompressed without convincing evidence of colitis. The appendix is\nsurgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Decompressed colon without convincing evidence of colitis.\n2. No acute process within the abdomen and pelvis to explain patient's\nsymptom." }, { "input": "Chest findings are reported separately.\n\nThere are new medium sized hypodense masses throughout the liver consistent\nwith metastatic disease. Gallbladder is largely filled with many medium sized\nrim calcified stones. The spleen is normal in size. The right kidney is\nptotic with a mild increase in the degree of hydronephrosis, although still\nmild. Percutaneous nephrostomy tube is again demonstrated in the left renal\ncollecting system. Degree of mild dilatation and ureteral dilatation is\nstable.\n\nThe stomach and small bowel are unremarkable. A left inguinal hernia contains\na segment of sigmoid colon without obstruction.\n\nA Foley catheter terminates in the bladder explaining small quantities of\nluminal air. There is again a large intraluminal mass in the right bladder\ndome with some suspected extramural extension, and to the left of the bladder,\na nearby nodule measuring 23 x 25 mm in axial ___, increased from 17 x\n17 mm. The left-sided moiety to the bladder is heavily infiltrated and may\nrepresent either a large bladder diverticulum that is heavily involved with a\nmass, which may havae increased, or it may just be that it is part of the main\nbody of the bladder with marked distortion secondary to extensive tumor\ninfiltration.\n\nSmall quantity of new ascites is present in the pelvic cul-de-sac. The\nprostate appears normal. Seminal vesicles are probably involved with tumor. \nPatchy vascular calcification is present. There is again an IVC filter in\nplace.\n\nThere is a new lytic metastasis within T12 and at least one suspected new\nadditional small lesion in L3. Moderate degenerative changes are present are\nunchanged along lower facet joints.", "output": "1. Marked increase in metastatic disease disease including widespread hepatic\ninvolvement and bone metastases.\n\n2. Probable increase in extensive infiltrative involvement of the bladder\nwith tumor. Surrounding fat stranding may relate to tumor infiltration or\nedema secondary to extensive tumor involvement although superimposed infection\nis not excluded.\n\n3. Mild worsening of mild to moderate right-sided hydronephrosis.\n\n4. Cholelithiasis.\n\n5. Sigmoid colon containing left inguinal hernia." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: There scattered subcentimeter hypodensities which are too small\nto fully characterize, but likely representing hepatic cysts or biliary\nhamartomas. The liver otherwise demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is a focal region of cortical thinning along the interpolar region of\nthe right kidney, which may represent sequela of prior infarct or infection. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen along the lumbosacral spine. There is mild\nretrolisthesis of L3-L4 vertebral level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of venous thrombus within the abdomen and pelvis." }, { "input": "LOWER CHEST: Multiple bilateral pulmonary nodules are re-demonstrated\nmeasuring up to 4 mm (2: 3, 6, 18). There is a 3 mm nodule in the right lower\nlobe with surrounding ground-glass opacity (02:16) and a 3 mm nodule in the\nleft lower lobe with surrounding ground-glass opacity (02:17), which were not\nseen on prior imaging. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are multiple\nbilateral renal cysts, measuring up to 4.1 cm in the lower pole of the right\nkidney and 2.1 cm in the upper pole of the left kidney. There is no\nhydronephrosis. There is a 5 mm nonobstructing stone in the lower pole of the\nleft kidney, with an additional adjacent punctate stone. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The patient is status post\nright hemicolectomy. The residual colon and rectum are notable for\ndiverticulosis without diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Nonobstructing left nephrolithiasis.\n2. A 3 mm right lower lobe pulmonary nodule with surrounding ground-glass\nopacity and a 3 mm left lower lobe pulmonary nodule with surrounding\nground-glass opacity are new from prior study. Additional bilateral pulmonary\nnodules are unchanged.\n For incidentally detected multiple subsolid nodules smaller than 6mm, CT\nfollow-up in 3 to 6 months is recommended. If the nodules are stable, CT\nfollow-up in 2 and ___ years should be considered.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis. There is no evidence of pleural\nor pericardial effusion. Coronary artery calcifications. Central line tip at\ncavoatrial junction.\n\nABDOMEN:\n\nStreak artifact from the patient's overlying upper extremities limits\nevaluation of the upper abdomen.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are benign bilateral parapelvic cysts. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is mild\nthickening of the lower rectum with adjacent stranding. There is no focal\ndrainable collection identified. No free intraperitoneal air or pneumatosis\nintestinalis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post right open reduction internal fixation of an\nintertrochanteric right femur fracture. There is mild compression fracture of\nL1 vertebral body, likely chronic, there is no paravertebral edema. Prominent\nSchmorl's node upper L3 endplate.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Findings suggestive of proctitis, may be inflammatory or infectious.\n2. Internal fixation of an intertrochanteric right femur fracture." }, { "input": "LOWER CHEST: Visualized lung bases are within normal limits. There is no\nevidence of pleural or pericardial effusion. Triangular-shaped density within\nthe anterior mediastinum is most consistent residual thymus\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 0.6 cm left interpolar region hypodensity is too small to\ncharacterize. There is mildly delayed excretion of contrast bilaterally. The\nkidneys otherwise are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No hernia. The stomach is distended and fluid-filled. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Bilateral top-normal external iliac lymph and scattered left\npara-aortic lymph nodes do not meet CT size criteria for enlargement. There\nis no mesenteric or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Delayed bilateral renal excretion of contrast. Please correlate\nclinically.\n2. Otherwise unremarkable.\n\nRECOMMENDATION(S): Correlation with renal function is recommended given\ndelayed bilateral renal excretion.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 12:05 AM, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. Micronodule measuring\nless than 2 mm in the right lower lobe is seen. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver is diffusely hypodense, likely due to fatty\nsteatosis. Hyperdense appearance of the gallbladder fossa and regional\nhyperdensity in the right lobe is likely due to fat sparing. There is no\nevidence of focal lesions within the limitations of an unenhanced scan. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows top normal in size and normal attenuation throughout,\nwithout evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There are multiple punctate non-obstructing renal stones\nin the upper and lower pole of the left kidney. No stones are seen on the\nright. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Non-obstructing left renal stones. No renal stones on the right. No\nhydronephrosis on either side.\n2. Normal appendix. No acute intra-abdominal or intrapelvic findings to\nexplain patient's symptoms.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. there is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild prominence of the\ncentral intrahepatic and extrahepatic biliary ducts, likely related to\npostcholecystectomy state. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter cortical hypodensity in the right kidney is too small to\ncharacterize, however likely represents a simple cyst. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is wall thickening and edema in\nthe sigmoid colon, with possible areas of decreased wall enhancement (2:50,\n601b:19). A small focus of air in the region of the duodenum is difficult to\nlocalize, and may be intraluminal, however a small focus of mesenteric portal\nvenous gas cannot be excluded (2:32). The remainder of the colon is\nfluid-filled without wall thickening. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a fibroid uterus, with multiple calcified\nfibroids. . No adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: A sclerotic lesion in the proximal right femur is partially imaged,\nand has been present since at least ___. There are severe\nmultilevel degenerative changes in the lumbar and lower thoracic spine. There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Wall thickening and edema in the sigmoid colon with possible areas of\ndecreased wall enhancement is consistent with colitis, differential includes\nischemic. Infectious or inflammatory etiologies are also in the differential.\n2. A small focus of air in the region of the duodenum is difficult to\nlocalize, and may be intraluminal, however a small focus of mesenteric venous\ngas cannot be excluded, and could be seen in the setting of ischemia.\n3. Mild central intrahepatic and extrahepatic biliary duct dilatation is\nlikely secondary to postcholecystectomy state.\n4. Fibroid uterus." }, { "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is prominence of the\nintrahepatic and extrahepatic bile ducts with this CBD measuring 12 mm in\ndiameter, which is within normal limits after cholecystectomy. The\ngallbladder is surgically absent.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: There is dilation of the duodenal C sweep to the level of\nfocal narrowing of the duodenum as it traverses between the abdominal aorta\nand superior mesenteric artery. Small bowel loops demonstrate normal caliber,\nwall thickness and enhancement throughout. Colon and rectum are within normal\nlimits with a large colonic fecal load. Appendix contains air, has normal\ncaliber without evidence of fat stranding (02:52).\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Uterus is of normal size and enhancement. No evidence of\nadnexal abnormality bilaterally.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. There is minimal anterolisthesis\nof L5 on S1 with bilateral pars defects. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. Dilation of the duodenal C-sweep the level of focal narrowing between the\nabdominal aorta and SMA could represent SMA compression syndrome in the\nappropriate clinical context; imaging findings alone are not sufficient for\ndiagnosis.\n2. Normal appendix. Large colonic fecal load.\n3. Mild prominence of the intra and extrahepatic bile ducts is within normal\nlimits after cholecystectomy.\n4. Minimal anterolisthesis of L5 on S1 with bilateral pars defects." }, { "input": "LOWER CHEST: There is minimal dependent atelectasis in the imaged lung bases. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: There is a large heterogeneously enhancing 14.2 x 10.6 cm mass in the\npelvis (2:59) with areas of hypodensity, which may represent central necrosis.\nThere is partial mass effect on the urinary bladder, which is otherwise\nunremarkable. There is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears to abut but be separate from the\naforementioned pelvic mass. The left ovary appears separate from the mass\n(60___:22). The right ovary is not optimally seen and may or may not be\ndistinct from the pelvic mass.\n\nLYMPH NODES: There is no abdominal, pelvic, or inguinal lymphadenopathy by CT\nsize criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Large, heterogeneous 14.2 x 10.6 cm pelvic mass of indeterminate etiology. \nThe uterus and left ovary appear separate from this mass. The right ovary is\nnot well visualized. If further identification of the right ovary would\naffect management, may consider pelvic ultrasound or MRI.\n2. Differential diagnosis includes GIST vs ovarian tumor not excluded. \nRecommend tissue sampling of pelvic mass for further characterization.\n\nRECOMMENDATION(S): Tissue sampling of pelvic mass." }, { "input": "LOWER CHEST: Please see separate report for CT of the chest performed ___..\n\nABDOMEN:\n\nHEPATOBILIARY: There is moderate intrahepatic biliary ductal dilatation in the\nleft hepatic lobe. There is also mild intrahepatic biliary ductal dilatation\nthe right hepatic lobe. There is heterogeneous soft tissue within the left\nhepatic duct, extending to the confluence of the right and left hepatic ducts\n(series 3, image 13 and series 601, image 41). Findings are most compatible\nwith intraductal cholangiocarcinoma. There is also mild dilatation of the\ncommon bile duct, measuring up to 10 mm. No definite liver mass is identified\nwithin the limitations of this single-phase postcontrast study.\n\nThe gallbladder is distended. No radiopaque stones are identified.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. Few scattered subcentimeter hypodensities in both\nkidneys are too small to characterize but statistically likely represent\ncysts. There is a 4 mm nonobstructing calculus in the interpolar region of\nthe right kidney (series 601, image 27). There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There are mildly enlarged gastrohepatic ligament lymph nodes\nmeasuring up to 8 mm in short axis (series 3, image 13). A conglomerate of\nperiportal/precaval lymph nodes measures 3.4 x 2.6 cm (series 601, image 49),\nlikely metastatic. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are small bilateral fat containing inguinal hernias..", "output": "1. Intrahepatic biliary ductal dilatation, moderate in the left hepatic lobe\nand mild in the right hepatic lobe. Heterogeneous soft tissue within the left\nhepatic duct, extending to the confluence of the right and left hepatic ducts,\nmost compatible with intraductal cholangiocarcinoma.\n2. Periportal/precaval lymphadenopathy is concerning for metastatic\ninvolvement." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a diffusely heterogeneous appearance of the liver\nwithout focal lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Moderate to large\nstool burden. The colon and rectum are within normal limits. The appendix is\nnot visualized, however there are no surrounding inflammatory changes.\n\nPELVIS: There is circumferential thickening of the bladder wall, which is\nlikely due to underdistention. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is normal in appearance for patient of this\nage. There is a 2.6 x 2.2 cm right adnexal cystic structure (series 2, image\n74), which is likely physiologic in a patient of this age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormalities within the abdomen or pelvis to explain abdominal\npain. Moderate to large stool burden.\n2. Diffusely heterogeneous appearance of the liver without focal lesions,\nwhich could be due to phase of contrast. Correlation with LFTs is\nrecommended. Anecdotally, this has been observed in patients on oral\ncontraceptives." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: Status post right nephrectomy. Left kidney appears normal except for\na tiny 2 mm nonobstructing calculus at the lower pole as seen previously. No\nhydronephrosis..\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. Appendix contains air, has normal caliber without evidence of fat\nstranding. There is diastasis of the midline fascia in the umbilical region\nwith mesenteric fat extending to the emboli kiss. No hernial defect is seen.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. Prior right nephrectomy. Tiny nonobstructing calculus lower pole of the\nleft kidney as seen previously. No adenopathy. No evidence for tumor\nrecurrence by CT scan." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: A heterogeneously hypoenhancing mass in hepatic segment III now\nspans approximately 5.2 x 2.8 cm, increased in size compared to the prior CT\nand MRI when it measured approximately 3.7 x 1.9 cm (2:60). Other\nsubcentimeter hypoenhancing lesions concerning for metastatic disease are\nagain noted in the peripheral aspect of segments VI (2:64) and VII (2:62), not\nappreciably changed. Stable low-density lesions compatible with hepatic cysts\nare again seen seen diffusely (2:48, 50, 52, 54, 55, 58). No obvious new\nhepatic lesions are identified. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. Mild central pneumobilia and biliary ductal\nprominence is again noted, unchanged. The gallbladder is surgically absent. \nAbdominal ascites has significantly increased, and is now moderate to large in\nvolume.\n\nPANCREAS: Postsurgical changes related to prior ___ procedure are again\nseen. Confluent ill-defined hypoenhancing soft tissue in the pancreatic bed\nis difficult to accurately measure, but grossly appears unchanged compared to\nprior examinations, with more clearly defined invasion of the posterior wall\nof the gastric cardia and body (02:58, 60).\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are unchanged in appearance, with cortical thinning of\nthe lower pole of the left kidney. No focal renal lesions of concern are\nnoted. Subcentimeter hypodensities in the lower pole of the left kidney and\ninterpolar right kidney are too small to completely characterize.\n\nGASTROINTESTINAL: Soft tissue mass invasion of the posterior wall of the\ngastric cardia and body appear similar (___:30). There is no evidence of\nsmall bowel obstruction. Numerous colonic diverticula are again noted.\n\nPELVIS: There is no significant pelvic lymphadenopathy or free fluid.\n\nLYMPH NODES: Soft tissue nodules in the left anterior perirenal space are\nagain seen, not significantly There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The above described recurrent soft tissue mass in the pancreatic\nresection bed continues to involve the left lateral aspect of the SMA origin\n(2:60). There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. The portal veins remain patent.\n\nBONES: There is continued grade 2 anterolisthesis of L4 on 5. No osseous\nlesion worrisome for malignancy or infection is identified in the abdomen and\npelvis.\n\nSOFT TISSUES: Numerous peritoneal and abdominal wall soft tissue nodules are\nenhancing and compatible with metastatic foci (2: 64, 65, 70). The largest\nmidline anterior abdominal wall soft tissue nodule is 2.4 x 1.6 cm, also\nincreased in size (2:77).", "output": "1. Interval progression of hepatic metastatic disease.\n2. Peritoneal carcinomatosis and recurrent soft tissue mass within the\npancreatic resection bed which invades the posterior gastric wall are similar\nin appearance.\n3. Increased volume of abdominopelvic ascites, now moderate." }, { "input": "Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nCT abdomen with contrast: Several hypodense hepatic lesions measuring up to\n3.1 cm in segment 2 are unchanged from the prior MR where they were\ncharacterized as cysts. The liver otherwise enhances homogeneously without new\nlesion, intra or extrahepatic biliary ductal dilatation. Pneumobilia is\nexpected given Whipple. Portal vein is patent. Gallbladder is surgically\nabsent.\n\nSpleen is absent. The adrenal glands are unremarkable. Postsurgical changes\nare present from a Whipple. Tiny residual portion of the pancreatic head\nappears unremarkable without focal lesion. Scattered bilateral millimetric\nrenal hypodensities are too small to fully characterize by CT but\ncharacterized as cysts on MR. ___ are areas of left renal cortical thinning\ncompatible with prior insult. The kidneys otherwise present symmetric\nnephrograms without suspicious lesion, hydronephrosis or perinephric\nabnormality.\n\nStomach rugae appear somewhat thickened, though this could be due to\ncontraction. The stomach and small bowel are otherwise unremarkable without\nevidence of obstruction. There is no evidence of obstruction at the\nanastomosis. There are scattered colonic diverticula, particularly in the\nsigmoid without evidence of diverticulitis. The large bowel is otherwise\nunremarkable.\n\nThere are prominent atherosclerotic calcifications in a normal-caliber\nabdominal aorta without focal aneurysmal segment. The celiac axis, SMA and\nbilateral renal arteries appear grossly patent. There is no mesenteric or\nretroperitoneal lymphadenopathy by CT size criterion. There is no ascites or\npneumoperitoneum. There is a small fat containing umbilical hernia.\n\nCT pelvis with contrast: The bladder, prostate and rectum are unremarkable.\nThere is a tiny fat containing left inguinal hernia. There is no inguinal or\npelvic sidewall lymphadenopathy by CT size criterion. There is no free pelvic\nfluid or air.\n\nOsseous structures: There is no suspicious focal osseous lesion. There is\ngrade 2 anterolisthesis of L4 on L5 with bilateral pars defects.", "output": "1. Postsurgical changes from a Whipple without evidence for local or\nmetastatic disease recurrence.\n2. Thick gastric folds which may be due to contraction however attention on\nfollow-up imaging is recommended.\n3. Areas of cortical thinning in the and left kidney suggestive of prior\ninflammatory insult.\n4. Hepatic and renal hypodensities characterized as cysts on prior MR.\n5. Bilateral L4 pars defects with grade 2 anterolisthesis." }, { "input": "LOWER CHEST: Persistent, moderate left and small right non-hemorrhagic\npleural effusions are again noted. For detailed description of the\nintrathoracic findings, please see the separate chest CT report.\n\nABDOMEN:\n\nHEPATOBILIARY: Redemonstrated are numerous hepatic hypodensities, the largest\nwhich measures 2.1 x 1.6 cm in the left hepatic lobe (05:57), consistent with\nsimple cysts and unchanged the prior examination. There is no suspicious,\nenhancing lesion concerning for metastasis identified. A small degree of\npneumobilia is unchanged. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post pancreatectomy. The previously noted\nprominent lymph node seen immediately posterior to the proximal SMV has\ndecreased in size, now measuring 7 mm in short axis (5:70). There is no\nsuspicious soft tissue mass or pathologically enlarged mesenteric or\nretroperitoneal lymph node identified.\n\nSPLEEN: The patient is status post splenectomy.\n\nADRENALS: Mild thickening of the left adrenal gland is unchanged. The right\nadrenal gland is normal in appearance.\n\nURINARY: Mild renal cortical thinning is again noted on the left. The kidneys\nare otherwise of normal and symmetric size with normal nephrogram. There is no\nevidence of stones, focal renal lesions, or hydronephrosis. There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post Whipple procedure, with an intact\ngastroenteric anastomotic site. There is no evidence of obstruction, and oral\ncontrast extends to the distal small bowel. Sigmoid diverticulosis is noted.\n\nRETROPERITONEUM: There is no evidence of pathologic retroperitoneal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is heavy calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: Multilevel degenerative changes are noted within the\nthoracolumbar spine. Stable, grade ___ anterolisthesis of L4 on L5 is likely\ndegenerative in nature. No suspicious osseous lesions are identified.", "output": "1. Status post Whipple procedure, pancreatectomy, and splenectomy without\nevidence of local tumor recurrence.\n2. Interval decrease in size of a previously identified, conspicuous,\n___ lymph node. No pathologic mesenteric or retroperitoneal\nlymphadenopathy is identified.\n3. For description of the intrathoracic findings, please see the separate CT\nchest report dictated on the same day." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nwedge-shaped hypoenhancing region in the periphery of segment 4a is unchanged\ncompared to the prior exam and likely represents a perfusional abnormality or\nfocal fatty deposition (5:72) There are no concerning focal lesions. \nScalloping of the hepatic contour is less conspicuous on today's exam. The\nportal and hepatic veins appear patent. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is a significant decrease in the degree of loculated perihepatic\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout. A 6 x 7 mm cystic\nlesion in the uncinate process (5:96) is unchanged compared to the prior exam.\nNo nodularity or duct dilation. Statistically, this lesion most likely\nrepresents a side-branch IPMN. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis. There is persisting but interval\ndecrease in the degree of perirectal stranding. A large right inguinal hernia\ncontaining multiple loops of non-dilated small bowel with fluid in the hernia\nsac is unchanged compared to the prior exam. The mucosa enhances normally. \nThere is mild the rare to heal by diverticulosis in the sigmoid colon. No\nevidence of diverticulitis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple small volume retrocrural lymph nodes which\nare unchanged compared to the prior exam. There is no mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild compression fractures at L2 and L5 which are unchanged compared\nto the prior exam. No retropulsed fragments.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of intra-abdominal or intrapelvic metastases\n\n2. Multiple small volume retrocrural lymph nodes are unchanged compared to the\nprior exam.\n\n3. Stable cystic lesion in the uncinate process statistically most likely\nrepresents a side-branch IPMN. No concerning features. Follow-up CT abdomen\nin ___ years time is recommended." }, { "input": "LOWER CHEST: The intrathoracic portion of this exam will be dictated under\nanother clip number.\n\nHEPATOBILIARY: The liver is normal in size and attenuation. No focal hepatic\nlesions are identified. The portal vein is patent. There is no intra or\nextrahepatic biliary duct dilatation. The gallbladder is normal-appearing.\n\nSPLEEN: The spleen is normal in size and enhancement.\n\nPANCREAS: An 8 mm hypodensity in the uncinate process is stable (5:89). There\nis no pancreatic duct dilation.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys display symmetric nephrograms with no evidence of\nhydronephrosis or mass lesion in either kidney. The ureters are symmetrical\nin their course to the bladder.\n\nGASTROINTESTINAL: The stomach is normal. Loops of small bowel are normal in\ncaliber. Multiple loops of small bowel are seen within a right inguinal\nhernia. Of note, the right inguinal hernia appears increased in size and now\ncontains more loops of small bowel when compared to the prior exam. There is\nno evidence small bowel obstruction. The large bowel is normal in caliber. \nThere is mild diverticulosis of the sigmoid colon. There is minimal fluid\nseen around the liver and spleen. Mild mid left omental nodularity has\nmarkedly decreased from ___ and is less conspicuous in comparison to the more\nrecent CT examination from ___.\n\nLYMPH NODES: Small retroperitoneal lymph nodes are overall similar in size\nfrom the prior examination and are not pathologically enlarged.\n\nVASCULAR: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nPELVIS: The bladder and rectum are normal. There is sigmoid colonic\ndiverticulosis. A right inguinal hernia contains loops of bowel and fluid.\n\nBONES AND SOFT TISSUES: No suspicious lesions are seen. Compression fractures\nof T11, T12, L1 and L4 are stable. Compression fractures of L2 of L5 are re-\ndemonstrated and stable.", "output": "1. Minimal perisplenic and perihepatic ascites. Omental implants have\ndecreased from the most recent prior examination from ___ and have\nsignificantly decreased from ___.\n2. No evidence of new metastatic disease or lymphadenopathy.\n3. 9 mm hypodensity in the uncinate process of the pancreas is stable. \nContinued attention on follow-up imaging.\n4. A large right inguinal hernia is increased in size and contains a longer\nsegment of small bowel, without obstruction." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nThere has been interval development of large volume ascites associated with\nperitoneal enhancement.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Again noted are compression deformities in the superior endplate of L5,\nL4, L2, L1, T12 and T11.\n\nSOFT TISSUES: There is a moderate-sized right-sided inguinal hernia containing\nfluid within it.", "output": "Interval development of large volume ascites along with peritoneal enhancement\ncould represent worsening peritoneal carcinomatosis." }, { "input": "LOWER CHEST: Again demonstrated is the extensive centrilobular and paraseptal\nemphysema in the lung bases, similar to ___. 2 mm right lower lobe\npulmonary nodule is unchanged since ___ (3; 8) and another 2 mm\npulmonary nodule in the right lower lobe is unchanged since ___ (3; 4).\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. An enteric tube terminates in\nthe antrum. Multiple loops of dilated small bowel with air-fluid levels\nconcerning for small bowel obstruction. There appears to be a transition\npoint in the right lower quadrant approximately 10 cm proximal to the\nileocecal valve with decompressed ileal loops distally (5; 24). A malignant\ncause for obstruction cannot be excluded although no soft tissue masses were\nidentified. These small bowel loops demonstrate normal wall thickness, and\nenhancement throughout without evidence of pneumatosis. Diverticulosis of the\nsigmoid colon is noted, without evidence of wall thickening and fat stranding.\nThe ascending colon is filled with stool and the descending and sigmoid colon\nare decompressed. A portion of the ascending colon and cecum is within a\nright inguinal hernia. The appendix is not visualized.\n\nThere is again re-demonstration of large volume ascites with ___ of 17\nassociated with peritoneal enhancement, better seen on prior CT. Evaluation\nof the omentum and previously noted nodularity and stranding are limited given\nlarge volume ascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Unchanged appearance of prostate. Seminal vesicles\nappear unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Re-demonstration of compression deformities of the superior endplate of\nT11, T12, L1, L 2, L4, and L5 vertebral bodies.\n\nSOFT TISSUES: A large right inguinal hernia containing peritoneal fluid and a\nportion of the cecum is noted with a 3.6 cm defect (5; 24).", "output": "1. Small-bowel obstruction with transition point in the right lower quadrant\napproximately 10 cm proximal to the ileocecal valve. Malignant cause for\nobstruction cannot be excluded although no soft tissue masses are identified. \nNo evidence of decreased mucosal enhancement or pneumatosis to suggest\nischemia.\n2. Large right inguinal hernia containing portion of the cecum.\n3. Unchanged large volume ascites with peritoneal enhancement concerning for\nmetastatic disease.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 11:41 pm, 10 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: A 3 mm right lower lobe solid nodule is unchanged (5:7). \nRedemonstration of severe, diffuse centrilobular and paraseptal emphysema\nincluding large bulla at the left lung base. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMild right hydronephrosis (5:30) is new from ___ and may be secondary\nto compression of the distal right ureter from distended bowel loops. \nExcreted contrast material is still seen the right renal pelvis. There is no\nleft hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the stomach, which is mildly\ndistended. A right lateral approach PleurX catheter drain terminates in the\nmid anterior abdomen. Multiple dilated small bowel loops measuring up to 4.2\ncm, with many loops containing fecalized material are seen. A transition\npoint in seen in the right mid abdomen (5:43). A second transition point is\nseen best on coronal images, series 7 image 18, also in the right hemiabdomen.\nA single loop of small bowel demonstrates apparent wall thickening (07:28). \nLarge stool burden is seen throughout the colon. The appendix is not\nvisualized. There is no free intraperitoneal air.\n\nSmall volume ascites is similar to ___. Hyperenhancing peritoneal\nlining a omental nodularity, for example (5:26), appears similar to prior.\n\nPELVIS: The urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: Unchanged appearance of the prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multiple compression deformities involving a T11-L2 and L4-L5 are\nunchanged. There are no new worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A right inguinal contains a small portion of the cecum and\nascitic fluid.", "output": "1. Multiple dilated loops of small bowel measuring up to 4.2 cm, with many\nloops containing fecalized material. Findings are consistent with a\nsmall-bowel obstruction, with a few transition point seen in the right mid\nabdomen and may be secondary to adhesions or peritoneal metastases. No free\nintraperitoneal air.\n2. Mild right hydronephrosis is new from ___, and may be secondary to\ncompression of the distal right ureter from dilated bowel loops.\n3. Redemonstration small volume ascites, hyperenhancing peritoneum and omental\nnodularity, compatible with known metastatic disease.\n4. Re-demonstration of large right inguinal hernia and multiple compression\ndeformities involving the lower thoracic and lumbar vertebral bodies, as\ndetailed above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:20 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. A 4.6\ncm simple cyst is noted within the midpole of the left kidney. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: Multiple prominent, borderline -enlarged mesenteric and\nretroperitoneal lymph nodes are noted, including a periportal lymph node\nmeasuring 1.5 cm in short axis (6:62), and several para-aortic lymph nodes\nmeasuring up to 1.2 cm in short axis (6:6 9).\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: A sclerotic focus within the T10 vertebral body\nlikely represents a bone island. There is no evidence of worrisome lesions.", "output": "1. No evidence of acute intra-abdominal process. Normal appendix.\n2. Multiple mildly enlarged retroperitoneal lymph nodes seen adjacent to the\nmain portal vein and intra-abdominal aorta. While nonspecific, gven the\npatient's history of lymphoma, findings may represent recurrent disease. \nPET-CT is recommended.\n3. For description of the intra -thoracic findings, please see the separate\nCT chest report." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodensities are noted throughout the liver, many of which are too\nsmall to characterize. Additional hypodensities measure up to 2.1 cm in\nsegment 8 and are compatible with simple cysts. No hepatic lesions are\nconcerning for metastatic disease. There is minimal intrahepatic biliary\ndilatation with 2 common bile duct stents in place, the larger of which\nappears patent throughout its course. There is expected pneumobilia, most\nnotable in the left hepatic lobe. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: In the pancreatic head/uncinate process, there is an ill-defined,\nhypodense 2.9 x 2.5 x 3.0 (AP by TRV by CC, series 5; image 106, series 8;\nimage 31). There is resultant upstream main pancreatic ductal dilatation,\nmeasuring up to 7 mm in size. These findings are consistent with pancreatic\nneoplasm. Please see pancreatic cancer staging template below.\n\nPANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 2.9 cm\nLocation head/uncinate, immediately to the right of the SMV\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nPresent\nBiliary tree abrupt cutoff with or without upstream dilatation: Present,\nalthough evaluation is limited due to biliary stenting.\n\nArterial evaluation\n\nSMA involvement: absent\n\nCeliac Axis involvement: absent\n\nCommon hepatic artery involvement: absent\n\nVariant anatomy: none\n\nVenous evaluation\n\nMPV involvement: absent\n\nSMV involvement: Present\nDegree of solid soft-tissue contact: >180\u00b0\nDegree of increased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein: present\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: mesenteric root collaterals\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: There is and a lymph node in the porta hepatis, which\nmeasures 0.8 cm in short axis (series 5, image 94). Although this lymph node\nis not necessarily suspicious in morphology, given its location and top-normal\nsize, metastatic disease cannot be excluded.\nOther extrapancreatic disease (invasion of adjacent structures): Please note\nthere is non-specific haziness surrounding the SMA axis at the root of the\nmesentery, which appears separate from the primary mass.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. 2.4 cm, anteriorly located accessory spleen is\nnoted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones or hydronephrosis. Multiple, cortically based\nrenal hypodensities are too small to characterize, but statistically likely to\nrepresent cysts. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. There is colonic diverticulosis without\nsurrounding inflammation to suggest diverticulitis. There is no evidence of\nmesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate is mildly enlarged. Seminal vesicles are\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is moderate degenerative change seen throughout the visualized\nthoracolumbar spine with anterior osteophytosis, loss of intervertebral disc\nheight, and vacuum disc phenomena at L4-L5 and L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Ill-defined, hypodense mass in the pancreatic head/uncinate process,\nmeasuring up to 2.9 cm in the axial plane, consistent with pancreatic\nneoplasm. Resultant upstream, main pancreatic ductal dilatation, measuring up\nto 7 mm in size. Minimal residual intrahepatic biliary dilatation, with\ncommon bile duct stents in place.\n2. Superior mesenteric and celiac axes as well as the main portal vein are\nfree of disease. Please note however that there is haziness surrounding the\nSMA axis at the root of the mesentery, which appears separate from the primary\nmass and is nonspecific. There is involvement of the superior mesenteric vein\nwith greater than 180 degrees of solid soft tissue contact. 0.8 cm lymph node\nat the porta hepatis is not necessarily suspicious in morphology, but should\nbe followed closely on future exams given location.\n3. Multiple hypodensities are seen throughout the liver, many of which are too\nsmall to characterize. Lesions which are large enough to characterize measure\nup to 2.2 cm in segment 8 of the liver and are consistent with simple cysts. \nAdditional hypodensities should be followed on future exams." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple well-circumscribed hepatic hypodensities are unchanged from ___\nand probably represent cysts; the largest lesion in hepatic segment IV\nmeasures 2.0 cm. A metallic CBD stent is in stable positioning with no\nsignificant interval change to left hepatic lobe predominant pneumobilia and\ngallbladder pneumobilia. The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: The pancreatic head/uncinate mass is described below. Moderate\natrophy of the pancreatic body and tail appear similar to prior.\n\nPANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 2.9 x 2.3 cm (previously 3.0 x 2.7 cm)\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent, unchanged upstream dilation up to 0.7 cm (4:107).\nBiliary tree abrupt cutoff with or without upstream dilatation: absent\n\nArterial evaluation\n\n___ involvement: present\nIncreased hazy attenuation/stranding contact: <=180\u00b0 (4:116)\nFocal vessel narrowing or contour irregularity: absent\nExtension to first ___ branch: present\n\nCeliac Axis involvement: present\nSolid soft-tissue contact: GDA >180\u00b0\nIncreased hazy attenuation/stranding contact: GDA, proper hepatic artery >180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nVariant anatomy: none\n\nVenous evaluation\n\nMPV involvement: present\nDegree of solid soft-tissue contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\n\nSMV involvement: present\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein: present\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: present, trace\nSuspicious lymph nodes: celiac node measuring 1.3 x 0.7 cm, stable (4:102)\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The bilateral adrenal glands appear bulky without definite\nnodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid renal lesions, or hydronephrosis. \nBilateral simple cysts measure up to 1.7 cm on the right and 1.3 cm on the\nleft. There are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Mucosal enhancement within the gastric antrum/first portion\nof duodenum is less pronounced compared to the prior study. Otherwise, the\nstomach is unremarkable, and small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening or fat stranding.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is trace ascites.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a T11 hemangioma.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in size of pancreatic head/uncinate mass which measures\n2.9 x 2.3 cm (previously 3.0 x 2.7 cm).\n2. Extensive vascular involvement, including portions of the celiac axis,\nsuperior mesenteric artery and vein, and main portal vein, is overall similar\nto the prior study.\n3. Trace ascites.\n4. Additional findings as detailed above." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple low-density lesions are seen scattered throughout the liver, stable\nin appearance since previous examination. The largest of these is again\nidentified at the hepatic dome, measuring up to 2.0 cm, consistent with a\nsimple cyst. There is no suspicious focal lesion. Previously seen biliary\nstent is no longer present. Small amount of central pneumobilia persists. \nThere is no intra or extrahepatic biliary dilatation. The gallbladder is\nnormal in size, and demonstrates mild diffuse wall thickening.\n\nPANCREAS: 3 fiducials are again visualized, demarcating the known ill-defined\npancreatic head lesion that is described below.\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): Heterogeneous and\nhypoattenuating\nSize (maximal axial dimension in cm): 3.1 x 2.5 cm, where previously measured\n3.1 x 2.3 cm\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nPresent, with main pancreatic duct measuring up to 7 mm in the pancreatic\nneck, similar to previous examination.\nBiliary tree abrupt cutoff with or without upstream dilatation: absent. \nPreviously seen stent is no longer present.\n\nArterial evaluation\n\nSMA involvement: Present\nSolid soft-tissue contact: Less than 180 degree (2:145), similar to previous\nexamination\nIncreased hazy attenuation/stranding contact: 360 degree through the length of\nthe superior mesenteric artery until the first branching\nFocal vessel narrowing or contour irregularity: absent\nExtension to first ___ branch: Present\n\nCeliac Axis involvement: Present\nSolid soft-tissue contact: Absent\nIncreased hazy attenuation/stranding contact: 360 degrees from just distal to\nthe origin of the celiac axis, extending to surround the common hepatic and\nproximal splenic artery.\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: Present\nSolid soft-tissue contact: Absent\nIncreased hazy attenuation/stranding contact: 360 degrees for entirely\nFocal vessel narrowing or contour irregularity: absent\nExtension to bifurcation of right/left hepatic artery: Present, with\nmesenteric haziness occupying the porta hepatis.\nThe gastro duodenal artery is also encased, with narrowing as it passes\nthrough the pancreatic head mass (2: 133 to 143)\n\nVenous evaluation\n\nMPV involvement: Present\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: 360 degrees\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\n\nSMV and portal confluence: Present\nDegree of solid soft-tissue contact: Encased\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein: Present (2:140)\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: Trace ascites in the pelvis\nSuspicious lymph nodes: A porta hepatis node measuring 8 mm (2:130) is noted. \nA few smaller rounded peripancreatic nodes are identified\nOther extrapancreatic disease (invasion of adjacent structures): There is loss\nof fat plane between the pancreatic mass and the adjacent second portion of\nthe duodenum (2:142 haziness extends to abut the IVC and left renal vein with\nless than 180 degree contact.\n\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions. There is no perinephric\nabnormality. There is no hydronephrosis or hydroureter. Few simple cysts are\nseen bilaterally. The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. There is moderate colonic\ndiverticulosis without evidence of acute diverticulitis. Appendix is not\nvisualized.\n\nPELVIS: Trace free fluid is noted in the pelvic cavity.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present. There is no abdominal\naortic aneurysm.\n\nBONES: There is overall decreased bone mineral density. No suspicious osseous\nlesion is identified. Moderate degenerative changes of the lumbar spine are\npresent. No acute fractures identified.\n\nSOFT TISSUES: Fluid is noted in the left inguinal canal, likely related to the\nsmall volume ascites. There is moderate fat stranding throughout the\nsubcutaneous tissues, likely related to third spacing.", "output": "1. An ill-defined pancreatic head/uncinate mass is overall stable in size\nmeasuring 3.1 x 2.5 cm. Extensive vascular involvement is not significantly\nchanged since previous examination. There is encasement and near-obliteration\nof the gastro duodenal artery by the mass. There is also encasement of the\nsuperior mesenteric vein and portal confluence without narrowing. Additional\nstranding encases the celiac axis and branches, superior mesenteric artery and\nthe main portal vein.\n2. The mass contacts the second portion of the duodenum with loss of\nintervening fat plane. No evidence of hepatic or other distant involvement at\nthis time.\n3. Trace ascites and third spacing.\n4. Osteopenia." }, { "input": "Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nThe liver is enlarged and is nodular in contour measuring 21.6 cm in\ncraniocaudal dimension in the midclavicular line. Numerous round hypodense\nlesions of varying sizes are noted throughout the liver. Two surgical clips\nare noted at the posterior right hepatic dome. There is no intra or\nextrahepatic biliary ductal dilatation. The portal vein is patent. The\ngallbladder is fluid filled and without evidence of radiopaque filling\ndefects.\n\nThe spleen, pancreas and adrenal glands are within normal limits.\n\nThe kidneys are normal in size and symmetrically enhancing without evidence of\nhydronephrosis. There are several subcentimeter hypodense lesions within the\nright kidney which are too small characterize by CT. No renal lesion is seen.\n\nThere is no significant retroperitoneal, mesenteric, pelvic or inguinal\nlymphadenopathy. There is no abdominal pelvic fluid collection or ascites.\n\nThe stomach is distended with contrast and is unremarkable in appearance.\nSmall bowel is normal in caliber without evidence of obstruction. There are\nscattered colonic diverticula without associated inflammatory changes. A\nnormal caliber appendix is visualized in the right lower quadrant of the\nabdomen.\n\nThe prostate is enlarged measuring 5.6 cm in transverse diameter. The seminal\nvesicles are normal in appearance. Urinary bladder is distended with fluid and\nwithout evidence of wall thickening, masses or stones. There is a small fat\ncontaining right inguinal hernia.\n\nDegenerative changes are noted within the thoracic and lumbar spine.", "output": "1. Innumerable hypodense lesions of varying sizes scattered throughout the\nliver concerning for metastatic disease. No CT evidence of a primary cancer\nwithin the abdomen and pelvis.\n2. Enlarged prostate. Please correlate with serum PSA levels and digital\nrectal exam." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 1.4 cm\nsimple cyst in the right interpolar region. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal abnormality is\ndetected given limitations of this unenhanced scan.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No hydronephrosis or urinary calculi. No acute findings to explain the\npatient's right flank pain." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is dilated up to 11 mm with\nminimal, periappendiceal fat stranding. This most likely represents acute\nappendicitis, although the appearance is slightly atypical as the appendix\ndoes not contain fluid or an appendicolith. Another, much less likely\npossibility is focal, chronic inflammatory bowel disease involving the\nappendix. However, the degree of periaendiceal stranding is minimal, there\nare no other signs of inflammatory bowel disease elsewhere in the\ngastrointestinal tract and the appendix was normal on the prior MRI from ___.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Intramural uterine hypodensities are most consistent\nwith small fibroids. The ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is surgical material in the right pelvis from a prior\nprocedure.", "output": "Probable, acute appendicitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken with nodular borders compatible with a\ncirrhotic morphology. In the peripheral subcapsular right lobe of the liver\nnear the dome, there is a central focus of enhancement with peripheral cystic\ncomponents which measures 1.6 x 1.6 cm (303:16). There are multiple\nhypoattenuating foci in the liver which likely represent simple cysts or\nbiliary hamartomas. There TIPS extending from the IVC into the right portal\nvein is patent. There is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 16.0 cm in maximal length (603:64)\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are subcentimeter hypodensities in both kidneys which are too small to\ncharacterize. There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Embolization coils are noted\nin the left and mid abdomen. No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Nodular focus of enhancement with cystic component measuring 1.6 cm in the\nright lobe of the liver near the dome does not demonstrate washout and is not\nfocally suspicious for HCC. However, comparison with prior studies, if\navailable, to evaluate chronicity is recommended. No lesion demonstrates\narterial hyper enhancement or washout or meets OPTN criteria for diagnosis of\nHCC.\n2. Other sub-centimeter hypoattenuating foci in the liver too small to\ncharacterize but statistically favor simple cysts or biliary hamartomas.\n3. Patent TIPS." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAreas of hypoenhancement around the falciform ligament are similar prior exam\nand likely represent areas of focal fatty deposition or perfusional\ndifferences. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Trace perihepatic free fluid is noted. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. A 7 mm\nhypodense lesion in the spleen (03:10) is too small to characterize, but\nunchanged from prior exam.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Subcentimeter hypodensity in the interpolar region\nof the right kidney is too small to characterize but likely a cyst.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized. There is\ntrace free fluid in the left hemipelvis, likely physiologic.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is no large fibroid uterus. There is small amount\nof intermediate density fluid within the endometrial cavity. There is a 4.4\ncm right adnexal cyst.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No acute intra-abdominal process.\n2. Endometrium is distended with intermediate density fluid and there is a 4.4\ncm right adnexal cyst. Recommend further evaluation with pelvic ultrasound if\npatient is postmenopausal.\n3. Trace perihepatic and left lower quadrant free fluid without identified\nunderlying cause." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. No pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nfocal lesions. No intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits, without stones or wall thickening. The\nmain portal vein appears patent. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout. A 4-mm hypodensity\nin the uncinate is overall unchanged when accounting for differences in slice\nselection since ___ and likely represents focal fat (Series 2, Image 34). No\nmass effect, pancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout. No focal\nsplenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and symmetric with normal nephrograms.\nA few tiny bilateral hypodensities are nonspecific and too small to accurately\ncharacterize on CT, but may represent cysts. No concerning focal renal lesion,\nhydronephrosis, or perinephric abnormality. No evidence of stones. The distal\nureters are within normal limits. The urinary bladder is not completely\ndistended, limiting evaluation, but appears grossly unremarkable.\n\nGASTROINTESTINAL: The stomach is decompressed. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Slight\nhyperenhancement and prominent thickening of the sigmoid colon walls, with\nadjacent fat stranding, vasa recta and mesenteric node prominence, with\nmultiple diverticuli, are compatible with acute diverticulitis (e.g., Series\n2, Image 69). The inflammed sigmoid colon abuts the uterus without a clear\nfat plane (Series 2, Image 69). No drainable fluid collection or evidence of\nextraluminal air. No bowel obstruction. No gas in the bowel wall. The\nappendix contains air and is normal in caliber without evidence of adjacent\nfat stranding.\n\nRETROPERITONEUM: No retroperitoneal or mesenteric lymphadenopathy by CT size\ncriteria.\n\nVASCULAR: No abdominal aortic aneurysm. Mild calcium burden in the abdominal\naorta and great abdominal arteries is stable.\n\nPELVIS: No pelvic or inguinal lymphadenopathy. No free fluid in the pelvis. \nThe fat plane between the uterus and affected sigmoid colon is indistinct as\ndescribed above.\n\nBONES AND SOFT TISSUES: No suspicious lytic or sclerotic bony lesion. There is\na tiny, non-complicated fat-containing umbilical hernia (Series 602b, Image\n41) the pelvic wall is within normal limits.", "output": "1. Acute sigmoid diverticulitis. No adjacent drainable fluid collection. No\nmacroperforation. Fat plane with uterus is not clearly seen.\n\n2. Tiny non-complicated fat-containing umbilical hernia.\n\n3. Stable probable focal fat in the uncinate of the pancreas." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a small simple cyst arising from the left kidney. No suspicious\nrenal mass. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized loops of small\nbowel are unremarkable. There is a left lower quadrant colostomy without\nevidence of complication. There is mild sigmoid colonic diverticulosis\nwithout diverticulitis. The rectal mass and associated lymph adenopathy are\ndecreased in size. For assessment of the rectum please see the MR from the\nsame date.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is a short segment nonocclusive thrombus in the proximal SMA\n(series 2, image 68), new from prior.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. For assessment of the known rectal mass and perirectal lymphadenopathy\nplease see MR rectum from the same date. No remote metastatic disease within\nthe abdomen and pelvis.\n2. Short segment, new, nonocclusive SMA thrombus." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.2 cm simple renal cyst in the midpole of the left kidney,\nunchanged. There is no evidence of suspicious renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. As before, the\npatient is status post left lower quadrant diverting colostomy. The rectal\nmass appears stable, if not milliametrically decreased in size compared to\n___, currently measuring up to 2.2 cm, previously 2.5 cm. Adjacent\nrectal lymph nodes are similar in appearance. Please refer to rectal MR\nperformed on the same day for more detailed assessment. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted. The previously reported short segment of nonocclusive SMA\nthrombus is not appreciated on the current study.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The known rectal mass appears stable, if not minimally decreased in size\ncompared to prior. However, please refer to MR rectum performed on same day\nfor more detailed assessment.\n2. No evidence of metastatic disease in the abdomen and pelvis.\n3. Interval resolution of the short-segment of nonocclusive SMA thrombus.\n4. Please refer to dedicated CT chest performed on the same day for\ndescription of intrathoracic findings." }, { "input": "LOWER CHEST: Mild dependent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Status post left\nlower quadrant diverting colostomy. Left-sided eccentric rectal mass is\nmildly decreased in size measuring 2 x 1.5 cm, previously measured 2.2 x 1.6\ncm. Similar haziness to the mesorectal fat. There is interval decreased size\nof the rectal lymph nodes when compared to the prior study. For instance the\nleft posterior rectal lymph node previously measured 0.7 x 0.6 cm, currently\nmeasures 0.4 x 0.3 cm (2:116). An additional lymph node in the posterior\nright mesorectal fat measures 0.7 x 0.3 cm (2:113), previously measured 1 x\n0.6 cm. Some of the lymph nodes are not appreciated on the current scan. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. Unchanged non pathologically\nenlarged prior right inguinal lymph nodes. See above regarding rectal lymph\nnodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval mild decreased size of known rectal mass measuring 2 cm. \nAdditionally, rectal lymph nodes have decreased in size and conspicuity.\n2. No evidence of distant metastatic disease in the abdomen or pelvis" }, { "input": "LOWER CHEST: Dependent atelectasis in lung bases which are otherwise clear. \nNo pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is new thrombosis of the right posterior portal vein (02:23). There\nalso appears to be thrombosis of small branches of the right anterior portal\nvein (02:16), new from prior.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Stomach is otherwise unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Patient is status post low anterior resection with diverting loop\nileostomy in the left lower quadrant. Patient's previously seen rectal mass\nis no longer visualized. A colonic pouch is noted. There is small volume\nsimple fluid anterior to the rectal pouch, anterior to the bladder, and in the\npresacral area containing small foci of air, presumably postsurgical. There\nalso small foci of intraperitoneal air also presumably postsurgical. Mild\nmesenteric edema is also presumably postsurgical. A right lower quadrant\napproach drain terminates in the presacral area.\n\nPELVIS: Bladder is decompressed around a Foley catheter. Small volume pelvic\nfree fluid as above.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia is noted.", "output": "1. New thrombosis of the right posterior portal vein as well as small branches\nof the right anterior portal vein.\n2. Status post low anterior resection with diverting loop ileostomy with\nexpected postsurgical changes including small volume pelvic free fluid and\nfoci of intraperitoneal free air. No evidence of organized, peripherally\nenhancing collection to suggest abscess." }, { "input": "LOWER CHEST: There are mild dependent atelectatic changes bilaterally.\n\nHEPATOBILIARY: There are wedge shaped areas of hyper enhancement within\nsegments 6 and 7 as well as segment 4 B. These are perfusional changes related\nto the previously identified small portal venous branch thrombosis. There are\nno suspicious masses. Main portal vein is patent. The right posterior portal\nvein is thrombosed. Gallbladder is unremarkable. There is no biliary ductal\ndilatation.\n\nPANCREAS: Unremarkable pancreatic contours with no ductal dilatation or\nsuspicious masses.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY:There is no hydronephrosis or suspicious renal masses.\n\nGASTROINTESTINAL: Stomach is under distended. Small bowel loops are not\ndilated. There is a left lower quadrant ileostomy, appears intact. Colon is\nopacified with contrast. There are some postsurgical changes in the right\nlower quadrant related to colonic resection and anastomosis. There is no\ncolonic wall thickening or pericolonic fat stranding. Surgical anastomosis in\nthe pelvis appears intact with no evidence of leak. There is unchanged\npericolonic stranding at the anastomosis. There is residual presacral fluid\nmeasuring 1.1 x 3.9 cm, decreased compared to previously (measuring 5.6 x\n1.4). There is no holdup of contrast at the anastomosis and no high-grade\nstenosis.\n\nPERITONEUM: There is no free air or free fluid. There is peritoneal stranding\nin the pelvis and along the left paracolic gutter which appear unchanged and\nlikely postsurgical..\n\nLYMPH NODES: There is no abdominopelvic adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches. No new acute venous thrombosis.\n\nPELVIS: Urinary bladder is distended. Mild fat stranding is noted along the\nposterolateral wall to the right secondary to the postsurgical changes in the\npelvis. Prostate and seminal vesicles are unremarkable. Colonic anastomosis\nappears intact.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions.\n\nSOFT TISSUES: There is mild subcutaneous soft tissue stranding in the right\nlower quadrant probably related to previous colostomy. There is a small fat\ncontaining umbilical hernia.", "output": "1. Postsurgical changes with intact anastomosis. Expected fat stranding at\nthe surgery site\n2. Decreasing size presacral fluid.\n3. Perfusional changes within the liver are a sequela of previously identified\ndistal branch portal vein thrombosis. Thrombosis of right posterior portal\nvein." }, { "input": "LOWER CHEST: 4 mm pulmonary nodule in the lingula abutting the mediastinum is\nstable since ___. Otherwise, visualized lung fields are within\nnormal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver is diffusely hypo enhancing, likely due to steatosis.\nThe contour is mildly nodular around the gallbladder fossa and the caudate is\nmildly enlarged. There is no evidence of focal lesions. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is mildly\ndistended but within normal limits. Multiple mildly enlarged periportal lymph\nnodes are overall stable since ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows top normal in size and normal attenuation throughout,\nwithout evidence of focal lesions. Accessory spleen measures 9 mm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the lower pole of right kidney is nonspecific,\nhowever likely a simple cyst and stable since ___. There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Slightly subluxed appearance of the coccyx is stable since ___. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted. Curvilinear\nsoft tissue densities in the subcutaneous fat likely represents prominent\nveins.", "output": "1. No acute intra-abdominal or intrapelvic abnormalities.\n2. Hepatic steatosis with mild periportal lymph node enlargement, likely\nreactive. Mildly nodular contour and caudate hypertrophy. The findings are\nconcerning for more advanced disease such as steatohepatitis or fibrosis. No\nevidence of portal hypertension.\n3. 4 mm pulmonary nodule in the lingula, stable since ___. No\nfurther follow-up is needed.\n4. Diverticulosis without diverticulitis.\n\nRECOMMENDATION(S): Work up for diffuse liver disease such as steatohepatitis\nor hepatic fibrosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nA tiny hypodensity too small to characterize but likely representing a renal\ncyst is seen in the lower pole of the right kidney. Otherwise, no focal renal\nlesions are seen. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Sigmoid\ndiverticula are noted without evidence of acute diverticulitis. Otherwise,\nthe colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Mildly prominent celiac nodes are noted, which are not\npathologically enlarged an which are likely secondary to known hepatitis. \nThere is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute findings to explain patient's symptoms.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 4:42 ___, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Small fat containing right\nBochdalek hernia is noted incidentally.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a subcentimeter hypodensity with in liver segment ___,\nwhich is too small to characterize, but likely represents a cyst or biliary\nhamartoma. Otherwise, the liver demonstrates homogenous attenuation\nthroughout. There is no evidence of solid lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix has air, is not dilated\nmeasuring 4 mm, and there are no surrounding inflammatory changes to suggest\nacute appendicitis (series 601b, image 24). Small amount of free fluid is\nnoted in the right lower quadrant.\n\nPELVIS: The bladder is distended with fluid, but otherwise unremarkable. The\ndistal ureters are also unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process. Specifically, normal appendix." }, { "input": "LOWER CHEST: There is a small right pleural effusion with associated\natelectasis of the right lower lobe. Slight linear atelectasis is also noted\nin the right middle lobe and left lower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a slight nodular contour to the liver compatible with\ngiven history of cirrhosis. In a patent segment 4A, there is a subcentimeter\nhyperenhancing nodule seen best on the arterial phase which remains\nhyperenhancing but to a lesser extent on the portal venous and delayed phase\nimaging. Therefore findings are suggestive of a flash filling hemangioma.\nThere is mild-to-moderate intrahepatic biliary dilatation mildly improved\nsince the prior MRCP in ___. The patient is status post cholecystectomy. \nThere is again chronic thrombosis of the main portal vein extending into the\nSMV with extensive intra-abdominal varices, similar in appearance since ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The patient is status post splenectomy. A splenule is noted in the\nsplenectomy bed, unchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended and there is mucosal hyper\nenhancement with suggestion of wall thickening which extends to the second\nportion of the duodenum. Findings may represent gastritis/duodenitis. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. A surgical\nclip is noted adjacent the dome of the urinary bladder. Moderate ascites is\npresent. Small fat containing bilateral inguinal hernias.\n\nREPRODUCTIVE ORGANS: Central prostatic calcifications are seen in a borderline\nenlarged prostate gland.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Chronic portal vein thrombosis with extension into the ___. Extensive\nintra-abdominal varices. These findings are not significantly changed since\n___.\n2. Status post splenectomy and cholecystectomy.\n3. Distended stomach with mucosal hyperenhancement and wall thickening\nextending to the second portion of the duodenum may represent\ngastritis/duodenitis. Upper endoscopy is recommended for further evaluation.\n4. Cirrhosis and moderate ascites." }, { "input": "LOWER CHEST: Unchanged small right-sided pleural effusion with right basilar\natelectasis.\n\nHEPATOBILIARY: Hepatic cirrhosis with caudate lobe hypertrophy. Heterogeneous\nenhancement of the liver on arterial phase which equilibrate on the portal\nvenous and delayed phases. No suspicious masses or HCC. There is a small\nlow-density collection within the right hepatic lobe containing a gas bubble\nrelated to the recent TIPS needle insertion site.\n\nPost TIPS catheter placement communicating between the right hepatic vein and\nright/main portal vein. There is no contrast opacification of the TIPS lumen\nconcerning for complete thrombosis. However, no extension into the IVC or\nright atrium. There is also progression of thrombosis of the portal vein, SMV\nand IMV branches. There is also notable lack of visualization of splenic vein\nin its entirety.\n\nCavernous transformation of portal vein. Hepatic veins are patent. Unchanged\nmoderate intrahepatic biliary ductal dilatation. Post cholecystectomy.\n\nPANCREAS: Millimetric hypodensities within the pancreatic tail likely\nrepresenting pancreatic cysts or side-branch IPMNs.\n\nSPLEEN: Post splenectomy. Splenule in the left upper abdomen.\n\nADRENALS: Left adrenal gland mild hypertrophy.\n\nURINARY:No hydronephrosis or nephrolithiasis. No suspicious masses.\n\nGASTROINTESTINAL: Small hiatal hernia. Stomach is under distended. Small\nbowel loops are of normal caliber. No appreciable hypoenhancement of\nsmall-bowel wall and no significant wall thickening. Large bowel is\nunremarkable.\n\nPERITONEUM: Moderate amount of intra-abdominal ascites.\n\nLYMPH NODES: Difficult to discern lymph nodes due to the extensive amount of\nintra-abdominal varices and ascites.\n\nVASCULAR: Extensive small varices throughout the abdomen. Normal caliber\nabdominal aorta. Patent intra-abdominal branches with no evidence of\natherosclerotic disease.\n\n\nBONES:No acute osseous abnormality.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Post TIPS procedure with completely thrombosed lumen. Thrombosis does not\nextend into the IVC or right atrium.\n2. Progression of thrombosis involving the portal vein, SMV and IMV the\nbranches.\n3. No small bowel findings to suggest venous ischemia.\n4. Other findings as above.\nFindings were communicated to the interventional radiology team, Dr. ___\n___ 14:45 by Dr. ___ fellow. Findings were also communicated\nto the caring team at 15:45." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions with associated\ncompressive atelectasis. There is also dependent atelectasis in the bilateral\nlower lobes.\n\nABDOMEN:\n\nHEPATOBILIARY AND VASCULAR: The liver demonstrates cirrhotic morphology with\ncaudate lobe hypertrophy. There is no evidence of focal lesions. There is\nsevere intra- and extrahepatic biliary dilatation which appears more prominent\nas compared to ___. CBD measures up to 12 mm in diameter, increased\ncompared the prior examination, with heterogeneous debris within the distal\ncommon bile duct. TIPS stent connecting the right portal vein to the right\nhepatic vein is patent. The left and main portal veins are patent. Superior\nmesenteric venous stent is patent. The porto-splenic confluence, superior\nmesenteric vein, superior mesenteric venous branches, and inferior mesenteric\nvein branches are patent, improved as compared to ___. There is\ncavernous transformation of the portal vein. The gallbladder is surgically\nabsent.\n\nThere is no evidence of abdominal aortic aneurysm. There is no background\natherosclerotic disease.\n\nPANCREAS: Punctate millimetric hypodense foci within the pancreatic tail\nlikely represent pancreatic cysts or side-branch IPMNs. There is no ductal\ndilatation.\n\nSPLEEN: The spleen is surgically absent. There is a splenule in the left\nupper quadrant.\n\nADRENALS: There is mild bulky hypertrophy of the left adrenal gland without\nfocal lesion. The right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. A flexiseal is noted in the rectum with prominent\ndistal colonic and rectal fecal load. The colon is otherwise unremarkable\nwithout evidence of obstruction. The appendix is not visualized but there is\nno secondary sign of acute appendicitis.\n\nPELVIS: There is a Foley in the bladder. Air in the anti dependent portions\nthe bladder is likely related to Foley insertion.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There are scattered mesenteric lymph nodes none of which are\npathologically enlarged by CT size criteria. There is no pelvic,\nretroperitoneal, or inguinal lymphadenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. TIPS stent, SMV stent, portal venous system, portosplenic confluence,\nsuperior mesenteric vein and its major branches, inferior mesenteric vein and\nmajor its branches are patent, new as compared to CT abdomen and pelvis ___ and compatible with successful interval catheter directed\nthrombolysis.\n2. Severe intrahepatic and extrahepatic biliary dilatation is worse as\ncompared to ___ with common bile duct measuring up to 12 mm in\nmaximal diameter, with subtle debris seen layering within the distal common\nbile duct, likely the cause of obstruction.\n3. Small bilateral pleural effusions." }, { "input": "Minor dependent changes are identified at each lung base.\n\nThere is unchanged mild intrahepatic biliary dilatation which can probably be\nexplained by prior cholecystectomy. No focal liver lesions are identified\naside from a very small vascular shunt in the left lateral segments (301:15). \nIn particular, no discrete liver masses are found.\n\nThere are small quantities of residual eccentric and web-like thrombus in a\nsuperior mesenteric venous stent but markedly reduced, with much less than 50%\nnarrowing. There is similar wall thickening of the major early jejunal branch\nalso consistent with sequela of chronic thrombus. A short segment of\nmoderately narrowed portal vein with wall thickening shows increased luminal\ncaliber, now measuring 7 mm greater, compared to at most 3 mm before. A TIPS\nshunt extending to the inferior vena cava is widely patent without evident\nfilling defects.\n\nFindings include unchanged cavernous transformation of the portal venous\nsystem and many mesenterosystemic collaterals, including prominent esophageal\nand paraesophageal varices.\n\nThe systemic arteries and veins appear widely patent. Hepatic artery branch to\nthe fourth segment branches late. Hepatic veins are widely patent.\n\nA small cystic lesion in the pancreatic tail measuring up to (303:36) shows no\nshort-term change and is only minimally increased over ___ years. Small\naccessory/regenerative spleen. Adrenals appear normal. Small cyst in the\ninterpolar right kidney is unchanged. Kidneys are otherwise unremarkable.\n\nStomach, small and large bowel are unremarkable.\n\nProstate is moderately enlarged with central hypertrophy. Seminal vesicles\nappear normal. Bladder is unremarkable. There is mild atherosclerotic\nchange. No ascites or lymphadenopathy.\n\nVertebral body heights and interspaces are preserved in height. There are no\nsuspicious bone lesions.", "output": "1. Substantial reduction in luminal narrowing of the main portal vein and\nsubstantially reduced filling defects in superior mesenteric venous stent\nfollowing recent procedure. Widely patent TIPS shunt.\n\n2. No short-term change in small cystic pancreatic lesion. Minimally\nincreased over ___ years. Long-term surveillance may be appropriate. In\nparticular, it may be appropriate to consider MR imaging in ___ years." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Liver\nparenchyma is low-attenuation suggestive of hepatic steatosis. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The descending\ncolon is edematous and is surrounded by prominent mesentery vessels. There is\nlarge stool burden with distension of the sigmoid and rectum. The appendix is\nnormal. There is a 9 mm rim enhancing focus adjacent and posterior lateral to\nthe rectum which could represent a sinus track. There is mild\nhyperenhancement of the external sphincter.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild proctocolitis extending to the descending and sigmoid portions, with\nloss of haustra reflecting more chronic disease. The findings could represent\ninflammatory bowel disease, infection, or the sequela of multiple enemas.\nConsider follow-up imaging in several weeks, versus colonoscopy.\n2. Large stool burden from rectal verge to distal sigmoid.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is wall\nhyperemia and edema of the sigmoid colon, rectum, and part of the endo canal\nconsistent with proctocolitis. There is a horseshoe shaped hypodense\ncollection within the perianal space, which extends cranially into the\nperirectal space. Largest area measures up to 6.3 x 6.3 x 2.9 cm (series 2;\nimage 73, series 602; image 42) and shows multiple septae these findings are\nconsistent with perirectal/perianal abscess. The appendix is normal and\ntraverses superiorly to the level of the liver.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is within normal limits. There is no large\nadnexal mass.\n\nLYMPH NODES: There are multiple enlarged mesorectal fascia lymph nodes, likely\nreactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. A horseshoe shaped rim enhancing fluid collection in the posterior perianal\nspace which extends cranially into the presacral space measuring up to 6.3 x\n6.3 x 2.9 cm, with multiple septae, consistent with perirectal/perianal\nabscess. There are multiple enlarged mesorectal fascia lymph nodes, likely\nreactive.\n2. Proctocolitis likely inflammatory or infectious." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is seen in the endometrial cavity in satisfactory\nposition. The bilateral adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of appendicitis.\n2. No acute findings in the abdomen or pelvis to explain the patient's\nsymptoms.\n3. IUD in satisfactory position in the endometrial cavity." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is severe hepatic steatosis with areas of fatty sparing. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic with innumerable calcifications, likely\nreflective of chronic pancreatitis. A peripherally enhancing, heterogeneous\nhypoattenuating lesion in the pancreatic tail measures 3.0 x 3.2 x 3.0 cm.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is thickening of the medial limb of the left adrenal gland,\nwhich is nonspecific. The right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits apart from sigmoid colon diverticulosis with\nno evidence of diverticulitis. The appendix is normal.\n\nPELVIS: There is a large amount of gas in and surrounding the bladder wall,\ntracking into the extraperitoneal spaces the of the pelvis including the\nbilateral obturator foramina, and extending superiorly along the\nretroperitoneum posterior to the psoas muscles (for example 303:67). There is\nno evidence of a fistulous connection between the bladder and colon. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There is no adnexal\nabnormality identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Images of the lumbar spine including grade 1 anterolisthesis of L5 on\nS1 are noted. There are no suspicious lytic or sclerotic osseous lesions.\n\nSOFT TISSUES: Subcutaneous gas is seen along the anterior pelvic wall, as well\nas deep to the left gluteus muscles.", "output": "1. Bladder wall pneumatosis with extensive extraperitoneal and retroperitoneal\nextension of gas is may represent emphysematous cystitis. Trauma or bladder\ninstrumentation may also cause this appearance. There is no evidence of\ncolovesical or vesicovaginal fistula.\n2. Pancreatic atrophy in calcification compatible with chronic pancreatitis as\nwell as a hypoattenuating pancreatic tail lesion which is most likely\nwalled-off necrosis from prior episode of acute pancreatitis. Correlation\nwith prior imaging is recommended.\n3. Diffuse severe hepatic steatosis.\n\nRECOMMENDATION(S): If no prior remote imaging is available (earlier than\navailable ___ exam), nonemergent MRCP is recommended." }, { "input": "LOWER CHEST: Re-demonstration of a large mostly left diaphragmatic defect with\nherniated multiple small and large bowel loops, that do not appear to be\nstrangulated. There is small amount of left-sided pleural effusion with left\nbasal atelectasis. Re-demonstration right lung base calcified pleural plaques\nwith the largest measuring 6.7 cm that appears stable or slightly bigger in\nsize compared to ___ CT of the chest where it measures 6.3 cm. Post\nesophagectomy with gastric pull-through.\n\nHEPATOBILIARY: Unenhanced liver is unremarkable. Gallbladder is unremarkable.\nNo biliary ductal dilatation.\n\nPANCREAS: Atrophic pancreas.\n\nSPLEEN: Normal in size.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY:Right kidneys unchanged in appearance. Left kidney is located in the\npelvis with under rotation, likely congenital. No hydronephrosis or\nnephrolithiasis.\n\nGASTROINTESTINAL: Post esophagectomy with gastric pull-through. Large left\ndiaphragmatic hernia. Most of the jejunal loops are herniated into the left\nchest wall cavity. These are nicely visualized on the upper GI fluoroscopy\nstudy ___. The hernia also contains the splenic flexure. Large\nbowel diverticulosis without diverticulitis. Dense contrast material\nidentified throughout the colon from recent fluoroscopy exam.\n\nPERITONEUM: No free air. No free fluid. No peritoneal stranding.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Atherosclerotic calcifications of abdominal aorta.\n\nPELVIS: Bladder is unremarkable. Moderate sized prostate gland. No pelvic\nadenopathy.\n\nBONES:Osteopenia. Severe degenerative changes of the lower lumbar spine. \nGrade 1 anterolisthesis of L5 on S1 without spondylolysis. There are severe\nbilateral hip joint degenerative changes.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Post esophagectomy with gastric pull-through.\n2. Re-demonstrated large left diaphragmatic hernia containing most of the\nproximal jejunal loops.\n3. Stable to minimally increased large partially calcified pleural plaques\nsuggesting prior asbestos exposure.\n4. Basal atelectasis with left-sided pleural effusion." }, { "input": "LOWER CHEST: Please see the dedicated chest CT dictation for further details\nof the lower thorax\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is markedly atrophic. The pancreatic duct is normal\ncaliber. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is unremarkable. The left kidney is located in the\npelvis and rotated, likely congenital. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post esophagogastrectomy. There is a left\ndiaphragmatic defect containing a large amount of nonobstructed loops of bowel\nwhich is similar to slightly increased in size when compared to the prior\nstudy. The bowel is normal caliber. Large volume of stool within the colon,\nconsider constipation. Numerous colonic diverticula. The appendix is not\ndefinitively seen, however there is no abnormal fat stranding in the expected\nlocation of the appendix. Ventral hernia containing nonobstructed loops of\nsmall bowel superior to the umbilicus. Left upper abdominal approach pigtail\ncatheter with tip within the loop of small bowel.\n\nPELVIS: Foley within the bladder with a small amount of likely iatrogenic air.\nThe bladder is mostly decompressed. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The aorta is tortuous. The aorta is normal caliber. Moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDextroscoliosis of the lumbar spine. Degenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.Mild\nbilateral gynecomastia", "output": "1. Re-demonstrated changes from esophagogastrectomy.\n2. Re-demonstrated low left diaphragmatic defect containing large volume of\nnon obstructed loops of small large bowel.\n3. Large volume colonic stool. Consider constipation.\n4. Additional findings as above" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Innumerable thin walled cysts are seen within the liver. The\nremaining liver parenchyma demonstrates homogenous attenuation throughout. \nThere is no evidence of solid lesions. There is mild biliary dilatation\nwithin the left lobe of the liver, that is stable compared to prior.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is an ill-defined mass, which was previously thought to arise\nfrom the right adrenal gland, now appears to be separate. There is encasement\nand compression of the IVC. The mass extends along the right crura and right\nhemidiaphragm (series 2, image 51, 55), which has progressed since ___. The adrenal glands appear normal bilaterally.\n\nURINARY: A left double-J ureteral stent is in appropriate positioning with\nmild bilateral hydronephrosis, which is stable compared to ___. \nThere are multiple subcentimeter hypodensities within the kidneys bilaterally,\nwhich are too small to characterize, but likely represent simple cysts. The\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nevidence of solid renal lesions. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is soft\ntissue density along the right and left pericolic gutters (series 2, image 85\nand series 601, image 27), which has progressed compared to ___,\nand likely represents omental deposits of metastatic disease. There is also\nsoft tissue density along the greater omentum anteriorly (series 2, image 93\nand series 602, image 36). The appendix is not visualized.\n\nPELVIS: There is asymmetric thickening of the right lateral and posterior\nbladder wall extending towards the cul-de-sac, which likely represents\nperitoneal spread of metastatic disease (series 602, image 38). There is a\nsmall amount of free fluid within the pelvis, which is new.\n\nREPRODUCTIVE ORGANS: The endometrium appears diffusely thickened, which is\nabnormal in a patient of this age (series 601, image 30).\n\nLYMPH NODES: A multiple stable subcentimeter retroperitoneal lymph nodes. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Diffuse sclerotic osseous metastatic lesions are distributed throughout\nthe lumbar spine, sacrum, and iliac bones bilaterally, similar in distribution\ncompared to the prior study. There is no evidence of pathologic fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New diffuse omental and peritoneal thickening involving the right and left\npericolic gutters, the greater omentum, and the bladder wall extending towards\nthe cul-de-sac, likely representing metastatic disease, which has progressed\nsignificantly compared to the CT dated ___.\n2. The ill-defined mass, which was previously thought to arise from the right\nadrenal gland, appears to primarily involve the right crus and diaphragm,\nencases the IVC, and has also progressed compared to prior.\n3. Diffuse endometrial thickening, which is abnormal in a patient of this age.\n4. Diffuse osseous metastatic disease, stable in appearance compared to prior.\n5. Left double-J ureteral stent in appropriate position with stable mild\nbilateral hydronephrosis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:28 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. The patient has had prior right\nmastectomy.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous hepatic hypodense cystic masses within loss replace\nmost of the hepatic parenchyma of the right lobe as well as some the left\nhepatic lobe persists and are overall unchanged number and probably also\nunchanged in size since at least ___, probably related to polycystic\nliver. The cysts displace the right anterior and posterior portal veins which\nare patent, unchanged. No new or solid hepatic masses. There a small amount\nof perihepatic ascites which is perhaps minimally increased from the prior\nexam (series 5, image 63; series 8, image 16, 31). Mild-to-moderate left\nintrahepatic biliary ductal dilation is overall unchanged (e.g. Series 3 5,\nimage 57, 53, 51). No extrahepatic biliary ductal dilation. The gallbladder\nis within normal limits. Soft tissue density in the region of the porta\nhepatis has slightly progressed, secondary to peritoneal tumor involvement\nwhich extends from the portocaval space and region of the right adrenal gland\nand right diaphragmatic crus (series 5, image 56-63). There is question of\nperitoneal disease abutting the anterior aspect of the left hepatic lobe, more\nconspicuous from the prior exam (series 5, image 49).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape but has\nsignificant soft tissue density fat stranding surrounding it and the adjacent\nright diaphragmatic crus is thickened, overall unchanged (series 5, image 53,\n56). The left adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cortical hypodensities are too small to accurately\ncharacterize but statistically most likely cysts, unchanged. A left double-J\nureteral stent is unchanged in position with the proximal portion in the a\nleft lower pole major calyx (series 8, image 31). Left hydroureteronephrosis\nhas improved since ___, now mild. Right hydroureteral nephrosis has\nalso improved since ___, now also mild. Right hydronephrosis is probably\nsecondary to tumor involvement surrounding the uretero-vesicular junction\n(series 5, image 109). No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Apparent\nthickening of the walls of the ascending, transverse, and part of the\ndescending colon and/or peritoneal and omental disease abutting the colon has\nprogressed. Apparent thickening of the walls of the sigmoid colon is likely\nsecondary to underdistention. The rectum is within normal limits. No bowel\nobstruction.\n\nRETROPERITONEUM, PERITONEUM AND OMENTUM: There is diffuse peritoneal\nthickening, worse on the right and in the pelvis, overall progressed from the\nprior exam (e.g., series 8, image 19, 21; series 5, image 70, 75, 90, 96). \nOmental fat stranding/caking is also worse compared to the prior exam (series\n5, image 81, 85, 90). This peritoneal and omental disease closely\napproximates the colonic walls, effacing the fat planes with possible serosal\ninvolvement, progressed from the prior exam (series 5, image 90, 87, 85, 75). \nSoft tissue tumor in the retroperitoneum surrounding the IVC and right adrenal\ngland has also progressed and has been detailed above (e.g., series 5, image\n61).\n\nPELVIS: The urinary bladder is partially distended. Apparent abnormal\nthickening and enhancement of the right anterior and posterior as well as\nright and medial left bladder dome walls, which appears worse from the prior\nexam, is probably largely peritoneal disease closely abutting the wall with\nsubmucosal disease (series 8, image 27; series 5, image 103). Enhancing\nperitoneal disease extends inferiorly along the urethra and the vagina (series\n3, image 26; series 5, image 111). Distinguishing tumor from normally\nenhancing vaginal mucosa is difficult.\n\nREPRODUCTIVE ORGANS: The endometrium remains thickened and heterogeneous. \nThe uterus is heterogeneous with an 8-mm hypodense lesion in the right uterus\n(series 5, image 100; series 8, image 28). The right ovary is normal. The\n2.4 x 1-cm left adnexal cystic structure likely in the ovary is larger than\nnormal for a post-menopausal patient but is unchanged (series 5, image 99). \nAs above, tumor extending along the bladder and urethra may extend to the\nvagina, difficult to distinguish from normally enhancing vaginal mucosa. \nThere is asymmetric, slightly nodular thickening of the right pelvic floor\nmuscle, minimally more pronounced since ___ (series 5, image 108).\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic side\nwall or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted. There is moderate atherosclerotic calcification at the origin of the\nceliac trunk (series 9, image 34). There is mild-to-moderate calcification at\nthe left renal ostium.\n\nThe portal veins, splenic vein, and SMV are patent. The IVC is encased by soft\ntissue retroperitoneal disease which has progressed from the prior exam, but\nthe IVC remains patent. Soft tissue density also surrounds the main portal\nvein posteriorly, but the vein is patent.\n\nBONES: The bones are diffusely demineralized. Multiple sclerotic osseous\nlesions in the right pelvis, sacral ala and multiple lumbar vertebral bodies\nhave overall increased in number and grown since ___ but are overall\nsimilar to the most recent exam in ___ (e.g. , series 5, image 87, 80,\n83, 81; series 9, image 32, 34). No evidence of pathologic fracture. No\ndefinite new osseous metastases. Multilevel degenerative changes of the\nlumbosacral spine, sacroiliac joints, and hips are moderate to severe. \nRetrolisthesis of L2 on L3 is mild and overall unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval progression of extensive, diffuse omental, peritoneal, and right\nretroperitoneal metastatic disease as above.\n2. Persistent bilateral mild hydroureteronephrosis, likely secondary to\nobstruction from peritoneal metastases in the region of the ureteral vesicular\njunction, slightly improved since ___. Double-J left ureteral stent is\nunchanged and in appropriate position.\n3. Multiple osseous metastases are overall unchanged.\n4. Heterogeneous uterus and thickened endometrium as well as 2.4-cm cystic\nstructure in the left ovary, unchanged but abnormal for this postmenopausal\npatient.\n5. Multiple hepatic cystic structures are unchanged since at least ___, likely polycystic liver." }, { "input": "LOWER CHEST: Please see separate report for intrathoracic findings from\nsame-day CT chest.\n\nABDOMEN:\n\nHEPATOBILIARY: Compared to ___, no significant change in numerous\nhepatic hypodense cystic masses throughout the liver, which replace most of\nthe hepatic parenchyma, right lobe greater than left lobe, likely related to\npolycystic liver. As before, the cysts displace the right anterior and\nposterior portal veins which remain patent. No new or solid hepatic masses. \nAgain seen is trace perihepatic ascites. There is unchanged intrahepatic\nbiliary ductal dilatation. No extrahepatic biliary ductal dilatation. Again\nseen is soft tissue density in the region the porta hepatis, likely\nrepresenting peritoneal tumor involvement and extending into the portacaval\nspace and region of the right adrenal gland and right diaphragmatic crus with\ninferior extension to the level of the aortic bifurcation. The gallbladder is\nrelatively contracted, limiting evaluation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape. \nThere is persistent soft tissue density fat stranding surrounding the right\nadrenal gland and persists thickening of the right diaphragmatic crus.\n\nURINARY: Interval removal of previously seen left double J ureteral stent. \nThere is new moderate left hydronephrosis and a delayed nephrogram on the\nleft. There is also moderate right hydronephrosis. There are multiple\nsubcentimeter hypodense lesions bilaterally, too small to characterize. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Again seen is\nthickening of the walls of the ascending, transverse and part of the\ndescending colon. This likely represents a combination of bowel serosal\ninvolvement and peritoneal metastatic disease. The rectum is unremarkable. \nNo bowel obstruction. The appendix is not definitively visualized.\n\nRETROPERITONEUM, PERITONEUM AND OMENTUM: No significant change in diffuse\nperitoneal thickening, greater on the right flank and in the pelvis (for\nexample, the ___, 75, 89,). Omental fat stranding/ caking is also unchanged\n(for example, ___, 87). As before, the peritoneal or omental disease closely\napproximates the colonic walls and effaces the fat planes with probable\nserosal involvement. Again seen is soft tissue tumor in the retroperitoneum\nsurrounding the IVC and right adrenal gland (___) and extending inferiorly to\nthe level of the aortic bifurcation.\n\nPELVIS: As before, there is likely peritoneal disease closely abutting the\nright lateral and posterior bladder walls as well as the dome. Again seen is\nperitoneal disease extending inferiorly along the urethra and vagina (___). \nMetastatic disease in the region of the trigone is likely the cause of the\nbilateral moderate hydronephrosis. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: As before, the uterus is heterogeneous. The left ovary\nis unremarkable. There is a 3.0 x 2.0 cm right adnexal cystic structure,\nlikely in the ovary, larger than expected for a postmenopausal patient (___).\nAs before, there is unchanged asymmetric nodular thickening of the right\npelvic floor musculature (___).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Again seen is calcification at the celiac trunk origin. As\ndescribed above, the IVC is encased by soft tissue retroperitoneal disease. \nThere is also tumor encasing the right renal artery. These vessels remain\npatent.\n\nBONES: No new osseous lesions. Again seen are multiple sclerotic osseous\nlesions throughout the spine and pelvis. No pathologic fractures. Unchanged\nmoderate degenerative changes of the visualized spine. Unchanged grade 1\nretrolisthesis of L2 on L3. Diffuse demineralization, as before.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Compared to ___, no significant change in diffuse metastatic\ndisease throughout the abdomen and pelvis involving the omentum, peritoneum\nand right retroperitoneum.\n2. Interval removal of left double J stent with new moderate left\nhydronephrosis. There is also moderate right hydronephrosis. These findings\nare likely secondary to obstruction caused by the metastatic disease in the\nregion of the bladder trigone.\n3. Unchanged diffuse osseous metastases. No pathologic fracture.\n4. New right ovarian cyst measuring 3.0cm in size. Recommend close attention\non follow-up imaging.\nPlease see separate report for intrathoracic findings from same-day CT chest.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:25 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. Patient status post right\nmastectomy.\n\nABDOMEN:\n\nHEPATOBILIARY: In comparison to ___, there is no significant\nchange in numerous hepatic hypodense cystic masses throughout the liver which\nagain replaced most of the hepatic parenchyma, right lobe greater than left\nlobe, consistent with a polycystic liver. In comparison to ___, the\nleft lobe cystic lesions have grown slightly; for example, at the lateral tip\nof the left lobe there is a cystic lesion measuring 4.1 cm in diameter\npreviously measuring 2.4 cm in diameter (5; 47).\n\nAgain, these cysts displace the right anterior and right posterior portal\nveins which remain patent. The left portal vein is also patent. Stable\nintrahepatic biliary dilatation likely from mass effect of cystic lesions and\nno evidence of extra hepatic biliary dilatation. The gallbladder is within\nnormal limits.The trace perihepatic ascites appears to have slightly increased\ncompared to ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape. \nThere continues to be persistent and possibly increased soft tissue fat\nstranding surrounding the right adrenal gland and thickening of the right\ndiaphragmatic crus as well as around the upper pole of right kidney.\n\nURINARY: Bilateral ureteral stents with no evidence of hydronephrosis. There\nis bilateral ureteral wall thickening noted surrounding bilateral ureteral\nstents (5; 67). Stable bilateral subcentimeter hypodensities too small to\ncharacterize. The kidneys are of normal and symmetric size with normal\nnephrogram. There appears to be increased fat stranding surrounding the right\nkidney. In addition there is soft tissue density medial to the inferior pole\nof the left kidney with ___ of 129 measuring 1.3 x 0.9 x 2.2 cm which appears\nslightly increased compared to ___ (8; 30).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Again there is\nsignificant wall thickening of the ascending transverse and descending colon\n(8; 18). The appendix is not visualized.\n\nRETROPERITONEUM, PERITONEUM, and OMENTUM:\nAgain, there is diffuse peritoneal thickening especially in the right flank\nand pelvis similar to ___ (5; 68, 75, 87). Omental caking is also\nunchanged (5; 83). As mentioned before, there also appears to be bowel wall\nserosal involvement. Soft tissue density is seen encasing the IVC, the right\nadrenal gland, and extending around the aorta and inferiorly to the aortic\nbifurcation.\n\nPELVIS: As seen before, there is peritoneal disease around the right lateral\nand posterior bladder wall as as well as the bladder dome, which appears to\nhave slightly increased since ___ and significantly increased since\n___ (5; 102). Again, the peritoneal disease is seen extending into the\nurethra and vagina (5; 108). Nodularity of the right pelvic floor muscle is\nunchanged. (5; 105). Free fluid in the pelvis is noted.\n\nREPRODUCTIVE ORGANS: The uterus is heterogeneous. Previously seen right\nadnexal cystic structure appears to be free pelvic fluid.\n\nLYMPH NODES: There are prominent mesenteric lymph nodes which do not meet CT\nsize criteria for lymphadenopathy. There is no retroperitoneal\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted with calcification at the takeoff of the celiac axis again\nnoted. Soft tissue density is seen encasing the right renal artery which\nappears patent.\n\nBONES: Diffuse sclerotic osseous metastatic lesions throughout the lumbar\nspine sacrum and iliac bones bilaterally are similar compared to ___. There is also diffuse demineralization. No pathologic fracture noted. \nUnchanged grade 1 retrolisthesis of L2 on L3.\n\nSOFT TISSUES: The anterior abdominal is within normal limits.", "output": "1. Overall slightly worse diffuse metastatic disease through the abdomen and\npelvis compared to ___ with increased size of peritoneal implant\nabutting the bladder wall.\n\n2. Bilateral ureteral stents with no evidence of hydronephrosis.\n3. Unchanged diffuse osseous metastases. No pathologic fracture.\n4. Previously noted possible right adnexal cystic structure appears to be free\npelvic fluid." }, { "input": "This study is mildly degraded by patient motion.\n\nLOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: Innumerable cystic lesions replace much of the hepatic\nparenchyma, as seen on previous imaging. These were previously described as\nsimple cysts on MRI from ___, and are compatible with polycystic\nliver disease. Compared to ___, there has been no significant\nchange in the size or extent of these cysts. There are no enhancing hepatic\nmasses. The gallbladder is unremarkable. There is no intra or extrahepatic\nbiliary ductal dilatation. As on prior imaging, the right Portal vein is\ndisplaced, but patent. The remainder of the Portal venous system appears\npatent.\n\nPANCREAS: The pancreas is normally enhancing, without evidence of ductal\ndilatation or focal pancreatic lesions. However, hyperdense material adjacent\nto the pancreatic tail within the splenic hilum and surrounding the splenic\nvein is concerning for metastatic disease, although the precise margins cannot\nbe distinguished due to a similar degree of enhancement (for example series 4,\nimage 54).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral double-J stents extend from the renal pelvis the urinary\nbladder in appropriate position. Bilateral subcentimeter round cortical\nhypodensities are too small to characterize, but most likely represent cysts. \nThese are unchanged compared to prior studies. Hyperdense soft tissue\nsurrounds the proximal and mid right ureter, and may represent metastatic\ndisease or inflammatory change related to double-J stent placement (series 4,\nimage 75).\n\nGASTROINTESTINAL: Enhancing soft tissue extends along the serosal surface of\nthe ascending colon, And extends into the pelvis. This is slightly improved\ncompared to ___ (series 4, image 70 and series 4, image 88)\nadditional foci of disease is seen around the small bowel in the left lower\nabdomen (series 4, image 80). There is also nodularity of the omentum (series\n4, image 81). Enhancing soft tissue concerning for metastasis also extends\nalong the serosal surface of the rectum (series 4, image 95). These findings\nare not significantly changed compared to prior.\n\nFood particulate is noted in the stomach along with contrast. Otherwise the\nstomach is unremarkable. There is no evidence of small or large bowel\nobstruction. There is no free air in the abdomen.\n\nPELVIS: Enhancing soft tissue is invades the dome and right-sided the bladder,\ncausing significant bladder wall thickening (series 7, image 25). This\nhyperdense soft tissue extends around the urethra and the superior vagina\n(series 4, image 110 and series 7 image 26). This appearance is grossly\nunchanged compared to ___. Bilateral double-J stents terminate\nin the urinary bladder. There has been resolution of free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Enhancing soft tissue in the pelvis is indistinguishable\nfrom the uterus (series 4, image 101). The previously identified right\nadnexal cyst is no longer seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Extensive mixed lytic and sclerotic lesions are again seen. Notable\nlesions include the left acetabulum (series 4, image 96), left iliac crest\n(series 4 image 83). The right iliac wing demonstrates a mottled appearance\nwith multiple sclerotic and lucent regions throughout (for example series 4,\nimage 86). The sacrum has a similar appearance. These findings are\nunchanged. A focal lucency in the L1 vertebral body is stable.\n\nThere are moderate degenerative changes of the lumbar spine, with minimal\nretrolisthesis of L2 on L3. There is multilevel disc height loss.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Extensive metastatic disease in the abdomen and pelvis is mostly unchanged\ncompared to ___. There may be minimal improvement of metastatic\ndeposits along the ascending colon. Pelvic metastases involving the bladder,\nuterus and superior vaginal canal are unchanged.\n2. Extensive mixed lytic and sclerotic bony lesions primarily in the pelvis\nare stable.\n3. Bilateral double-J ureteral stents are in unchanged and appropriate\nposition. There is no hydronephrosis.\n4. Innumerable cysts replacing much of the hepatic parenchyma compatible with\npolycystic liver are unchanged. No suspicious hepatic lesions are identified.\n5. Please refer to the dedicated chest CT report from the same date for\nthoracic Findings." }, { "input": "LOWER CHEST: Patient is status post right mastectomy. Visualized portions of\nthe lung bases are grossly clear. No pericardial or pleural effusion seen. \nPlease see the separate report of the CT chest performed on the same date.\n\nABDOMEN:\n\nHEPATOBILIARY: There are numerous cystic lesions throughout both lobes of the\nliver but predominately in the right lobe. This appearance is unchanged\ncompared to the prior study. There are coarse calcification seen at the\njunction of the right and left hepatic lobes (06:52), also unchanged. No new\nlesions seen. No biliary duct dilatation. Portal vein is patent. The\ngallbladder is not definitely visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are bilateral ureteral stents in-situ, in appropriate position.\nThere is mild prominence of the left renal pelvis. The left kidney is mildly\natrophic with mild diffuse cortical thinning. There is a 1.1 cm\nhyperattenuating lesion in the upper pole the left kidney on the noncontrast\nimages (03:23). There is no appreciable enhancement in this region following\ncontrast administration consistent with a hemorrhagic cyst. Additional\nsmaller hypoenhancing lesions in the bilateral kidneys are too small to\ndefinitively characterize but statistically likely represent cysts and are\nunchanged compared to the prior study. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. At the level the\nupper rectum there is ill-defined infiltrative abnormal soft tissue which\nextends along the posterolateral bladder wall, is a inseparable from the\nuterus and inseparable from the upper rectum (10:33). Due to the infiltrative\nnature of this mass is difficult to measure accurately, on axial images this\nis estimated at 7.2 x 5.8 cm in the axial plane. Eccentric bladder wall\nthickening best appreciated on the coronal reformats also appears unchanged. \nThe appendix is not definitely visualized however there are no secondary signs\ninflammation in the right lower quadrant. There is nodularity of the\nperitoneal fat in the left upper quadrant (09:18), this is better visualized\non today's study than the prior due to resolution of the previously seen bowel\nobstruction, but is grossly unchanged. Nodularity of the omental fat (6:89)\nis also grossly unchanged.\n\nPELVIS: Eccentric bladder wall thickening along the right post row lateral\nbladder wall is similar in degree when compared to the prior study. The\ndistal portions of the bilateral JJ stents are seen in the bladder. No\nbladder calculi seen. There is a small amount of free fluid in the cul de sac\n(6:98).\n\nREPRODUCTIVE ORGANS: The uterus is inseparable from the infiltrative soft\ntissue mass centered in the pelvis. Otherwise, unremarkable in appearance.\n\nRETROPERITONEUM AND MESENTERY: There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy. There is no\nabdominal aortic aneurysm. Mild atherosclerotic disease is noted. The\nmesenteric vessels appear patent.\n\nBONES: There is a diffusely mottled appearance throughout the spine and pelvic\nbones consistent with the patient's known mixed lytic and sclerotic bony\nmetastatic disease.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged appearances of the infiltrative soft tissue mass which extends\nbetween the upper rectum, is inseparable from the uterus and invades the\nposterior and lateral bladder wall. Small amount of adjacent free fluid.\n2. Peritoneal and omental nodularity consistent with metastatic disease,\nunchanged in appearance when compared to the prior study.\n3. Mixed lytic and sclerotic appearance involving the spine and pelvic bones\nconsistent with the patient's known bony metastatic disease.\n4. Interval resolution of the previously seen large bowel obstruction.\n5. Interval improvement in the bilateral hydronephrosis with minimal residual\nleft-sided hydronephrosis seen." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nThere is extensive peritoneal irregular thickening in the upper abdomen, along\nthe greater omentum, and also extensive peritoneal thickening in the pelvis. \nAlthough no well-circumscribed focal measurable mass is easily comparable by\nsize compared to prior study, the degree of retroperitoneal and peritoneal\nthickening overall appears slightly increased. There is trace ascites. This\nhas also slightly increased.\n\nHEPATOBILIARY: Stable appearance of numerous hepatic cysts replacing the\nmajority of the right lobe of liver with less marked involvement of the left\nlobe. There is stable mild intrahepatic bile duct dilatation in the lateral\nsegment of the left lobe. The portal vein is patent. The gallbladder not\ndefinitively visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are bilateral ureteral stents in satisfactory position. There\nis no hydronephrosis. There are stable bilateral subcentimeter renal\nhypodensities. No new concerning renal lesion.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Extensive nodular thickening of the peritoneum in the pelvis is\ndemonstrated. Plaque-like rind of soft tissue thickening extends along the\nposterior and right lateral aspect of the bladder (series 2, image 101)\nextending inferiorly to partly encases the urethra (series 2, image 106). \nProcess is also inseparable from the vagina. Trace fluid in the pelvis is\nsimilar to prior.\n\nREPRODUCTIVE ORGANS: Extensive peritoneal infiltration inseparable from the\nuterus and vagina.\n\nLYMPH NODES: There is infiltrative retroperitoneal soft tissue thickening in\nthe upper abdomen in the pre aortic, aortocaval and para-aortic regions\n(series 2, image 61), increased when compared to prior study. For example,\naortocaval soft tissue now measures 12 mm, previously 8 mm.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Heterogeneous patchy areas of sclerosis in the right hemipelvis appears\nsimilar. Extensive heterogeneous sclerotic abnormality or abnormality of the\nspine also appears similar. No new compression deformity. Degenerative\nchanges seen in lumbar spine and hip joints more marked at the left hip.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Retroperitoneal infiltration, and extensive peritoneal and omental\ninfiltration in the abdomen and pelvis. Although it is difficult to directly\ncompare a measurable lesion with prior, there is impression of slight increase\nin disease bulk compared to previous study. There is trace ascites which has\nincreased from prior.\n2. Multifocal areas of sclerosis in the skeleton likely reflect osseous\nmetastatic disease.\nPlease see separate chest CT report for details of intrathoracic findings." }, { "input": "LOWER CHEST: The lung bases are clear. There is no pericardial or pleural\neffusion.\n\nABDOMEN: The liver enhances homogeneously and is without focal lesions. The\ngallbladder is normal without radiopaque gallstones. There is no intra or\nextrahepatic biliary duct dilation. The portal vein is patent. The adrenal\nglands and spleen are unremarkable There is a 2.1 cm cyst within the upper\npole of the spleen. The spleen is otherwise unremarkable.\n\nThe kidneys enhance symmetrically. There is no hydronephrosis. Multiple sub cm\nhypodensities within the bilateral kidneys are too small to characterize, but\nstatistically likely represent simple cysts.\n\nThe small and large bowel are normal in caliber without focal wall thickening.\nThere is no intra-abdominal free fluid or free air.\n\nThe abdominal aorta is normal in caliber without focal wall thickening. There\nis no retroperitoneal lymphadenopathy by CT size criteria.\n\nPELVIS: The bladder is well distended and normal. There is a small amount of\nfree fluid within the pelvis, likely within physiologic limits. There is no\npelvic sidewall or inguinal adenopathy by CT size criteria.\n\nOSSEOUS STRUCTURES: Left-sided transverse process fractures at L2 and L3. No\nadditional fractures identified. Vertebral body height and alignment are\nmaintained.", "output": "1. Left-sided transverse process fractures of L2 and L3. No additional\nfractures identified.\n2. No evidence of intra-abdominal or pelvic injury.\n3. Small amount of free fluid within the pelvis, likely physiologic." }, { "input": "LOWER CHEST: Visualized lung fields are notable for mild bibasilar dependent\natelectasis. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Intrahepatic and extrahepatic biliary\nductal dilatation is unchanged from prior study, with the CBD measuring 1.7\ncm. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. There are multiple right renal cysts, the largest\nin the upper pole measuring 2.3 cm, similar to prior. Multiple additional\nbilateral subcentimeter hypodensities are too small to characterize by CT. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is otherwise\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is not\nvisualized, though there are no secondary signs of appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are not\nwell-visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMinimal anterolisthesis of L4 on L5 and loss of intervertebral disc space\nheight at L5-S1 are unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is\na 1.5 cm rim enhancing abnormality adjacent to the right ischial tuberosity on\nseries 2, ___ 78. This is not depicted in its entirety. The underlying bone\nis unremarkable.", "output": "1. No acute intra-abdominal process to explain the patient's symptoms.\n2. Intrahepatic and extrahepatic biliary ductal dilatation is unchanged from\n___, likely related to prior cholecystectomy.\n3. 1.5 cm rim enhancing abnormality adjacent to the ischial tuberosity may\nrepresent a chronic hamstring injury with hematoma or overlying bursitis. A\nsmall abscess cannot be entirely excluded and if this is of clinical concern\nfurther evaluation with MRI could be considered\n\nRECOMMENDATION(S): MRI could be considered as described above\n\nNOTIFICATION: The findings regarding impression 3. Were discussed with\n___, by ___, M.D. on the telephone on ___ at\n1:42 pm, 10 minutes after discovery of the findings." }, { "input": "LOWER CHEST: There is bibasilar atelectasis without focal consolidation. \nThere is no pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is a short segment colonic wall\nhyperemia and edema in the sigmoid colon with surrounding stranding and\nhyperemia of the vasa recta, which is likely consistent with diverticulitis\nversus short segment colitis. No drainable fluid collection or extraluminal\ngas is seen. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Short segment of colonic wall thickening, hyperemia and edema in the sigmoid\ncolon with surrounding fat stranding and hyperemia of the vasa recta, likely\nconsistent with diverticulitis versus or short segment colitis. No drainable\nfluid collection or extraluminal gas." }, { "input": "LOWER CHEST: The lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: Unremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: No hydronephrosis or nephrolithiasis. The kidneys are unremarkable.\n\nGASTROINTESTINAL: A few duodenal diverticula are noted. There is no\nintestinal obstruction or ascites. Sigmoid sutures are noted.\n\nPELVIS: Hysterectomy changes are seen.\n\nPERITONEUM/RETROPERITONEUM: No ascites or pneumoperitoneum.\n\nLYMPH NODES: No abdominopelvic adenopathy.\n\nVASCULAR: Moderate atherosclerotic calcifications of the aorta which is normal\ncaliber. The hepatic vasculature is patent.\n\nBONES: No suspicious osseous lesion.", "output": "No findings of metastatic disease in the abdomen or pelvis." }, { "input": "Chest-please see separately dictated same day CT of the chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nWithin the limitations of study with no IV contrast, there is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Pigtail catheter terminates in the nondistended gallbladder.\n\nPANCREAS: The pancreas with no lesions. There is no significant\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and no gross focal findings.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. No hydronephrosis. \nToo small to characterize hypodensity in the right lower pole is possibly cyst\n(2:74).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel and the colon and\nrectum are with no gross findings.. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nSmall quantity of ascites demonstrated in the upper abdomen surrounding the\nliver and spleen, extending into the pelvis, measuring simple fluid density, 9\n___.\n\nREPRODUCTIVE ORGANS: There is well-defined oval structure in right pelvis\nmeasuring up to 8 cm (2:101), relatively dense, 33 ___, and could represent\nright adnexa cyst, possibly hemorrhagic, for further evaluation by ultrasound.\n\nRETROPERITONEUM AND MESENTERY: There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy. There is no\nabdominal aortic aneurysm. Mild atherosclerotic disease is noted. The\nmesenteric vessels appear patent.\n\nSOFT TISSUE AND BONES: There is significant chest and abdomen wall edema,\npredominantly at the level of the flanks, lower abdomen and pelvis.\n\nThe edema extends to lower extremities, but no free air demonstrated in soft\ntissues. No clear collections. The left tibial and fibular stump is with no\nevidence of osteomyelitis. There are no discrete collections.\n\nSmall hematoma in the right psoas muscle centered at the level of L4, (2:82\n601:48).", "output": "-Bronchopneumonia is centered in the imaged left upper lobe. Reported\nseparately in the same day CT of the chest.\n-Small quantity of ascites, measuring simple fluid density.\n-Small hematoma in the right psoas muscle.\n-Oval structure in the right pelvis measures up to 8 cm is possibly right\nadnexal cyst, increased density is suggestive that it might be hemorrhagic,\nconsider further evaluation by ultrasound.\n-Extensive subcutaneous edema involving chest, abdomen, pelvis and lower\nextremities. Left lower extremity stump appears normal with no evidence of\nosteomyelitis or soft tissue collections." }, { "input": "Chest-please see separately dictated same day CT of the chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nWithin the limitations of study with no IV contrast, there is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Pigtail catheter terminates in the nondistended gallbladder.\n\nPANCREAS: The pancreas with no lesions. There is no significant\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and no gross focal findings.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. No hydronephrosis. \nToo small to characterize hypodensity in the right lower pole is possibly cyst\n(2:74).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel and the colon and\nrectum are with no gross findings.. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nSmall quantity of ascites demonstrated in the upper abdomen surrounding the\nliver and spleen, extending into the pelvis, measuring simple fluid density, 9\n___.\n\nREPRODUCTIVE ORGANS: There is well-defined oval structure in right pelvis\nmeasuring up to 8 cm (2:101), relatively dense, 33 ___, and could represent\nright adnexa cyst, possibly hemorrhagic, for further evaluation by ultrasound.\n\nRETROPERITONEUM AND MESENTERY: There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy. There is no\nabdominal aortic aneurysm. Mild atherosclerotic disease is noted. The\nmesenteric vessels appear patent.\n\nSOFT TISSUE AND BONES: There is significant chest and abdomen wall edema,\npredominantly at the level of the flanks, lower abdomen and pelvis.\n\nThe edema extends to lower extremities, but no free air demonstrated in soft\ntissues. No clear collections. The left tibial and fibular stump is with no\nevidence of osteomyelitis. There are no discrete collections.\n\nSmall hematoma in the right psoas muscle centered at the level of L4, (2:82\n601:48).", "output": "-Bronchopneumonia is centered in the imaged left upper lobe. Reported\nseparately in the same day CT of the chest.\n-Small quantity of ascites, measuring simple fluid density.\n-Small hematoma in the right psoas muscle.\n-Oval structure in the right pelvis measures up to 8 cm is possibly right\nadnexal cyst, increased density is suggestive that it might be hemorrhagic,\nconsider further evaluation by ultrasound.\n-Extensive subcutaneous edema involving chest, abdomen, pelvis and lower\nextremities. Left lower extremity stump appears normal with no evidence of\nosteomyelitis or soft tissue collections." }, { "input": "LOWER CHEST: Trace left and small right pleural effusion with associated\natelectasis. The right pleural effusion appears similar to prior. A central\nline is partially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. A percutaneous cholecystostomy tube is\nredemonstrated, with the tip terminating within the gallbladder lumen. \nHigh-density stones and sludge are seen within the gallbladder. No\ngallbladder wall edema, pericholecystic fluid, or pericholecystic fat\nstranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is small in size, but similar to prior. No evidence of\nfocal lesions.\n\nADRENALS: A fat containing density within the left adrenal gland measures 2.1\ncm (02:24). The right adrenal gland is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral subcentimeter hypodensities are too small to characterize. \nThere is no evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: An NG tube is in place. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. A rectal tube is in place. Otherwise, the colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: A Foley catheter is in situ. The urinary bladder and distal ureters\nare unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A circumscribed, predominantly oval-shaped, intermediate\ndensity structure arises from the right adnexa, adjacent to the right ovary,\nand measures 12.1 x 6.1 cm (601:31).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Edema within the chest and abdominal wall is mildly improved\nfrom prior. Scattered rounded densities within the subcutaneous tissue of the\nanterior abdomen are likely sequela of prior injections. A probable hematoma\nof the right psoas muscle measures 3.8 x 3.2 cm (02:47), slightly decreased in\nsize from prior.", "output": "1. Redemonstrated percutaneous cholecystostomy tube, with the tip terminating\nwithin the gallbladder lumen. No gallbladder wall edema, pericholecystic\nfluid, or pericholecystic fat stranding. No evidence of adjacent fluid\ncollection or abscess. No biliary dilatation. Redemonstrated high-density\nstones and sludge within the gallbladder lumen.\n2. Interval mild increase in size of an oval-shaped, approximately 12.1 x 6.1\ncm, intermediate density lesion arising from the right adnexa, adjacent to the\novary, which may be a paraovarian cyst.\n3. Interval mild decrease in size of a right psoas hematoma.\n4. 2.1 cm probable left adrenal myelolipoma.\n5. Trace left and small right pleural effusion, with associated atelectasis." }, { "input": "LOWER CHEST: Linear atelectasis or scarring is present in the bilateral lung\nbases. There is no pleural or pericardial effusion. Coronary arterial\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A\nsegment IV hypodensity spanning 11 mm was present previously, compatible with\na small cyst or biliary hamartoma (02:13). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral percutaneous nephrostomy tubes are in place. There is mild\nright hydronephrosis and pelviectasis, as well as moderate left\nhydroureteronephrosis, with dilation of the left ureter throughout its extent\nto the level of the pelvis. Bilateral perinephric fat stranding is also\nnoted. An exophytic lower pole right renal cyst is unchanged (02:29).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is not visualized.\n\nPELVIS: Streak artifact from right total hip arthroplasty limits assessment of\ndeep pelvic structures. Within these limitations, a Foley catheter is noted\nwithin the bladder. No large pelvic mass is identified. There is no free\nfluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes are again noted throughout the lumbar\nspine, with continued grade 1 anterolisthesis of L5 on S1 and L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Bilateral hydronephrosis, worse on the left, with perinephric edema and fat\nstranding, compatible with obstructive uropathy.\n2. Percutaneous nephrostomy tubes are in place bilaterally, and a Foley\ncatheter is present within the bladder.\n3. Colonic diverticulosis.\n4. Multilevel grade 1 spondylolisthesis in the lower lumbar spine, unchanged." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There are severe coronary artery\nand aortic valvular calcifications. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsegment ___ liver hypodensity measuring 9 mm is unchanged and most consistent\nwith a simple cyst. There is mild intrahepatic biliary duct dilation,\nunchanged. The gallbladder mildly distended without surrounding stranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are bilateral PCNU stents which appear well-positioned. There\nis no hydronephrosis. Atrophic right kidney unchanged in appearance. There\nis a 1.8 x 1.3 cm simple cyst in the left lower pole. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Stomach is decompressed. \nSmall and large bowel are normal in caliber without focal wall thickening. \nNot visualized but no secondary signs of appendicitis in the right lower\nquadrant. There is diverticulosis of the sigmoid colon.\n\nPELVIS: Streak artifact from right total hip arthroplasty limits evaluation of\ndeep pelvic structures. Within these limitations, a Foley catheter is seen\nwithin a decompressed bladder. No large pelvic mass or free fluid is seen.\n\nREPRODUCTIVE ORGANS: The reproductive organs are not well seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the lumbar spine including mild\nanterolisthesis of L4-5, also seen previously. In addition there is disc\nspace narrowing at L4-5 and L5-S1.\n\nSOFT TISSUES: There is a small umbilical hernia.", "output": "1. No acute intra-abdominal process.\n2. Well-positioned bilateral PCNU stents. No evidence of current\nhydronephrosis." }, { "input": "LOWER CHEST: Visualized lung fields are notable for bibasilar atelectasis. \nThe heart is mildly enlarged with coronary artery calcifications. No evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. 1.2\nx 0.9 cm (02:12) segment 8 hepatic hypodensity is unchanged since prior\nexamination and consistent with a cyst. There is no evidence of worrisome\nlesions within the limitations of an unenhanced scan. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\ntop-normal in size without gallstones, or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again seen are bilateral percutaneous nephroureterostomy stents\nwhich are in appropriate position. The right kidney is again noted to be\natrophic in size. There is mild enlargement with mild hydronephrosis of the\nleft kidney with adjacent perinephric fat stranding. Within the upper pole of\nthe right kidney is a 1.5 x 1.6 cm (02:26) exophytic right upper pole renal\ncyst. Within the lower pole left kidney is a 1.3 x 0.8 cm (02:31) hypodensity\nconsistent with a cyst. No nephrolithiasis.\n\nGASTROINTESTINAL: The esophagus is unremarkable. The stomach is decompressed.\nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The visualized colon and rectum are otherwise\nunremarkable. The appendix is not visualized, however no secondary signs\nacute appendicitis. Mild fat stranding along bilateral lateral conal fascia\nis likely reactive in nature. No fluid collection.\n\nPELVIS: Limited evaluation due to beam hardening artifact from right hip\narthroplasty. Bladder is not well assessed due to artifact. There is trace\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No large adnexal mass.\n\nLYMPH NODES: Scattered top-normal retroperitoneal lymph nodes do not meet CT\nsize criteria for enlargement and are similar in appearance to prior\nexamination. There is no mesenteric, inguinal, or left pelvic side well\nlymphadenopathy. Limited evaluation the right pelvic sidewall due to right\nhip arthroplasty.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine. Mild\nanterolisthesis of L4 on L5 and L5 on S1 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New left-sided hydronephrosis with perinephric fat stranding, and enlarged\nleft kidney. No obstructing renal stone. Correlation with urinalysis is\nsuggested regarding possibility of superimposed infection.\n2. Bilateral percutaneous nephrostomy ureteral stents are in appropriate\nposition.\n3. Chronic findings including diverticulosis, renal cysts, and segment 8\nhepatic cyst." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN: The liver, spleen, pancreas, adrenal glands and kidneys are\nunremarkable aside for bilateral hypodense renal lesions too small to\ncharacterize and a few right renal cysts measuring up to 2.6 cm.\n\nGASTROINTESTINAL: There is no bowel obstruction or ascites. The appendix is\nunremarkable.\n\nPELVIS: Evaluation of the pelvis is slightly limited by streak artifact from\nright hip arthroplasty. Central prostate calcifications are noted. Apparent\nhyperdensity in the right seminal vesicle is likely artifactual, as seen\npreviously.\n\nLYMPH NODES: No enlarged nodes in the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Right hip arthroplasty is noted partially obscuring the pelvis from\nstreak artifact. Punctate focus sclerosis in the L4 vertebral body is likely\na bone island.\n\nSOFT TISSUES: Interval decrease in size of the known right gluteus maximus\nhematoma, although this is only partially imaged. There has been interval\nplacement of a drainage catheter with expected adjacent gas. Uncertain if the\nhyperdensity in the within this hematoma is due to evolution of the blood\ncontents or due to the reported sarcoma.", "output": "1. Interval drain placement and decrease in size of the partially imaged right\ngluteal hematoma with regions of hyperdensity as described above. No findings\nof metastatic disease in the abdomen or pelvis.\n2. Please refer to dedicated chest CT performed on the same date for\ndescription of intrathoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are several\nperipheral areas of abnormal hypoenhancement of the right kidney and mild\nsurrounding fat stranding concerning for pyelonephritis. There is no evidence\nof focal renal lesions or hydronephrosis. Subcentimeter hypodensity in the\nlower pole of the left kidney is too small to characterize, but likely\nrepresents a simple cyst.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. No adnexal abnormalities are\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes of the lumbar spine with loss of disc height at\nL4-L5 and grade 1 retrolisthesis of L3-L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute right pyelonephritis. No focal fluid collections." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of solid focal lesions. 2 small sub 5 mm hypodensities\nin the left lobe are again seen, unchanged since ___. The previously seen\nsmall hemangioma in the right lobe is not visualized. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder was collapsed at the time of the exam. There is\nno free fluid in the pelvis. Artifacts from right hip replacement obscure\ndetail in the lower pelvis\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The torso see of the\nthoracoabdominal aorta is noted as previously. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nTotal hip replacement on the right PE\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No abnormality seen in the abdomen pelvis. No evidence of tumor.\n2. Tortuous aorta.\n3. Post total hip replacement on the right." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout\nin keeping with steatosis. There is no evidence of focal lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. There is a right lower quadrant\ncolostomy with no evidence of proximal obstruction or complication. There is\nno suspicious mass or abnormal wall thickening. Appendix contains air, has\nnormal caliber without evidence of fat stranding.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is mild calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: The uterus is retroverted and bulky. There is\nhypodensity or fluid within the endometrial cavity - history of endometrial\ndysplasia noted. There are nabothian cysts in the cervix. There are bilateral\nadnexal cysts that are likely follicular in nature in a premenopausal patient.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. Right lower quadrant colostomy with no evidence of obstruction or\nsuspicious mass. No evidence of metastatic disease in the abdomen and pelvis\n2. Retroverted, bulky uterus with hypodensity within the endometrial cavity -\nhistory of endometrial dysplasia noted." }, { "input": "LOWER CHEST:\nThe lung bases are clear. The visualized heart and pericardium are within\nnormal limits.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent with\nclips in the gallbladder fossa. The common bowel duct is minimally dilated,\nconsistent with a post cholecystectomy state.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There are multiple loops of minimally dilated, fluid filled\nsmall bowel however and there is no evidence of small bowel obstruction or\ntransition in bowel caliber identified. The surgical anastomosis is seen\nwithin the left lower quadrant ((see series 5, image 69) and appears patent.\nThere is trace free fluid seen adjacent to multiple bowel loops, adjacent to\nthe liver. The stomach is moderately dilated with fluid. The remaining colon\nappears within normal limits..\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is a small amount of free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are surgically absent.\n\nBONES AND SOFT TISSUES:\n\nNo suspicious bony lesions are identified. Soft tissue defects in the\ninvolving the anterior and right lateral abdominal wall are consistent with\nrecent surgical intervention..", "output": "1. Minimally dilated loops of small bowel filled with fluid consistent with\npostoperative ileus. No evidence of obstruction.\n2. Trace free fluid in the abdomen and minimal free fluid in the pelvis. No\nevidence of organizing fluid collection.\n3. Moderately distended stomach." }, { "input": "LOWER CHEST:\nThere is a small left-sided pleural effusion with adjacent atelectasis. The\nlungs are otherwise clear. The heart is normal in size with a small\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is again low in attenuation compatible with hepatic\nsteatosis. The gallbladder is surgically absent.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nGASTROINTESTINAL: Again noted are prominent, dilated small bowel loops,\ncompatible with a postoperative ileus. Nasogastric tube terminates in the\ndistal gastric body. The study was performed with rectal contrast, which is\nseen extravasating into the dependent portion of the abdomen, from the\nileosigmoid anastomosis (5:64). Contrast and gas collection in the left mid\nabdomen (601b:28) represent sequela of anastomotic leak.\nRETROPERITONEUM: There is fluid interspersed about the mesentery. This fluid\nis intermediate in density, representing mixed contrast and enteric contents.\nThere are no pathologically enlarged mesenteric or retroperitoneal lymph\nnodes.\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is a moderate amount of\nintermediate density free fluid in the pelvis, representing extravasated\ncontrast and enteric fluid.\nREPRODUCTIVE ORGANS: The uterus and ovaries are surgically absent.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal wall defects in the right\nanterior and ventral abdominal wall are likely a function of recent surgery.", "output": "1. Large amount of intra-abdominal free fluid with locules of air,\nrepresenting extraluminal rectal contrast extravasation, seen adjacent to the\nsigmoid anastomosis. This is consistent with anastomotic leak.\n2. Prominent loops of small bowel, in keeping with a postoperative ileus.\n3. Hepatic steatosis\n4. New small left pleural effusion." }, { "input": "LOWER CHEST: There is a 5 mm ground-glass nodular opacity at the right lung\nbase (series 2, image 18). Small pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a probable ciliated forgut cyst in hepatic segment IVB (series 2,\nimage 42) There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is no hiatal hernia. Small bowel is normal in caliber\nwithout focal wall thickening. There is thickening and hyperenhancement as\nwell as Vasa recta engorgement in the region of the rectum. Wall thickening,\nhyperenhancement, and surrounding stranding extends contiguously proximally\ninvolving the sigmoid, descending and very distal transverse/splenic flexure\nof the colon colon. Beyond this point more proximally at the level of the\ntransverse colon and right colon the large-bowel normalizes. There is no\nintra-abdominal free air. There is a small amount of perihepatic ascites. \nThere is mild hyperemia of the appendix which is normal in diameter 0.7 cm, no\nadjacent inflammatory changes, unlikely appendicitis.\n\nPELVIS: The bladder is distended. There is trace free fluid in the pelvis. \nThere are prominent, likely reactive mesorectal lymph nodes on the right side\nmeasuring up to 1.0 cm. Inguinal lymph nodes are also mildly enlarged\nmeasuring up to 1.3 cm on the right. There are no pelvic sidewall lymph\nnodes.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There are multiple prominent retroperitoneal lymph nodes. There\nare none that are pathologically enlarged. There are no pathologically\nenlarged mesenteric lymph node.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There are no suspicious bony lesions. There is no superficial soft\ntissue abnormality.\n\nSOFT TISSUES: There is mild diffuse anasarca.", "output": "1. Contiguous colitis extending from the splenic flexure to the rectum,\nconsistent with active ulcerative colitis. No bowel dilatation. No free air\nor intra-abdominal fluid collection.\n2. Borderline size appendix, 0.7 cm, no periappendiceal stranding, unlikely to\nrepresent acute appendicitis in the absence of clinical symptoms.\n3. 5 mm right lower lobe ground-glass pulmonary nodule.\n\n For an incidentally detected single part-solid nodule smaller than 6mm, no CT\nfollow-up is recommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: There is bibasilar atelectasis or aspiration. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is bilateral symmetric mild fat stranding, unlikely to be\nrelated to recent trauma. . The kidneys are of normal and symmetric size\nwith normal nephrogram. There is no evidence of focal renal lesions or\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is an acute fracture of the right L1 transverse process. There\nis no evidence of worrisome osseous lesions. Multilevel degenerative changes\nof the imaged spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute fracture of the right L1 transverse process.\n2. There is bibasilar atelectasis or aspiration.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 9:33 AM, 10 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Please refer to the separately dictated CT of the chest for\ndetailed evaluation of the pulmonary masses.\n\nHEPATOBILIARY: Re-demonstrated are subcentimeter hepatic hypodensities, too\nsmall to characterize, likely simple cysts or hamartomas. The hepatic veins\nand the portal veins are patent. There is no biliary ductal dilatation. \nGallbladder appears unremarkable.\n\nPANCREAS: Pancreas is unremarkable with no pancreatic ductal dilatation or\nsuspicious mass lesions.\n\nSPLEEN: Spleen is normal in size.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY:There is re-demonstration of marked right-sided hydroureteronephrosis\nwith renal cortical atrophy secondary to the obstructing right pelvic mass. \nThe left kidney appears unremarkable with normal enhancement and no suspicious\nmass lesions.\n\nGASTROINTESTINAL: Stomach appears unremarkable. Small bowel loops are normal\nin caliber. Large bowel appears unremarkable except for scattered colonic\ndiverticulosis without diverticulitis.\n\nPERITONEUM: There is no free air. There is trace amount of intra-abdominal\nascites. There is motion of an anterior peritoneal mass below the level of\nthe umbilicus. This has minimally increased in size where it currently\nmeasures 4.6 x 4 cm compared to 4.1 x 3.2 cm. There are no other new\nmesenteric masses.\n\nLYMPH NODES: There is no retroperitoneal adenopathy.\n\nVASCULAR: There is re-demonstration of complete tumoral invasion throughout\nthe IVC extending into the intrahepatic IVC. An infrarenal IVC filter is\nagain noted. The tumor extends into the bilateral common iliac vessels. This\ntumor also involves bilateral external iliac vessels.\n\nPELVIS: Re-demonstration of complex solid/cystic mass with internal\ncalcifications along the right pelvic sidewall and invading into the IVC and\nbilateral iliac veins. Remains difficult to measure however, appears\nprogressed in size compared to ___ study, currently measuring 5.3 x 6.3 x\n10 cm compared to 4.3 x 6.4 x 8.7 cm. Urinary bladder appears unremarkable.\n\nBONES:There are no acute or suspicious destructive osseous lesions.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Continued enlargement of the right pelvic sidewall mixed solid and cystic\nmass, biopsy-proven endometrial stromal sarcoma.\n2. Unchanged tumoral invasion into the IVC and bilateral iliac veins.\n3. Continued enlargement of anterior omental mass as described above.\n4. Please refer to the separately dictated CT of the chest for detailed\nevaluation.\n5. Other chronic findings as above." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are again scattered subcentimeter hypodensities in the\nliver, too small to characterize. Otherwise, the liver demonstrates\nhomogenous attenuation throughout. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There has been mild improvement in extensive right\nhydroureteronephrosis since ___ with persistent marked\nhydroureteronephrosis and atrophy of the right renal cortex. A 1.5 cm simple\ncyst is again seen in the interpolar region of the left kidney. The kidneys\nare of normal and symmetric size with normal nephrogram. There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not seen. There is an\nanterior omental mass measuring 6.1 x 3.9 cm increased in size previously 5.1\nx 3.5 cm..\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There a mixed cystic and solid mass in the pelvis. This\nis decreased in size. A heterogeneous component that previously measured 11.4\nx 8.7 cm currently measures 7.1 x 5.5 cm and is less enhancing. More inferior\non series 5, ___ 102 there is a 6.5 x 6.3 cm mass also increased in size\npreviously 8.3 x 6.8 cm. The pelvic mass again demonstrates mass effect upon\nthe bladder.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no inguinal lymphadenopathy. Pelvic lymphadenopathy is difficult to assess\ndue to encasement by the complex pelvic mass.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. The IVC filter is in unchanged position.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is degenerative changes seen along the visualized lumbosacral spine with\nmild grade 1 anterolisthesis of the L4-L5 vertebral level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mixed response with decrease in size and enhancement of ill-defined pelvic\nmass with persistent infiltration of the IVC\n2. Increase in size of anterior omental mass. No new lesions seen\n3. There is mild interval improvement in extensive right hydroureteronephrosis\nsince ___.\n4. Please refer to the dedicated CT chest exam for full description of\nintrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are scattered hepatic hypodensities, too small to\ncharacterize, however remains stable. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic, with resolution of the previously\nvisualized severe hydronephrosis. There are stable bilateral renal cysts. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nThere has been interval increase in size of a mixed solid-cystic omental\nimplant, now measuring 5.1 x 8.7 cm, previously measuring 3.9 x 6.1 cm.\n\nPELVIS: There has been interval decrease in size of a mixed solid-cystic\nlesion in the right hemipelvis, now measuring 5.0 x 5.3 cm in greatest\ndimension, previously measuring 6.5 x 6.3 cm. A hypoenhancing lesion cranial\nto this mass is also decreased in size, now measuring 3.6 x 4.8 cm, previously\nmeasuring 5.5 x 7.1 cm.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is contiguous tumoral extension/thrombus in the right common\niliac vein extending into the inferior vena cava, with an IVC stent in place. \nThere is abnormal thickening of the IVC above the level of the IVC filter, as\nseen on the previous study, concerning for tumor thrombus. There is no\nabdominal aortic aneurysm. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mixed treatment response with decrease in size of the pelvic masses as\ndescribed, with persistent infiltration of the right common iliac vein and\nIVC.\n2. Interval increase in size of the anterior omental mass.\n3. The chest will be reported separately." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is scattered subcentimeter low density lesions throughout\nthe liver, unchanged from prior exam and remain too small to adequately\ncharacterize. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic with small cysts. The left kidney is\nnormal in size with multiple small cysts. There is no evidence of \nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nThere is interval increase in size of mixed solid cystic omental implant\nmeasuring 6.6 x 11.4 cm, previously 5.1 x 8.7 cm.\n\nPELVIS: There is interval decrease in size of mixed solid and cystic lesion in\nthe right hemipelvis measuring 3.7 x 4.8 cm, previously 5.0 x 5.3 cm. A\nlow-density lesion inferior to this lesion has also decreased size measuring\n2.7 x 3.8 cm, previously 3.6 x 4.8 cm.\n\nThe urinary bladder is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is continues tumoral extension/thrombosis in the right common\niliac vein extending to the inferior vena cava, with an IVC filter in place. \nThere is abnormal thickening of he IVC above the level of IVC filter as noted\non the prior exam, concerning for tumor thrombus.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMarked degenerative changes are seen in the lumbar spine characterized by\nmultilevel loss of intervertebral disc heights at osteophyte lipping. There\nis a 4 mm a degenerative anterolisthesis of L4 on L5, unchanged from prior\nexam.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mixed treatment response, characterized by interval decrease in size of\nright hemipelvis implants and increase in size of metastatic omental implant.\n2. Stable continuous tumoral extension/thrombosis in the right common iliac\nvein extending to the inferior vena cava, with an IVC filter in place. Stable\nabnormal thickening of he IVC above the level of IVC filter, also concerning\nfor tumor thrombus." }, { "input": "LOWER THORAX: Ground-glass density involving bilateral lower lobes, right\ngreater than left.\n\nHEPATOBILIARY: There is a lobulated contour along the posterior aspect of the\nright hepatic lobe without discrete mass. No biliary ductal dilatation.\nUnremarkable gallbladder.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis. Unremarkable\nbladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small bowel is normal in\ncaliber. There is endoluminal nodularity involving the terminal ileum (axial\nseries 3, image 56). There is also masslike thickening of the cecum and\nproximal ascending colon (axial series 3, image 46; coronal series 6, image\n30) with soft tissue nodules studding the external contour of the cecum. The\nremaining large bowel demonstrates scattered colonic diverticula but otherwise\nunremarkable appearance. Normal appendix.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly, with exophytic nodule protruding\ninto the bladder.\n\nLYMPH NODES: There is extensive retroperitoneal, mesenteric, and pelvic\nlymphadenopathy with surrounding haziness of the mesentery. Index nodes\n(axial series 3):\n\n1. Periportal, image 25, measuring 16 x 30 mm.\n2. Periaortic, image 38, measuring 12 x 22 mm.\n3. Mesenteric, image 48, measuring 17 x 37 mm.\n4. Mesenteric, image 52, measuring 18 x 39 mm.\n5. Right obturator, image 71, measuring 8 x 16 mm.\nPERITONEUM, RETROPERITONEUM, MESENTERY: Extensive retroperitoneal mesenteric\nadenopathy as described above with haziness of the mesenteric fat.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic\ncalcification.\n\nBONES: No suspicious osseous lesion.\n\nSOFT TISSUES: Unremarkable.", "output": "1. Extensive retroperitoneal, mesenteric, and pelvic lymphadenopathy with\nassociated haziness of the mesenteric fat suspicious for lymphoma.\n2. Masslike thickening of the cecum with endoluminal nodularity of the\nterminal ileum could represent a primary colonic neoplasm, however\nlymphomatous involvement of the small and large bowel is a consideration given\nnodular appearance and diffuse adenopathy.\n3. Ground-glass density involving bilateral lower lobes, right greater than\nleft may be infectious/inflammatory." }, { "input": "LOWER CHEST: A 13 mm nodular density at the right lung base (02:11) measures\nof fat attenuation.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring up to 15.1 cm with normal attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. In the expected location of the appendix there is a large amount\nof phlegmon and fluid spanning up to 5.7 x 6.1 cm extending into the right\nhemipelvis suggestive of a contained perforated appendicitis. A punctate\ncalcific density is visualized within the fluid collection and may represent\nan appendicolith (2:62).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring up to 6.5 cm.\n\nLYMPH NODES: Prominent mesenteric lymph nodes measuring up to 7 mm as well as\nretroperitoneal lymph nodes measuring up to 9 mm are most likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes visualized throughout the imaged\nportion of the thoracolumbar spine notable for mild anterolisthesis of L4 on\nL5. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Surgical mesh clips are visualized along the anterior abdominal\nwall. A left inguinal hernia containing fat is noted.", "output": "1. Perforated appendicitis with associated phlegmon and fluid.\n\n2. Splenomegaly.\n\n3. 13 mm fat attenuation nodular density at the right lung apex may be\nsecondary to chronic aspiration.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:45 pm." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 2.2 cm accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSmall hypodensity in the mid to lower pole of the left kidney is too small to\ncharacterize, likely a cortical cyst. There is no evidence of hydronephrosis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small to moderate sized hiatal hernia. Otherwise\nthe stomach is unremarkable. Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. No evidence of thrombus seen within the IVC or pelvic veins.\n3. Small to moderate size hiatal hernia.\n\nNOTIFICATION: The findings were discussed with ___ from Dr. ___\n___, by ___, M.D. on the telephone on ___ at 2:00\npm, 10 minutes after discovery of the findings. The results were also\ndiscussed with Dr. ___ on the telephone on ___ at 2:25 ___, 25\nminutes after discovery of the findings." }, { "input": "Heart size is normal. Imaged lung bases are clear.\n\nCT abdomen: The liver is diffusely hypoattenuating, compatible with steatosis.\nThe liver otherwise enhances homogeneously without focal mass or biliary\ndilatation. The gallbladder is normal. Portal vein is patent.\n\nSpleen, pancreas and adrenal glands are normal. Accessory spleen is noted in\nthe splenic hilum.\n\nKidneys present symmetric nephrograms and excretion of contrast without focal\nmass, hydronephrosis or perinephric abnormality.\n\nThe stomach, duodenum and remainder of the small bowel are normal caliber,\nwithout evidence of obstruction. A single diverticulum is noted in the sigmoid\ncolon without evidence of diverticulitis. The colon is otherwise thin-walled\nand unremarkable without pericolonic fat stranding or fluid collection. Normal\nappendix measuring 3 mm in caliber is located in the low mid abdomen (2:60).\n\nAbdominal aorta is normal caliber. Scattered at mesenteric and retroperitoneal\nlymph nodes are not pathologically enlarged. No ascites, pneumoperitoneum or\nventral abdominal hernia.\n\nCT pelvis: Bladder, uterus and the rectum are unremarkable. Bilateral ovaries\nare normal with physiologic follicular activity. No free air. Trace free\npelvic fluid Prominent inguinal lymph nodes measure up to 11 mm on the right\nbut are not pathologically enlarged. No pathologically enlarged pelvic\nsidewall lymph nodes.\n\nBones and soft tissues: No suspicious focal bone lesion.", "output": "1. No acute CT findings. Specifically, normal appendix and no evidence of\ncolitis.\n2. Diffusely hypoattenuating liver compatible with steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation. The\ngallbladder is mildly distended and a 1.2 cm stone is noted within the\ngallbladder.\n\nPANCREAS: Unremarkable. There is no peripancreatic stranding.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable.\n\nGASTROINTESTINAL: There is no intestinal obstruction. The appendix\nunremarkable. There is a large amount of hemoperitoneum, more so in the\npelvis.\n\nREPRODUCTIVE ORGANS: An IUD is noted. A 2.3 cm right corpus luteum is noted. \nThe ovaries are surrounded by hemorrhage and their anatomy is not well\ndemonstrated. There is no swirling of the right gonadal vasculature.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Large amount of hemoperitoneum, more so in the pelvis, concerning for a right\nhemorrhagic ruptured corpus luteum with large amount of hematoma in the\nbilateral adnexa.\n\nRECOMMENDATION(S): Pelvic ultrasound.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:39 am, 5 minutes\nafter discovery of the findings.\n\n The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 7:00 am, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Please refer to separately dictated CT of the chest.\n\nHEPATOBILIARY: Intermediate density 2 cm segment ___ well-circumscribed\nlesion, the lesion measures 39 ___ on the noncontrast enhanced scan and 47 ___\non the postcontrast enhanced scan. It may represent a hyperdense cyst.. \nOther millimetric hepatic hypodensities, too small to characterize. Portal\nvein is patent. Under distended gall bladder. No intrahepatic or\nextrahepatic bile ductal dilatation.\n\nPANCREAS: Atrophic pancreas.\n\nSPLEEN: Normal in size.\n\nADRENALS: Heterogeneous enhancing left adrenal mass measuring 3.2 cm. This\nis most concerning for a metastatic lesion. There is a smaller right adrenal\nnodule with similar enhancement characteristics.\n\nURINARY:No hydronephrosis. No nephrolithiasis. No suspicious renal masses. \nUnder distended urinary bladder due to the presence of a Foley catheter.\n\nGASTROINTESTINAL: Stomach is unremarkable. No dilated loops of small bowel. \nUnremarkable appendix. Scattered colonic diverticulosis without\ndiverticulitis.\n\nPERITONEUM: No free air. Trace of free fluid in ___'s pouch.\n\nLYMPH NODES: No retroperitoneal or mesenteric adenopathy. Millimetric lymph\nnodes at the level of GE junction, does not meet criteria for adenopathy.\n\nVASCULAR: Normal caliber abdominal aorta with patent intra-abdominal branches.\n\nPELVIS: Enlarged prostate. Rectum is unremarkable. Small fat containing\nright inguinal hernia.\n\nBONES:Degenerative changes of the lumbar spine.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Heterogenous bilateral adrenal nodules, concerning for metastatic disease\n2. Hemorrhagic cyst in the liver\n3. Trace ascites.\n\nRECOMMENDATION(S): Adrenal lesions could be further evaluated with MRI" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. No intra-abdominal\nfree air free fluid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The patient is status post recent abdominal surgery. Minimal\nstranding and foci of subcutaneous gas is seen along the anterior abdominal\nwall at the level of the umbilicus consistent with recent laparoscopic\nprocedure. No subcutaneous fluid collections identified.", "output": "1. No acute intra-abdominal process. Minimal subcutaneous gas and stranding\nseen at the level of the umbilicus consistent with recent surgery. No\nsubcutaneous fluid collections identified. No intra-abdominal ascites is\nidentified." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: An 8 mm hypodensity noted at the uncinate process of the pancreas\nmay represent some insinuating fat, or possibly a small pancreatic lipoma or\nIPMN. It is unchanged since ___ and of unlikely clinical significance.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 10 mm accessory splenule is seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are a few subcentimeter renal hypodensities seen bilaterally which are\ntoo small to characterize but statistically represent small cysts. No\ndefinite suspicious focal renal lesion is seen. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatus hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Mild pelvic stranding is likely postsurgical and\nhas demonstrated interval improvement.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post hysterectomy with no evidence of local recurrence or metastatic\ndisease in the abdomen and pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: There is partial visualization of the patient's known metastatic\ndisease in the lungs which has progressed. For example, a 1.6 x 1.5 cm solid\nnodule in the left lung base on 05:10 previously measured 0.9 x 0.8 cm on ___. A 1.9 x 1.7 cm solid nodule in the lingula previously measured\n1.0 x 1.1 cm on ___ (2:5). There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous hypoattenuating liver lesions are seen, many of which\nhave increased in size. For example a dominant lesion in the posterior right\nhepatic lobe on ___:26 measures 5.7 x 4.1 cm, previously 5.2 x 3.4 cm on ___. A second dominant lesion in the right hepatic lobe on 05:19\nmeasures 5.3 x 5.1 cm, previously 5.3 x 4.9 cm. Additionally, there are new\nsatellite lesions surrounding this mass (05:24). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. There is stable appearance of a 0.9 x 0.7 cm\ncalcification within the anterior interpolar region of the right kidney. \nThere are bilateral simple cysts, stable. Additional bilateral subcentimeter\nhypodensities are too small to characterize. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is relatively decompressed, without obvious\nfocal wall thickening or masses. The bowel demonstrates normal caliber and\nthickness without evidence of obstruction.\n\nA mass arising from the cecum is increased in size measuring 6.3 x 4.9 cm in\nthe axial plane (05:58), previously measuring 3.9 x 3.9 cm on ___.\n\nSoft tissue deposit invading the rectosigmoid junction is also increased in\nsize measuring 4.9 x 2.8 cm (5:66), previously measuring 4.3 x 1.5 cm.\n\nSoft tissue deposit along the descending colon are increased in size measuring\n5.3 x 3.3 cm (05:54), previously 3.9 x 2.8 cm.\n\nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free-fluid in the right pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy. As before, a soft tissue mass in the right pelvis\nextends into the lower abdomen, ultimately connecting with the right cecal\nmass.\n\nLYMPH NODES: As before, retroperitoneal nodal tissue exerts mass-effect upon\nthe IVC at approximately the level of the ___ takeoff (05:42). There is a\nstable 1.3 cm lymph node in the right pelvic sidewall (5:66). There is no\ninguinal lymphadenopathy.\n\nThere are a few stable subcentimeter soft tissue deposits in the upper abdomen\nand pelvis. 1 is adjacent to the spleen on 07:23. Another is inferior to the\nspleen in the left upper quadrant on ___ adjacent to the splenic flexure. \n2 additional nodules are seen adjacent to the cecum on 07:19 and 07:21. \nAdditional tiny soft tissue nodules adjacent to the cecum are seen on 7:23 and\n7:24..\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable sclerotic focus in the T12 vertebral body most likely represents a bone\nisland.\n\nSOFT TISSUES: Soft tissue densities in the subcutaneous fat of the anterior\nabdominal wall are again seen, possibly related to subcutaneous medication\ninjections.", "output": "Increased size of multiple metastatic soft tissue deposits along the\ndescending colon and cecum as well as hepatic metastases and partially\nvisualized pulmonary metastases in the lung bases. There are tiny\nsubcentimeter soft tissue deposits in the upper abdomen and pelvis which are\noverall similar compared to the prior study." }, { "input": "LOWER CHEST: There is bibasilar atelectasis as well as likely a component of\nscarring at the right lung base which may represent the sequelae of chronic\naspiration. Otherwise, the visualized lung fields are within normal limits.\nThere is no pleural or pericardial effusion. Heart size is enlarged, the\npatient is status post CABG with median sternotomy.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is slightly distended,\nhowever there is no evidence of wall thickening, pericholecystic fluid or fat\nstranding. There are no radiopaque gallstones.\n\nPANCREAS: There is fat stranding surrounding the pancreatic parenchyma\nconsistent with acute interstitial pancreatitis. The pancreas demonstrates\nnormal attenuation throughout. No fluid collection is found. There is no\npancreatic ductal dilatation or calcification.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 1.4 x 1.2 cm nodule in the medial limb of the left\nadrenal gland, incompletely evaluated on the current study. The right and left\nadrenal glands are otherwise normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is renal scarring at the lower pole of the left kidney. There is no\nevidence of focal renal lesions or hydronephrosis. There is nonspecific\nsubtle perinephric fluid, most conspicuous is at the upper pole of the right\nkidney.\n\nGASTROINTESTINAL: The patient is status post placement of a percutaneous\ngastrostomy tube which appears appropriately positioned. Oral contrast is\nseen within the gastric lumen without evidence of extravasation. Visualized\nsmall and large bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.\n\nLYMPH NODES: Conspicuous retroperitoneal lymph nodes are likely reactive in\netiology.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is severe both\ncalcified and noncalcified atherosclerotic plaque seen to involve the entirety\nof the visualized abdominal aorta. There is focal narrowing at the origin of\nthe celiac axis with the suggestion of post-stenotic dilatation (02:28).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Stranding pancreatic parenchyma consistent with acute pancreatitis.\n2. Distended gallbladder, not necessarily significant clinically. No evidence\nof wall thickening, pericholecystic fluid or fat stranding. There are no\nradiopaque gallstones.\n3. Bibasilar atelectasis as well as component of scarring at the right lung\nbase which may represent the sequela of chronic aspiration, although finding\nis nonspecific.\n4. Extensive vascular disease about the visualized abdominal aorta and its\nbranches as described above.\n5. Left adrenal nodule as described above." }, { "input": "LOWER CHEST: Bilateral, nonhemorrhagic pleural effusions, left greater than\nright, with adjacent right basilar compressive atelectasis and left lung\ncollapse.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder wall appears edematous\nwith pericholecystic fluid, likely due to surrounding inflammation. No\ncholelithiasis.\n\nPANCREAS: Enlarged, edematous, low attenuation pancreas, with minimal normally\nenhancing pancreatic parenchyma, is consistent with necrotizing pancreatitis\nand is significantly progressed since ___. There is extensive\nperipancreatic stranding. Multiple acute necrotic collections are noted within\nthe head, body, and tail of the pancreas (series 2; image 37). However, no\ndiscrete enhancing wall is noted to suggest organized collection.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. 1 cm hypodensity in the inferior portion of the\nspleen is too small to characterize.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Free intra-abdominal air is noted consistent with open\nabdomen. The stomach is unremarkable. Enteric tube is noted to terminate\nwithin the fourth portion of the duodenum. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse soft tissue edema with anterior consistent with\npatient's known laparotomy for abdominal compartment syndrome.", "output": "1. Necrotizing pancreatitis is significantly progressed compared to prior. \nMultiple acute necrotic collections are noted within the head, body, and tail\nof the pancreas (series 2; image 37). However, no discrete enhancing wall is\nnoted to suggest organized collection.\n2. Moderate-sized bilateral pleural effusions, left greater than right with\nadjacent right basilar compressive atelectasis and left lower lobe collapse. \nThese findings are new since ___.\n3. Diffuse soft tissue edema, anterior abdominal wall defect, and\nintra-abdominal free air are consistent with open abdomen." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Mild bibasilar\ndependent atelectasis is noted. There is no evidence of pleural or\npericardial effusion. Coronary calcifications are incidentally noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Multiple dilated loops of\nsmall bowel measuring up to 4.6 cm with fecalized contents are demonstrated\nwith a region of transition in the caliber of the bowel loops within the right\nlower quadrant, where an approximately 10 cm long segment of small bowel\ndemonstrates relative luminal narrowing, mild concentric wall thickening, mild\nadjacent fat stranding and fluid (02:52), similar in location to that seen on\nthe prior study. Decompressed distal small bowel loops are presents. The\ncolon and rectum are within normal limits. The appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: . Mild enlargement of the prostate measuring up to 4.1\ncm is demonstrated. Seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are seen in the visualized spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Small bowel obstruction with transition point in the right lower quadrant\nwhere a short segment of small bowel demonstrates mild luminal narrowing, wall\nthickening, adjacent fat stranding and fluid concerning for a nonspecific\nenteritis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 11:31 AM, 5 minutes after discussion\nwith attending." }, { "input": "LOWER CHEST: Trace bibasilar atelectasis. The heart and pericardium are\nwithin normal limits.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is minimally distended with enteric contents. \nMultiple loops of dilated small bowel are identified within the pelvis\nmeasuring up to 4.2 cm. A change in bowel caliber is identified within the\nleft hemi abdomen however no definite transition point is identified. There\nis minimal free fluid in the abdomen as well as mild bowel wall thickening of\nthe small bowel within the right lower quadrant (02:59) concerning for\npossible bowel wall ischemia. No pneumatosis or pneumoperitoneum is\nidentified. There is mild diverticulosis of the sigmoid colon. The appendix\nis surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing right inguinal hernia.", "output": "1. Multiple loops of dilated small bowel with a transition in bowel caliber\nidentified within the left lower quadrant concerning for small bowel\nobstruction. Minimal intra-abdominal free fluid and small bowel wall\nthickening are concerning for possible bowel wall ischemia however no\npneumatosis or intraperitoneal free air is identified." }, { "input": "LOWER CHEST: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nHEPATOBILIARY: The liver is normal in size and attenuation. No focal hepatic\nlesions are identified. The portal vein is patent. There is no intra or\nextrahepatic biliary duct dilatation. The gallbladder is normal-appearing.\n\nSPLEEN: The spleen is normal in size and enhancement.\n\nPANCREAS: The pancreas shows normal enhancement. There is no pancreatic duct\ndilatation or peripancreatic fat stranding.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys display symmetric nephrograms with no evidence of\nhydronephrosis or mass lesion in either kidney. The ureters are symmetrical\nin their course to the bladder.\n\nGASTROINTESTINAL: The stomach is within normal limits. As before, multiple\nloops of dilated small bowel are identified within the right hemipelvis and\nright hemi abdomen measuring up to 4.2 cm with a transition point identified\nin the right lower quadrant (2:65). The small bowel wall in the area of\ntransition enhances normally. Trace adjacent free fluid is demonstrated. \nThere is no evidence of pneumatosis or pneumoperitoneum. The appendix is not\nvisualized.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Normal caliber aorta with moderate atherosclerosis.\n\nPELVIS: Bladder is within normal limits. Rectum is within normal limits. \nMild sigmoid diverticulosis without diverticulitis.\n\nBONES AND SOFT TISSUES: No worrisome osseous lesions are seen. Small right\nfat containing inguinal hernia.", "output": "Multiple loops of dilated small bowel measuring up to 4.2 cm with a transition\npoint identified within the right lower quadrant consistent with small bowel\nobstruction. No pneumatosis. Trace free fluid adjacent to loops of dilated\nsmall bowel is demonstrated, however no hypoenhancing bowel wall is identified\nto suggest ischemia. No pneumoperitoneum." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are multiple dilated\nloops of small bowel measuring up to 4.9 cm with fecalized intraluminal\ncontents and decompressed more distal loops of small bowel in the right lower\nquadrant, suggesting a small-bowel obstruction. No discrete transition point\nidentified. Diverticulosis of the colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is surgically absent. There is\ntrace mesenteric free fluid (2:68).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 3.5 x 1.9 cm rim enhancing fluid collection just\nsuperior to the umbilicus, may represent a postoperative seroma secondary to\nrecent laparoscopic surgery (2:55, 602b:39). There is a small fat containing\nright inguinal hernia.", "output": "1. Multiple dilated loops of small bowel measuring up to 4.9 cm, with\nfecalized intraluminal contents. Though note discrete transition point\nidentified there is distal decompression suggesting component of obstruction\nwhich could be low-grade or partial in nature. Trace mesenteric free fluid in\nthe lower abdomen. No pneumatosis or abnormal bowel wall enhancement.\n2. A 3.5 cm rim enhancing fluid collection just superior to the umbilicus may\nrepresent a postoperative seroma secondary to recent laparoscopic surgery,\ncorrelate clinically." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout,\nconsistent with hepatic steatosis. A subcentimeter hepatic hypodensity is too\nsmall to characterize, however is unchanged from ___, likely representing a\nhepatic cyst or biliary hamartoma. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are punctate nonobstructing stones in the bilateral kidneys measuring up\nto 3 mm in the upper pole the right kidney. There is no hydronephrosis. \nThere is mild bilateral symmetric perinephric stranding, nonspecific. There\nare multiple simple cysts in the bilateral kidneys, measuring up to 3.8 cm in\nthe right upper pole. Multiple additional subcentimeter cortical\nhypodensities bilaterally are too small to characterize, however likely\nrepresent cysts. There is no evidence of urothelial lesions. The distal\nureters and bladder are unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2:67).\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is ectatic, measuring up to 2.5 cm, without\naortic aneurysm. Moderate atherosclerotic disease is noted.\n\nBONES: There are multilevel degenerative changes in the lumbar spine. A\nchronic moderate compression deformity at L2 is not significantly changed. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Multiple punctate nonobstructing stones in the bilateral kidneys. No\nobstructing stones or hydronephrosis.\n2. Mild bilateral symmetric perinephric stranding, nonspecific.\n3. Bilateral simple renal cysts and other renal subcentimeter hypodensities,\ntoo small to fully characterize, but also likely cysts. No suspicious renal\nmasses.\n4. Prostatomegaly.\n5. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.Trace perisplenic fluid without evidence of focal\nsplenic injury.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a small left renal intermedullary hypodensity too small to\ncharacterize though likely compatible with a simple renal cyst. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Stranding abutting the lesser curvature of the stomach with\ntrace fluid near the gastric body that could be post-traumatic versus\ninflammatory. No extraluminal air is seen. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of simple free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Numerous small mesenteric and retroperitoneal lymph nodes are\nseen, none of which meet size criteria for enlargement. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "Inflammation and adjacent free fluid posterior to the stomach as well as trace\nperisplenic and pelvic free fluid without solid organ injury or extraluminal\nair. Findings could be posttraumatic mesenteric injury or from an inflammatory\nprocess." }, { "input": "LOWER CHEST: Mild dependent atelectasis is seen in the imaged lung bases. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal size with normal nephrogram. A left\ndouble-J nephroureteral stent is seen. Embolization coils/material are again\nseen in the right kidney. Additional punctate foci of hyperdensity in the\nright kidney likely represent tiny nonobstructing calculi. A 1.6 cm\nnonobstructing renal calculus is seen in the left lower pole (601b:28). A\nsecond 0.4 cm nonobstructing stone is seen in the left upper pole (601b:32). \nA 1 mm stone is seen adjacent to the left ureteral stent (2:59).\n\nThere is fullness of the left renal pelvis without frank hydronephrosis. \nFilling defects are seen in the left renal pelvis, likely representing blood\nproducts. Multiple subcentimeter hypodensities are again seen in the right\nkidney, too small to characterize. There is no perinephric abnormality. The\nbladder is unremarkable. No extravasation of excreted contrast is identified.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no abdominal, pelvic, or inguinal lymphadenopathy by CT\nsize criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is bilateral L5 spondylolysis without spondylolisthesis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post left double-J nephroureteral stent with filling defects in the\nleft renal pelvis, likely representing blood products.\n2. Bilateral nonobstructing renal calculi, as described above, measuring up to\n1.6 cm in the left lower pole on the left. Tiny 1 mm calculus in the left\nureter adjacent to the nephroureteral stent.\n3. No extravasation of excreted contrast is identified." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are thickened and may represent\nadrenal hyperplasia.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis. Bilateral subcentimeter hypodense lesions are too small to\ncharacterize likely represent cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Diverticulosis of the\nsigmoid colon is noted, without evidence of wall thickening and fat stranding.\nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Enlarged prostate measuring 5.1 x 6.8 x 6.1 cm containing\ncoarse calcification. Seminal vesicles appear unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes are noted in the lumbar spine, most\nnotable at L3-L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Enlarged prostate measuring up to 6.8 cm.\n3. Bilateral thickened adrenal glands may represent renal hypoplasia." }, { "input": "LOWER CHEST: There is mild bibasilar subsegmental atelectasis. Coronary\nartery calcifications are noted. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. An\n11 x 11 cm simple fluid density lobulated structure in the right hepatic lobe\nwithout an appreciable wall is most likely a cyst (02:13). Additional\nscattered subcentimeter hypodensities are too small to characterize, but\nlikely represent cysts or biliary hamartomas. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 1.4 x 1.3 cm right adrenal nodule is indeterminate. The left\nadrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.6 cm left inferior pole exophytic cyst is noted. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatus hernia. A duodenal diverticulum is\nincidentally noted. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Fluid in small bowel loops that are\nnot dilated is a nonspecific finding, but can be seen in enteritis. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is not visualized.\n\nPELVIS: The bladder wall is diffusely thickened. There is a Foley catheter in\nplace. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is mildly aneurysmal at the diaphragmatic hiatus\nmeasuring up to 3.2 cm. There are multiple areas of focal ectasia in the\ninfrarenal abdominal aorta with mural thrombus. Extensive atherosclerotic\ndisease is noted. Vessel origin narrowing is noted at the celiac and SMA\nwithout evidence of occlusion on this non angiographic study.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Fluid-filled nondilated small bowel loops are nonspecific, but can be seen\nin enteritis. Evidence of bowel ischemia or obstruction.\n2. 1.4 x 1.3 cm indeterminate right adrenal nodule. An outpatient dedicated\nadrenal CT or MRI can be obtained for further characterization.\n3. Diffuse thickening of the bladder wall may be related to chronic bladder\noutlet obstruction, however bladder malignancy or infection should also be\nconsidered. Correlate with cystoscopy or urine cytology.\n4. Large, lobulated right hepatic lobe cyst.\n\nRECOMMENDATION(S):\n1. Dedicated adrenal CT for further characterization of indeterminate right\nadrenal nodule.\n2. Cystoscopy to evaluate bladder wall thickening if clinically appropriate." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 4.1 x 3.1 cm enhancing left adrenal mass that\ndemonstrates minimal contrast washout on 3 minutes exam. The right adrenal\ngland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSeveral right renal hypodensities are visualized compatible with simple renal\ncysts measuring up to 1.8 cm. There is no evidence of hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: There is small hiatal hernia. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is diffuse thickening of the endometrium with an\ninternal soft tissue component compatible with known endometrial cancer. The\nbilateral ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nare few prominent pelvic sidewall lymph nodes measuring up to 7 mm with normal\narchitecture and no evidence of lymphadenopathy. There is no inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diffuse endometrial thickening compatible with known endometrial malignancy\nand no evidence of parametrial invasion or pelvic lymphadenopathy.\n2. Heterogeneously enhancing left adrenal mass measuring 4.1 cm that is\nindeterminate.\n3. Please refer to same-day CT chest for further characterization of thoracic\nfindings.\n\nRECOMMENDATION(S): Recommend adrenal MRI for further characterization of left\nadrenal mass." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is a small amount ascites. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is\nre-demonstration of a 4.1 x 3.2 cm enhancing left adrenal mass (05:28),\nunchanged since ___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThe 2.3 cm hypodensity in the right interpolar kidney is similar in appearance\nto the prior exam and is likely a simple renal cyst. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Again noted is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. The uterus\nand bilateral ovaries are surgically absent and postsurgical changes are noted\nat the vaginal cuff. There is small amount of free fluid in the pelvis,\nlikely postsurgical. There is no evidence of a discrete fluid collection.\n\nLYMPH NODES: There is scattered retroperitoneal and portacaval nodes, however,\nthese are not enlarged by CT criteria. There is no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPunctate focus of sclerosis in the right acetabulum and left femoral head are\nlikely bone islands. Degenerative changes are noted in the thoracolumbar\nspine.\n\nSOFT TISSUES: There are several sites of focal fat stranding in the anterior\nabdomen, likely secondary to recent port placement. There is a small pocket\nof heterogeneous phlegmonous change deep to the right abdominal port site\nmeasuring 3.0 x 3.1 cm (5:66). There is a second pocket slightly superior\nwhich measures 1.9 x 1.2 cm (5:63). Soft tissue edema is seen tracking from\nthe phlegmonous collection toward the skin surface with some adjacent fat\nstranding.", "output": "1. Postsurgical changes are noted. There is no discrete drainable fluid\ncollection. There are multiple pockets of phlegmonous change deep to the\nright abdominal port site in the subcutaneous tissues, as described above.\n2. Re-demonstrated is a 4.1 x 3.2 enhancing left adrenal mass, unchanged since\nthe ___ study.\n3. Diverticulosis of the sigmoid colon without evidence of acute\ndiverticulitis.\n4. Trace ascites.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 3:00 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a heterogeneously enhancing mass in the left adrenal gland\nmeasuring 4.0 x 3.2 cm (03:57), previously 4.1 x 3.2 cm in ___. \nThe right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRe-demonstrated is a 2.3 cm hypodensity the right interpolar kidney, likely a\nsimple renal cyst, unchanged. There is no evidence of suspicious focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy. Postsurgical changes are again noted at the vaginal\ncuff. There are no adnexal masses.\n\nLYMPH NODES: Re-demonstrated are multiple prominent retroperitoneal and\nportacaval nodes, however, these are not pathologically enlarged by CT size\ncriteria. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPunctate foci of sclerosis in the right iliac and left femoral head are\nunchanged and likely bone islands. Multilevel degenerative changes are again\nnoted throughout the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. There\nhas been interval resolution of fat stranding in the anterior abdominal wall.", "output": "1. Indeterminate, heterogeneously enhancing left adrenal mass is stable since\n___.\n2. Otherwise, no evidence of new metastatic disease in the abdomen or pelvis.\n3. Please refer to dedicated CT chest performed on the same date for\ndescription of intrathoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Small left the\nand trace right pleural effusions. There is overlying compressive\natelectasis. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a subcentimeter hypodense lesion in segment for a\n(___), too small to characterize. The liver otherwise demonstrates\nhomogenous attenuation throughout. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Interval decrease in previously seen perisplenic\nfluid collection (___).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nUnchanged right simple renal cyst. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a left\nlower quadrant ostomy as well as other post-operative changes. There is a\nright anterior drain with tip in the right lower quadrant. There is no\nassociated fluid collection or abscess elsewhere in the abdomen or pelvis. \nThere is mild surrounding soft tissue stranding. The rectum is within normal\nlimits. . The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The aorta is tortuous. Mild\natherosclerotic disease is noted.\n\nBONES: No suspicious lytic or blastic bony lesions. No fractures. Again seen\nare multilevel degenerative changes of the visualized spine.\n\nSOFT TISSUES: There is minimal unchanged soft tissue stranding in the\nsubcutaneous soft tissues surrounding the right lower quadrant drain. There\nis punctate foci of gas in the surrounding subcutaneous tissues (___), which\ncould be related to subcutaneous injections. No evidence of new or enlarging\nabscess in the subcutaneous tissues.", "output": "1. No evidence of abscess or fluid collection in the abdomen or pelvis. Again\nseen is a right anterior drain with tip in the right lower quadrant without\nassociated fluid collection. Soft tissue induration is again seen along the\nsubcutaneous tissue adjacent to the drain; correlate with direct visualization\nfor possible cellulitis.\n2. As before, there is a left lower quadrant ostomy.\n3. Small left and trace right pleural effusion." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions, left greater than\nright. Carotid artery calcification is evident. There is a left-sided\npacemaker.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There are multiple small gallstones. \nThere is no gallbladder-wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a punctate nonobstructing right mid renal calculus. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\nscattered colonic diverticula. There are no pericolonic inflammatory changes.\n\nPELVIS: Nondistention of the bladder precludes adequate evaluation of the\nbladder wall. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted.\n\nBONES: Degenerative changes are evident in the spine and hips.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Diverticulosis without diverticulitis\n2. Prostatic hypertrophy.\n3. Gallstones.\n4. Bilateral pleural effusions.\n5. Punctate right renal calculus.\n6. Vascular calcification." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a large\nwell-circumscribed 7 x 6.6 x 6.7 cm exophytic paranephric hypodensity of the\nright kidney likely compatible with a paranephric simple cyst, which is\nnonobstructing. There are multiple bilateral cortical renal stones largest\nwhich is a right upper pole renal stone measuring 1 x 0.7 cm (seen on 02:36\nmeasuring 382.5 ___. There are smaller renal stones, one of the right\ninterpolar region measuring 0.6 cm (see 02:34 measuring 377 ___ and another of\nthe left lower renal pole measuring 0.6 cm (see 02:42 measuring 587 ___. None\nof the renal stones are obstructing. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple bilateral renal stones as detailed above. No hydronephrosis.\n2. Large 7 cm nonobstructing right parapelvic simple renal cyst." }, { "input": "LOWER CHEST: Emphysema is notable in the bilateral lower lungs. There is no\npleural or pericardial effusion. Pacemaker leads are demonstrated entering\nthe right atrium and right ventricle.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout. A rounded\nhypodensity in the pancreatic head measuring 10 x 9 x 9 mm (02:26, 601:27) is\nincompletely characterized on current exam. There is no evidence of\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Punctate\ncalcification in the inferior pole of the spleen likely represents a calcified\ngranuloma (02:21).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mildly enlarged\nair and stool-filled rectum. There is mild colonic fecal loading, the colon\nis otherwise unremarkable. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nRETROPERITONEUM AND MESENTERY: There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy. There is no\nabdominal aortic aneurysm. Extensive atherosclerotic disease noted. The\nmesenteric vessels appear patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild to moderate degenerative changes of the thoracolumbar spine most severe\nat L3-L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence to suggest diverticulitis.\n2. Rounded hypodensity in the pancreatic head measuring 10 x 9 x 9 mm is\nincompletely characterized on current exam. Recommend follow-up MRCP for\nfurther characterization.\n3. No other acute intra-abdominal or intrapelvic process to account for\npatient's symptoms.\n\nRECOMMENDATION(S): Outpatient MRCP to further assess pancreatic head cystic\nlesion." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. Incidentally noted is tip of\nright ventricular lead of cardiac conduction device, which terminates in the\nright ventricle.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple liver hypodensities, which are too small to characterize\nbut likely represent biliary hamartomas versus cysts. In the face of known\nmalignancy, these lesions are incompletely characterized. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: Pancreas is normal in attenuation. Again seen in the pancreatic\nhead is a 0.9 x 0.8 cm hypodensity, which is incompletely characterized on\nthis exam. No main pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is mild thickening of the bilateral adrenal glands without\nfocal lesion.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is soft\ntissue asymmetry in the right rectal wall, measuring 4.4 x 3.5 x 3.4 cm,\nlikely known rectal mass. This lesion has significantly increased in\nconspicuity compared to ___. Also seen, and new from prior,\nimmediately above the ileocecal valve, is an area of cecal wall thickening\n(series 3; images 69-74), concerning for an additional area of malignancy. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not visualized. There is no large adnexal\nmass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to extensive\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 4.4 x 3.5 x 3.4 cm soft tissue asymmetry in the right colonic wall likely\nrepresents known rectal mass. Lesion is significantly increased in\nconspicuity compared to ___. No evidence metastatic disease in the\nabdomen or pelvis.\n2. Also new from prior, immediately above the ileocecal valve in the ascending\ncolon, is an area of cecal wall thickening, malignancy cannot be excluded.. \nIf this area of the colon was not visualized on recent colonoscopy, further\nevaluation is recommended.\n3. Unchanged 0.9 x 0.8 cm hypodensity in the pancreatic head, which is\nincompletely characterized on this exam, and may represent side branch IPMN. \nThis lesion can be followed on future oncology CT exams versus MRCP.\n4. Please see dictation from concurrent CT chest for intrathoracic findings." }, { "input": "LOWER CHEST: Re-demonstrated is a 2 mm pulmonary nodule in the posterior\naspect of the right lower lobe, stable in comparison to the CT abdomen pelvis\ndated ___. Visualized lung fields are within normal limits. There\nis no evidence of pleural or pericardial effusion. There is no hiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The previously identified hepatic\nlesion within hepatic segment II, previously characterized on MRI as FNH, is\nnot seen on the current exam. There is an area of focal fatty sparing\nadjacent to the falciform ligament. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Previously noted cystic\npancreatic lesions as identified on MRI dated ___ are not well seen\non this exam. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA focal hypodensity within the upper pole of the left kidney is too small to\ncharacterize but likely represents a simple renal cyst. There is no evidence\nof concern focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\ntransverse and sigmoid diverticula without evidence of wall thickening\nassociated fat stranding. The colon and rectum are otherwise within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is a tortuosity of the pelvic veins bilaterally with\nprominence of the ovarian veins bilaterally (601:36). There is no abdominal\naortic aneurysm. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are seen about the thoracolumbar spine. There\nis mild to moderate anterolisthesis of L4 on L5. There is mild retrolisthesis\nof T12 on L1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of hepatic abscess or concerning focal liver lesion. The\ngallbladder is within normal limits. There is no intrahepatic or extrahepatic\nbiliary dilatation.\n2. No evidence of small-bowel obstruction.\n3. There is a tortuosity of the pelvic veins bilaterally with prominence of\nthe ovarian veins bilaterally. Clinical correlation is recommended for pelvic\ncongestion syndrome.\n4. Re-demonstrated is a 2 mm pulmonary nodule in the posterior aspect of the\nright lower lobe, stable in comparison to the CT abdomen pelvis dated ___." }, { "input": "LOWER CHEST: A moderate right pleural effusion is increased in size since\n___. A small left pleural effusion is unchanged. There is\nbibasilar atelectasis. Ground-glass opacities in the anterior aspect of the\nright lower lobe anterior basal segment reflects either atelectasis or\ndeveloping infection. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenal glands appear uniformly thickened, unchanged.\n\nURINARY: The left kidney remains markedly atrophic. There is either a 3 mm\nposterior interpolar nonobstructing stone or prominent vascular calcification\n(series 2, image 31). No left hydronephrosis. Since ___, a right\npercutaneous nephrostomy tube has been removed. There is new moderate right\nhydronephrosis. A double-J ureteral stent is coiled within a distended right\nupper pole calyx proximally and within the urinary bladder distally. A right\nupper pole stone measures up to 1.7 cm. A second stone measuring up to 1.8 cm\nhas changed in position since ___, now located within the posterior\naspect of the renal pelvis (series 2, image 36). A previously seen fluid\ncollection anterior to the proximal right ureter has decreased in size, now\nmeasuring 2.7 x 2.1 cm and previously measuring 4.6 x 2.3 cm (series 2, image\n44).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal. There is small volume ascites.\n\nPELVIS: The urinary bladder is decompressed. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Foley catheter balloon is inflated within the prostate.\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nIrregularity of the right inferior pubic ramus reflects prior fracture,\nunchanged since ___. An L4 compression fracture is unchanged. \nLeft proximal femur surgical hardware is noted.\n\nSOFT TISSUES: Diffuse soft tissue edema is increased since ___,\nconsistent with anasarca. Few locules of subcutaneous emphysema in the\nlateral right abdominal wall presumably reflect recent removal of the\npre-existing percutaneous nephrostomy tube.", "output": "1. Interval removal of a right percutaneous nephrostomy tube, probably recent\ngiven locules of subcutaneous emphysema in the adjacent abdominal wall. There\nis new moderate right hydronephrosis. The right double-J ureteral stent\nappears appropriately positioned.\n2. A fluid collection adjacent to the proximal right ureter has decreased in\nsize since ___, now measuring up to 2.7 cm and previously measuring\nup to 4.6 cm.\n3. Bilateral nephrolithiasis with right-sided stones measuring 1.7 and 1.8 cm.\nThe 1.8 cm stone has changed in position since ___, now located in\nthe posterior aspect of the renal pelvis.\n4. Foley catheter balloon inflated within the prostate.\n5. Ground-glass opacities focally within the lateral basal segment of the\nright lower lobe probably reflects atelectasis, but difficult to exclude\ninfection in the appropriate clinical setting.\n6. Anasarca with an increased moderate right pleural effusion, small left\npleural effusion, small volume ascites, and diffuse soft tissue edema.\n7. Diverticulosis without diverticulitis.\n\nNOTIFICATION: Update of Foley catheter placement discussed with Dr. ___\nby Dr. ___." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: There is heterogeneous attenuation of the pancreas with moderate\nperipancreatic stranding. There is no peripancreatic fluid collection. There\nis no evidence of pancreatic duct dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is atrophic. Note is again made of right renal\ncalculi. Interpolar parenchyma calculus measuring 14 mm is unchanged. There\nis a 21 mm calculus in the lower calyx of the right kidney which may represent\nthe previously seen calculus in the right renal pelvis. Double-J stent is in\nplace. There is no hydronephrosis. There has been interval improvement of\nright renal pelvic dilatation. There is a persisting and slightly decreased\nsize of a fluid collection anterior to the proximal right ureter.\n\nThere is no evidence of retroperitoneal hemorrhage.\n\nGASTROINTESTINAL:\nThe stomach is unremarkable. Small bowel loops demonstrate normal caliber and\nwall thickness throughout.\nThere is extensive distal descending colon and sigmoid diverticulosis. There\nis thickening of the entire length of the sigmoid colon with minimal adjacent\nstranding which appears more prominent compared to the prior study. There is\nno extraluminal fluid collection or gas. There is no large bowel obstruction.\nThe appendix is normal.\n\nPELVIS: Urinary bladder is collapsed. A Foley catheter is in place however\nthe balloon is expanded within the prostatic urethra.\n\nThere is small amount of free fluid in the upper abdomen and pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic lesion in the left L5 pedicle and T11 vertebral body are unchanged\nand likely bone islands. Right hip fixation hardware is partially imaged and\nappears grossly intact. Multilevel degenerative changes are noted in the\nspine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of intra-abdominal hemorrhage.\n2. Mild thickening of the sigmoid colon on a background of extensive\ndiverticulosis may be due to luminal under distension but appears more\nprominent compared to the prior study and therefore mild uncomplicated\ndiverticulitis cannot be completely excluded.\n3. Moderate peripancreatic stranding is nonspecific but can be seen in the\ncontext of acute/subacute pancreatitis. Correlation with serum lipase is\nrecommended.\n4. Small volume ascites.\n5. The balloon of the Foley catheter is inflated within the prostatic urethra\nand repositioning is recommended." }, { "input": "LOWER CHEST: Partially imaged small to moderate left greater than right\nbilateral pleural effusions are new from prior exam. There is mild associated\ncompressive atelectasis at the bases bilaterally. Subpleural lung nodules in\nthe left lower lobe measuring up to 7 mm (6:9) are noted, similar to prior. \nAdditional metastatic lung lesion seen on the outside hospital CT scan are not\nimaged on the current study.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nTrace perihepatic ascites is similar to prior.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is trace perisplenic ascites.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral percutaneous nephrostomy tubes terminate in the collecting systems\nbilaterally in previously seen bilateral hydronephrosis has resolved. There\nis no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Mild hydroureter bilaterally extends the level of\nthe pelvic mass at which point the ureters are not well visualized and\npresumably obstructed.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Contrast opacifies the colon and extends to\nthe level of the rectum.\n\nNumerous large heterogeneously enhancing masses are seen in the abdomen and\npelvis. The largest is located in the pelvis between the rectum and the\nbladder and measures approximately 10.1 x 13.2 x 17.3 cm, increased from prior\nwhen it measured approximately 8.0 x 11.0 x 15.8 cm when measured in a similar\nmanner. Second large hypodense mass located in the left mid abdomen measures\napproximately 6.1 x 13.0 x 11.1 cm, previously 4.9 x 10.4 by 11.1 cm. This\nmass is centrally hypoenhancing, likely signifying central necrosis. New\nomental nodularity extends superior to this mass (06:22), likely representing\nmetastatic deposits.\n\nPELVIS: Bladder is decompressed and the large pelvic mass exerts significant\nmass effect on his posterior and superior aspects. Several engorged vessels\nare seen around the bladder. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post total abdominal hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES: Necrotic conglomerate aortocaval lymphadenopathy located\nposterior to the pancreatic head and splaying the aorta and IVC compressing\nthe IVC measures 5.2 x 4.9 cm, not significantly changed compared to prior. \nAn aortocaval node measures up to 11 mm (06:42) additional periaortic node\nmeasures up to 8 mm (06:40), both grossly stable from prior. Multiple small\nmesenteric nodes are not pathologically enlarged. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultiple small sclerotic lesions pelvis femurs bilaterally are unchanged from\nrecent prior and likely represent bone islands.\n\nSOFT TISSUES: Postsurgical changes noted along the anterior abdominal wall.", "output": "1. Slight interval increase in size of a large heterogeneously enhancing\npelvic mass measuring up to 17.3 cm.\n2. Slight interval increase in size of a centrally necrotic omental mass\nlocated in the left upper abdomen measuring up to 13.0 cm with new enhancing\nsolid nodules extending superiorly from this mass consistent with new\nperitoneal deposits.\n3. No significant change in necrotic conglomerate retroperitoneal\nlymphadenopathy.\n4. Interval placement of bilateral percutaneous nephrostomy tubes with\ninterval resolution of hydronephrosis.\n5. New small to moderate left greater than right-sided pleural effusions with\nassociated bibasilar atelectasis.\n6. Nodules in the left lung base better evaluated on recent CT torso,\npresumably metastatic." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral percutaneous nephrostomy tubes terminate within the\ncollecting system. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. No evidence of bowel obstruction. The\nappendix is not visualized.\n\nTwo large, heterogeneously enhancing masses are again seen. A heterogeneous,\ncentrally hypodense mass of the left mid abdomen measures approximately 8.4 x\n4.5 x 9.5 cm (5:79, 8:18), previously 13.0 x 6.1 x 11.1 cm. A heterogeneously\nenhancing pelvic mass, located between the bladder and the rectum, measures\napproximately 10 x 7.6 x 7.6 cm (5:101, 8:27), previously 16.2 x 11.0 x 10.3\ncm. No new masses are seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post total abdominal hysterectomy\nand bilateral salpingo oophorectomy.\n\nLYMPH NODES: A centrally hypodense, necrotic conglomerate of aortocaval\nlymphadenopathy posterior to the pancreatic head measures approximately 5.0 x\n4.3 x 5.6 cm (5:62, 8:19), previously 5.9 x 4.9 x 6.2 cm. Multiple other\nretroperitoneal nodes measure up to 8 mm, for example a prominent, unchanged\npara-aortic node (5:70). Multiple mesenteric nodes are not pathologically\nenlarged by CT size criteria. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Multiple sclerotic foci of the right femoral head, right iliac bone,\nand left inferior pubic ramus are unchanged from prior, likely bone islands. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes of the anterior abdominal wall.", "output": "1. Interval decrease in size of known, heterogeneously enhancing masses of the\nleft mid abdomen and of the pelvis. No new masses are seen.\n2. Mild interval decrease in size of a necrotic conglomerate of\nretroperitoneal lymphadenopathy. No new lymphadenopathy.\n3. Bilateral percutaneous nephrostomy tubes, with no evidence of\nhydronephrosis.\n4. Please refer to the separate report of the chest CT performed on the same\nday for thoracic characterization." }, { "input": "LOWER CHEST: The lung bases are clear. No pleural effusion.\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable.\n\nPANCREAS: The pancreas is within normal limits.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: There are stable hypodense lesions too small to characterize. No\nhydronephrosis demonstrated.\n\nGASTROINTESTINAL: No intestinal obstruction. There is worsening of ascites\nand worsening of carcinomatosis, for example there are new implants in the\nomentum, with a new measurable implant on the right measuring 2.1 cm on series\n4, image 62. The confluent carcinomatosis on the left side measures up to 5.7\ncm in maximal thickness, previously 4.1 cm. A large left lower quadrant\nimplant measures 7.8 cm, previously 4.7 cm. New subdiaphragmatic implants are\nalso present.\n\nPELVIS: The large pelvic mass concerning for the known tumor recurrence\nmeasures 14 cm, previously up to 9 cm.\n\nLYMPH NODES: The retroperitoneal adenopathy is improved, for instance an\ninteraortocaval lymph node now measures 2.7 cm, previously 3.7 cm. No\nenlarged pelvic lymph nodes are demonstrated.\n\nVascular: Multiple mildly enlarged gastroepiploic collaterals are again\ndemonstrated. The hepatic vasculature is patent.\n\nBONES: No aggressive osseous lesions identified.\n\nSOFT TISSUES: Post surgical changes status post midline laparotomy are again\ndemonstrated. The ascites and carcinomatosis extend into small ventral\nhernias in the anterior abdominal wall.", "output": "Despite mild decrease of retroperitoneal adenopathy, there has been marked\ninterval worsening of disease evidenced by new and enlarging carcinomatosis,\nworsening of ascites and enlargement of the large pelvic mass." }, { "input": "Intrathoracic findings are separately reported.\n\nCT ABDOMEN: The lack of intravenous contrast limits evaluation of the solid\norgans. The liver, gallbladder, pancreas, spleen and adrenal glands are\nnormal. A few punctate calcifications in the spleen likely reflect prior\ngranulomatous infection. The native kidneys are atrophic. There is a slightly\nhyperdense rounded lesion arising from the native left kidney measuring 1.4 x\n1.4 cm (2:71). Based on its density it is most likely a hyperdense cyst but a\nultrasound is recommended for further characterization. No hydronephrosis is\nseen.\n\nThere is no retroperitoneal or abdominal adenopathy. No free air or free fluid\nis present. The aorta is normal in caliber. The stomach and intra-abdominal\nloops of bowel are normal caliber. Scattered sigmoid diverticulae are noted\nwithout inflammatory changes. Minimal thickening of the sigmoid bowel wall is\nthought to be related to underdistention.\n\nCT PELVIS: The right iliac fossa renal transplant shows mild hydronephrosis\nand hydroureter to the level of a right inguinal hernia. A portion of the\nurinary bladder and the distal ureter of the right iliac fossa transplant\nextend into a moderate right inguinal hernia with apparent compression of the\nureter at its entry into the hernia (601b:32). There is no perinephric fluid\ncollection or stranding. The wall of the renal pelvis appears thickened which\ncould represent pyelitis.\n\nThe bladder is decompressed by a Foley catheter. There is no free pelvic\nfluid. There is no inguinal or pelvic adenopathy.\n\n OSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesion\nidentified.", "output": "1. Mild hydroureteronephrosis of the renal transplant to the level of a right\ninguinal hernia containing a portion of the urinary bladder and the transplant\nureter, which appears compressed at its entry into the hernia (601b:32).\nSuperimposed infection is not excluded but there is no perinephric stranding\nor fluid. The wall of the renal pelvis appears thickened which could represent\npyelitis.\n2. 1.4 cm hyperdense lesion arising from the atrophic left kidney may\nrepresent a proteinaceous/ hemorrhagic cyst. However, this lesion should be\nfurther characterized by renal ultrasound or MRI to exclude a solid mass.\n3. Sigmoid diverticulosis without evidence of diverticulitis.\n4. Intrathoracic findings are separately reported.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\ntelephone on ___ at 12:09 AM, 15 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: A small right lower lobe calcified granuloma is unchanged\n(Series 2, image 2). Visualized lung fields are otherwise within normal\nlimits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nAn approximately 2.1 cm right lower pole renal cortical hyperdense (50 ___,\nthin-walled lesion is new since ___ and could represent a cyst with\nhemorrhage or debris (series 2, image 37). No hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Contrast reaches the rectum. The colon is\ndistended with stool and air. No bowel obstruction. No drainable fluid\ncollection. No free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. An incidental lipoma in the right lower pelvis with\nmass effect on the bladder is similar to ___ (series 2, image 61).\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is moderate fat stranding or scarring in the soft tissue\naround the umbilicus (Se 2, im 51; se 602b, im 44), related to postsurgical\nchange. There is a small Richter's hernia in the right mid abdomen, just\nbelow the inferior border of the rectus (series 2, image 44; series 602b,\nimage 38). No evidence of bowel obstruction or incarceration. The abdominal\nand pelvic wall is within normal limits.", "output": "1. No bowel obstruction or drainable fluid collection.\n2. Small right mid abdomen richter's hernia; no evidence of complication.\n3. Cholelithiasis.\n4. 2.1-cm right lower renal pole cortical lesion that is hyperdense and could\nrepresent a cyst with hemorrhage or debris, new since ___. .\n\nRECOMMENDATION(S): To better evaluate the new renal hyperdense cyst, a renal\nultrasound on a non-emergent basis is recommended to further characterize the\nlesion, if not already done so" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A high attenuation\nright lower pole renal cyst is better evaluated on the prior study. There is\nno hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: A somewhat large incidental right pelvic sidewall lipoma has mass\neffect on the bladder and right adnexa, unchanged. Otherwise, the urinary\nbladder and distal ureters are unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild stranding or scarring in the periumbilical soft tissues is\nunchanged from ___. There is a small hernia through the linea\n___ immediately to the right of midline, which contains a small loop of colon\nwithout evidence of complication, unchanged.", "output": "1. A right pelvic lipoma has mild mass effect on the bladder and right adnexa,\nwhich is unchanged from multiple prior studies.\n2. Cholelithiasis without evidence of cholecystitis.\n3. Periumbilical soft tissue stranding is unchanged from multiple prior\nstudies.\n4. A high-attenuation right lower pole renal cyst is better evaluated on ___.\nOf note, no studies at this institution document a prior small bowel\nobstruction." }, { "input": "LOWER CHEST: There is minimal atelectasis at the right lung base. There is no\nevidence of pleural or pericardial effusion. The left atrium is enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular in contour, consistent with history of\ncirrhosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent. There is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged, measuring 14 cm. A subcentimeter\nsplenic hypodensity is incompletely characterized.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are punctate non-obstructing stones in the left kidney. There is no\nhydronephrosis. There is no perinephric abnormality. There are bilateral\nrenal cysts measuring up to 6.3 cm in the left lower pole. There is no\nevidence of urothelial lesions. The distal ureters and bladder are not well\nevaluated due to streak artifact from bilateral hip arthroplasties.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: Evaluation of the pelvis is limited secondary to streak artifact from\nbilateral hip arthroplasties. There is abnormal pelvic descent, not well\nevaluated on this study.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. The portal vein, splenic vein, and\nSMV are patent. Upper abdominal varices and a splenorenal shunt are similar\nto prior.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Patient is status post bilateral hip arthroplasty. There are\ndegenerative changes in the lumbar spine. There is diffuse osteopenia. There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Few punctate left non-obstructing renal stones. No obstructing renal\nstones.\n2. Cirrhosis with splenomegaly and upper abdominal varices. No ascites.\n3. Diverticulosis with no evidence of acute diverticulitis." }, { "input": "LOWER CHEST: There are trace bilateral pleural effusions, improved.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. Mild intrahepatic biliary ductal dilatation\nis unchanged. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass. An\nextraluminal fluid and gas containing collection along the proximal greater\ncurvature of the excluded stomach is moderately decreased in size with a small\namount of residual associated inflammation. The dominant portion of the\ncollection measures 3.3 x 1.0 cm (series 2, image 17) (previously 3.7 x 1.7\ncm). No oral contrast is seen in the proximal excluded loop. The small bowel\nsmall bowel anastomosis in the left upper quadrant is unremarkable. The\nappendix is filled with inspissated contrast.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: Prominent retroperitoneal lymph nodes do not meet CT size\ncriteria for lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in the perigastric extraluminal fluid collection.\n2. The patient is status post Roux-en-Y gastric bypass. No oral contrast is\nseen in the excluded stomach." }, { "input": "LOWER CHEST: Coronary artery calcifications are unchanged. Visualized lung\nfields are within normal limits, with interval resolution of pleural\neffusions. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass and\nendoscopic GG fistula intervention. There is filling of the previously\nexcluded stomach. The remaining stomach empties well. The previously noted\nfluid collection along the proximal greater curvature of the excluded stomach\nhas resolved. The small bowel small bowel anastomosis in the left upper\nquadrant is unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is large bowel dilatation,\nsimilar to prior study. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is narrowing of disc space at level L3-4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The previously-seen perigastric extraluminal fluid collection has resolved.\n2. The patient is status post GG fistula intervention, with incomplete closure\nas evidenced by filling of contrast throughout the excluded and non excluded\nstomach." }, { "input": "LOWER CHEST: There is minimal dependent atelectasis. There is no evidence of\npleural pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is minimal intrahepatic and\nextrahepatic biliary dilation, likely secondary to cholecystectomy. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Status post gastric bypass procedure. Small bowel\nanastomosis noted in the left upper quadrant. There is no evidence of\nobstruction. Oral contrast is seen to the level of the descending colon. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. Appendix normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There are no adnexal\nabnormalities.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process." }, { "input": "LOWER CHEST: The heart is normal in size. There are calcifications of the\nleft circumflex artery. There also mild aortic valvular calcifications. \nThere is no pericardial effusion. There are small bilateral pleural\neffusions, left greater than right, with associated compressive atelectasis,\nincreased compared to the prior CT from ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary ductal dilatation. The common bile duct is top normal in caliber,\nmeasuring up to 7 mm, with smooth distal tapering. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass. There\nis a 3.7 x 1.7 cm x 2.7 cm collection containing gas and fluid abutting the\nposterior margin of the excluded stomach (series 5, image 16), mildly\nincreased and size compared to the prior CT from ___ and\npreviously 2.9 cm x 1.5 cm x 2.1 cm, concerning for a leak, with worsened\nadjacent mild inflammatory changes and stranding. . Additionally,\nimmediately posterior to the back margin of the staple line, there is similar\nvolume of extraluminal air and small volume of contrast series 5, image 16,\nlargest pocket measuring 1.9 cm, compared with 1.5 cm on prior There is no\noral contrast within the pancreaticobiliary limb. There is some enteric\ncontrast in the distal stomach, lower in volume compared to prior.\n\nThere is mild ___ dilatation of the jejunojejunostomy. Small\nbowel loops otherwise demonstrate normal caliber, wall thickness, and\nenhancement throughout.\n\nThere is mild diffuse distention of the colon with gradual dilution of oral\ncontrast and air-fluid levels, suggestive of mild colonic ileus. The rectum\nis within normal limits.\n\nPERITONEUM: There is overall improvement of previously seen postoperative\npneumoperitoneum, with a few foci of residual extraluminal gas and fluid in\nthe region the gastric fundus.\n\nPELVIS: The bladder is distended with fluid. There are bilateral jets of\ncontrast from the distal ureters. There is a small amount of free fluid in\nthe cul-de-sac.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild multilevel endplate degenerative changes, as well as bilateral\nfacet arthropathy of the lower lumbar spine.\n\nSOFT TISSUES: There are incisional changes of the midline anterior abdominal\nwall.", "output": "1. Postsurgical changes of Roux-en-Y gastric bypass. 3.7 x 1.7 cm collection\ncontaining gas and fluid abutting the posterior margin of the excluded\nstomach, has increased in size, with more prominent adjacent mild inflammatory\nchanges in stranding. Few additional smaller foci of extraluminal air and\nfluid, tiny area of contrast is mildly increased.\n2. Overall improvement of previously seen pneumoperitoneum.\n3. Mild diffuse distention of the colon with gradual dilution of oral contrast\nand air-fluid levels, suggestive of mild colonic ileus.\n4. Small bilateral pleural effusions, left greater than right, have increased." }, { "input": "LOWER CHEST: Please see chest CT report from same day for chest findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There has been interval enlargement of the 2 dominant\nmetastatic lesions in the right lobe of the liver measuring up to 2.8 cm. On\ntoday's examination there additionally 4 new metastatic lesions within the\nright lobe consistent with progression of disease. There is cholelithiasis\nwithout evidence of acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Enhancing soft tissue within the right renal pelvis highly concerning\nfor transitional cell carcinoma has slightly increased in size compared to\nprior examination, currently measuring approximately 3.3 x 3 cm, previously\nmeasuring 3 x 2.6 cm. No hydronephrosis is noted. Hemorrhagic cyst extending\nfrom the lower pole the right kidney has decreased in size from prior\nexamination. The left kidney is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nextensive diverticulosis without evidence of acute diverticulitis. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 3.9 cm cystic lesion in the right adnexal with\na clip/ calcification. 2 clips/ calcification are noted in the left adnexa. \n.\n\nLYMPH NODES: Small interaortocaval lymph nodes are noted however no\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is an 8 mm splenic artery aneurysm.\n\nBONES: Multilevel degenerative changes of the spine are noted. There are\nmultiple vertebral body hemangiomas.\n\nSOFT TISSUES: There is a sacral decubitus ulcer.", "output": "1. There has been interval increase in size of metastatic liver lesions with\nmultiple new liver lesions consistent with progression of metastatic disease.\n2. Enhancing soft tissue in the right renal pelvis has slightly increased in\nsize for from prior examination concerning for transitional cell carcinoma.\n3. Cholelithiasis without evidence of acute cholecystitis.\n4. Sacral decubitus ulcer appears unchanged from prior." }, { "input": "Chest findings are reported separately.\nA 8 mm hypodense focus in the mid to lower pole of the right kidney is too\nsmall to characterize, but unchanged. No focal liver lesions are identified.\nThe pancreas, spleen and adrenal glands appear within normal limits. The\ngallbladder is decompressed.\nThe stomach, small and large bowel appear within normal limits.\nUterus, adnexa, and bladder are unremarkable. Major mesenteric arteries and\nveins appear patent. There is no lymphadenopathy or ascites.\nModerate degenerative changes affect lower lumbar facet joints. There are no\nsuspicious lytic or blastic bone lesions. Sclerotic change about the pubic\nsymphysis is likely degenerative and unchanged.", "output": "No evidence for malignant involvement of the abdomen or pelvis." }, { "input": "LOWER CHEST: Please refer to the dedicated CT chest exam performed on the same\nday for a description of the thoracic findings including left-sided pulmonary\nmasses/metastases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nfocal hepatic lesion. No intrahepatic or extrahepatic biliary ductal\ndilatation. The gallbladder is decompressed and normal without calcified\ngallstones. No ascites. The main portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions, pancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout, without any\nfocal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nA 7-mm right renal cortical midpole lesion too small to definitively\ncharacterize on CT is unchanged since ___ and likely a cyst with\nhemorrhage/debris (Se 5, Im 67). No evidence of a concerning focal renal\nlesion, hydronephrosis, or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. No bowel obstruction or intra-abdominal\nfluid collection. No free air.\n\nPELVIS: The partially filled urinary bladder and distal ureters are\nunremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No calcified atherosclerotic disease\nis noted.\n\nBONES: No suspicious lytic or sclerotic osseous lesion. Mild retrolisthesis\nof L2 on L3 and mild anterolisthesis of L4-L5 are unchanged. Sclerotic,\nprobable degenerative changes of the S1 vertebral body are also unchanged. \nModerate degenerative changes are noted throughout the thoracic, lumbar, and\nsacral spine with loss of intervertebral disc height and vacuum phenomenon as\nwell as osteophytes, unchanged. Vertebral body heights are preserved. \nSclerotic changes in the pubic symphysis are also likely degenerative and also\nunchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence of metastatic disease in the abdomen or pelvis.\n\n2. Please refer to the dedicated chest CT report from the same day for above\nthe diaphragm findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis is\nnoted in the colon. Otherwise, the colon and rectum are within normal limits.\nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no\nevidence of adnexal abnormality bilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 retrolisthesis of L2 - L3 and grade 1 anterolisthesis of L4 -\nL5 vertebral levels (series 9, image 42).\n\nSOFT TISSUES: A left breast implant is identified. Patient is status post\nleft mastectomy.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Please refer to same day CT chest report for full detail of intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. A left breast implant is\nidentified. The patient has had prior right mastectomy.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAn 1-cm intermediate density lesion arising from the right mid pole renal\ncortex is too small to accurately characterize on CT but is unchanged since at\nleast ___, most likely a cyst with debris (series 12, image 32). No\nconcerning focal renal lesions. No hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. No bowel obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: An 8-mm portal caval lymph node is overall similar to ___\n(series 5, image 58). No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is noted.\n\nBONES: No osseous lesions concerning for malignancy or infection. No acute\nfracture. Mild anterolisthesis of L4 on L5 is unchanged. Mild retrolisthesis\nof L2 on L3 is also unchanged. There may be an intraosseous hemangioma at L1\n(series 9, image 38; series 12, image 25).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of metastasis in the abdomen or pelvis." }, { "input": "LOWER CHEST: There is a 0.6 cm left lower lobe nodule (___), not seen on\nmultiple prior studies but unchanged compared to ___. There is\nmild right lower lobe bronchiectasis. Otherwise, visualized lung fields are\nwithin normal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post left hepatectomy. The remaining\nliver is nodular and shrunken, consistent with cirrhosis. Compared to ___ (the most recent abdominal CTA), interval increase in size of a\n3.9 x 3.6 cm arterial hyperenhancing caudate lobe lesion with washout (___),\nconsistent with hepatocellular carcinoma. There are multiple new smaller\nhyperenhancing lesions, which also demonstrate washout and are concerning for\nhepatocellular carcinoma (for example, a 0.8 cm segment VI lesion (___), a\n1.1 x 1.1 cm segment ___ lesion (___) and a 0.6 cm segment VI lesion (___). \nAgain seen is mild intrahepatic biliary ductal dilatation. No extrahepatic\nbiliary dilatation. The gallbladder contains gallstones without wall\nthickening or surrounding inflammation. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring 14.0 cm in craniocaudal dimension. \nAgain seen are multiple large areas of non enhancement of the splenic\nparenchyma, consistent with splenic infarcts, possibly related to prior\nembolizations.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again seen is an unchanged 1.8 x 1.8 cm arterial hyper enhancing\nlesion in lower pole of the right kidney (___) and an unchanged 1.8 x 1.7 cm\nintermediate density lesion in the midpole of the left kidney (___). As\nbefore, these lesions are concerning for renal cell carcinoma. The kidneys\nare of normal and symmetric size with normal nephrogram. No hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Moderate hiatal hernia with a patulous esophagus. \nOtherwise, the stomach is unremarkable. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Diverticulosis of the\nsigmoid colon is noted, without evidence of wall thickening and fat stranding.\nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: As before, the endometrial cavity is distended with\nfluid, measuring up to 1.9 cm in transverse diameter, previously 2.2 cm.\n\nLYMPH NODES: There are a few prominent, though nonenlarged, retroperitoneal\nand bilateral inguinal lymph nodes. There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Multiple collateral vessels are again noted within the perisplenic\nand anterior abdominal regions. There is an unchanged completely thrombosed\nsplenic artery aneurysm, measuring up to 3.4 cm. Splenic artery stent appears\npatent. Embolization coils are again noted at the splenic hilum. Extensive\nesophageal varices are again noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Compared to the most recent abdominal CTA, ___, interval\nincrease in size of a 3.9 x 3.6 cm arterial hyperenhancing caudate lobe lesion\nwith washout, consistent with hepatocellular carcinoma.\n2. There are multiple new smaller hyperenhancing lesions which also\ndemonstrate washout and are concerning for hepatocellular carcinoma.\n3. Unchanged 1.8 by 1.8 right renal lower pole lesion and unchanged 1.8 x 1.7\ncm intermediate density left renal midpole lesion, again suspicious for renal\ncell carcinoma.\n4. Cirrhotic liver with sequelae of portal hypertension, including\nsplenomegaly and esophageal and abdominal varices. No ascites.\n5. Stable thrombosed splenic artery aneurysm with patent splenic artery stent\nand unchanged splenic infarcts." }, { "input": "Lungs: An unchanged 6 mm left lower lobe nodule is seen, stable since ___. There is right lower lobe bronchiectasis. No pleural effusions are\nseen.\n\nLiver: The patient has a history of previous liver resection in ___ in ___.\nThere is again cirrhotic appearance of the liver, with nodular contour with\nesophageal varices.\n\nThere has been interval growth of the known hepatocellular carcinoma (HCC) in\nthe caudate lobe, measuring 8.9 cm x 5.8 cm, previously 3.6 cm x 3.9 cm. It\nabuts the right adrenal gland. Interval growth of multiple satellite lesions.\nFor example, two lesions posterior to the dominant lesion measures 2.4 cm and\n1.4 cm, previously 0.6 cm and 0.8 cm.\n\nAt least 10 new lesions are seen throughout the liver, measuring up to 2.1 cm\nin diameter.\n\nBiliary: There is mild intrahepatic bile duct dilatation at the dome. There\nis moderate intrahepatic bile duct dilatation along the medial edge of the\nliver. New areas of mild intrahepatic bile duct dilatation are seen\nthroughout the liver. The common bile duct measures up to 1.5 cm and is\ndilated. The gallbladder contains small gallstones.\n\nSpleen: There are splenic infarcts as before. This spleen again enlarged.\n\nPancreas: The pancreas is atrophic. No pancreatic duct dilatation is seen.\n\nAdrenal glands: The right adrenal gland abuts the dominant liver lesion. The\nleft adrenal gland is unremarkable.\n\nUrinary: The solid mass in the anterior aspect of the midpole of the right\nkidney measures 2.0 cm in diameter, previously 1.8 cm in diameter. The solid\nmass in the posterior aspect of the midpole of the left kidney measures 2.3 cm\nin diameter, previously 1.8 cm. No hydronephrosis.\n\nGastrointestinal: A moderate hiatal hernia is seen. The bowel is within\nnormal limits. There is no evidence of obstruction.\n\nVascular: There is mild atherosclerotic calcifications of the abdominal aorta.\nAt least 2 renal arteries are seen bilaterally. There is a replaced right\nhepatic artery. The right portal vein and right and central hepatic veins are\npatent. Splenic artery aneurysm coils are seen. Collateral vessels are seen\nsurrounding the inferior mesenteric artery.\n\nLymph nodes: No size significant lymph nodes are seen.\n\nBone and soft tissues: No suspicious bone lesion is seen. Mild degenerative\nchanges of the lumbar spine are seen. Mild levocurvature of the lumbar spine.", "output": "1. Increase in size of the mass in the caudate lobe of the liver, with growth\nof multiple satellite hepatic lesions, as well as new hepatic lesions,\nconsistent with multifocal HCC. There are associated new areas of mild\nintrahepatic bile duct dilatation. The portal and hepatic veins are patent.\n\n2. Bilateral renal solid masses are again seen, minimally enlarged compared to\nthe previous examination, likely renal cell carcinoma.\n\n3. Cholelithiasis, with no evidence of cholecystitis." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. Aorto-bifemoral grafts are\nre-visualized and appear unchanged compared to previous imaging. The native\naorta remains somewhat opacified, and demonstrates extensive calcific\natherosclerotic disease.\n\nLOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Coronary calcifications are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY:\nRedemonstrated hemangioma in segment 6 of the liver appears stable compared to\nprior exams and measures 1.2 x 0.9 cm (series 3a, image 37.) The liver\notherwise has homogenous attenuation throughout. A large calcified gallstone\nis seen in the gallbladder. There is no evidence of focal lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS:\nThe known hyper-enhancing neuroendocrine tumor on the pancreatic tail appears\nminimally decreased in size compared to prior exams, measuring 5.1 x 3.6 cm\n(series 3b, image 112), with multiple fiducials again visualized. There is no\nevidence of pancreatic ductal dilatation or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY:\nMultiple subcentimeter bilateral simple appearing cysts are again visualized,\nthe largest measuring 9 x 9 mm. The kidneys are of normal and symmetric size\nwith normal nephrogram. There is no evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is moderately distended with food. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder appears markedly distended. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with a hyperdense or enhancing\nlesion within the right prostatic apex, unchanged from prior exam. \nCorrelation is recommended with physical exam and PSA as clinically indicated.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Minimal decrease in size of known neuroendocrine tumor on the pancreatic\ntail, measuring 5.1 x 3.6 cm on current exam compared with previously measured\n5.2 x 4.1 cm. No evidence of metastatic disease in the abdomen or pelvis.\n2. Previously noted hyperdense or enhancing lesion within the right prostatic\napex. Correlation is recommended with physical exam and PSA as clinically\nindicated.\n3. Redemonstrated aorto-bifemoral grafts with preserved patency.\n4. Incidental findings, as described above." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Coronary artery calcifications\nare noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is an approximately 7 mm hilar accessory\nspleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is mild bilateral\nperinephric stranding, right greater than left, which is nonspecific on this\nnoncontrast exam.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. A 1.2 x 1.8 cm right\nadnexal cyst appears simple. Left adnexa appears within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diverticulosis without evidence of surrounding inflammation or colonic wall\nthickening to suggest diverticulitis. No intra-abdominal collection.\n2. A 1.2 cm x 1.8 right adnexal cyst. If patient is postmenopausal, recommend\nfollow-up pelvic ultrasound in ___ year.\n3. Asymmetric right-sided perinephric stranding. Correlation with urinalysis\nsuggested as pyelonephritis would be possible.\n\nRECOMMENDATION(S): If patient is postmenopausal, recommend ___ year follow-up\npelvic ultrasound to reassess 1.2 cm right adnexal cyst." }, { "input": "Heart size is normal without significant pericardial fluid. There is trace\nbibasilar atelectasis. The imaged lung bases are otherwise clear.\n\nCT abdomen without contrast: The liver is diffusely hypo attenuating\ncompatible with steatosis. Gallbladder, spleen, adrenal glands and pancreas\nare grossly unremarkable given limits of a noncontrast examination. There is\na 21 mm right interpolar simple renal cyst. Kidneys are otherwise grossly\nunremarkable without stone or hydronephrosis.\n\nStomach, duodenum and small bowel loops are grossly unremarkable without\nevidence of obstruction.\n\nThere is an abnormal appearance of the appendix, dilated to a maximum of 3.0\ncm (601b:51). In additional, there is dense masslike area in this region. \nThere is prominent surrounding fat stranding. Stranding abuts the right\ncommon iliac artery. Several areas of ill-defined nodularity are seen\nthroughout the peritoneum adjacent to the ascending, transverse and descending\ncolon as well as an ill-defined soft tissue mass centered at the tail of the\npancreas, abutting the splenic inferior pole measuring 3.5 x 3.3 cm.\n\nThe abdominal aorta is normal in caliber. There is no retroperitoneal\nlymphadenopathy. There is no ascites or pneumoperitoneum. There is a small\nfat containing umbilical hernia.\n\nCT pelvis without contrast: The bladder, prostate and rectum are grossly\nunremarkable. There is no free pelvic fluid or air. There is no inguinal or\npelvic sidewall lymphadenopathy by CT size criteria.\n\nBones and soft tissues: There is no suspicious focal bone lesion.", "output": "1. Focal dilatation of the appendix up to 3 cm with nodular soft tissue\ncomponent, prominent surrounding phlegmonous change and fat stranding\nrepresenting either ruptured appendicitis or appendiceal neoplasm.\n2. Multiple soft tissue deposits along the greater omentum are concerning for\nneoplastic deposits.\n3. Dense soft tissue mass centered at the tail of the pancreas and inseparable\nfrom the inferior spleen may reflect metastasis or primary neoplasm.\n4. Hepatic steatosis." }, { "input": "LOWER CHEST: A left lower lobe subpleural nodule is unchanged ___. \nMild bibasilar atelectasis is also noted. The imaged portion of the heart is\nunremarkable. A small lymph node at the cardiophrenic recess appears\nunchanged, series 2, image 12. No pleural effusion.\n\nABDOMEN:\n\nSubtle hypodensity of the a patent parenchyma is consistent with steatosis. \nNo discrete liver lesion is seen on this unenhanced exam. The gallbladder\nappears unremarkable. The spleen is surgically absent. Adrenals are normal\nbilaterally. Patient is status post distal pancreatectomy. The remainder of\nthe pancreas appears unremarkable though poorly assessed in the absence of IV\ncontrast. Kidneys appear unremarkable without stones or hydronephrosis. A\nhypodensity in the interpolar right kidney most likely represents a cyst\nbetter assessed on prior MR abdomen.\n\nThe stomach is decompressed. The duodenum appears normal. The abdominal\naorta is normal in course and caliber without significant atherosclerosis.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. \nSuture material is noted in the right lower quadrant reflecting prior bowel\nresection. Small volume loculated ascites is similar as seen previously and\noverall pattern of peritoneal thickening appears unchanged. The colon\ncontains a mild fecal load. No free air is seen. Urinary bladder is\ndecompressed. No pelvic sidewall or inguinal adenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Limited exam in the absence of IV contrast.\nNo bowel obstruction. Small volume loculated ascites again noted in the\nsetting of known peritoneal carcinomatosis. Overall appearance appears\nsimilar to the prior CT exam." }, { "input": "LOWER CHEST: There is mild dependent atelectasis. There is a 3 mm pulmonary\nnodule at the right lung base, stable. There are small bilateral\nnonhemorrhagic pleural effusions. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is slightly distended and contains a probable\ngallstone, without evidence of gallbladder wall thickening or pericholecystic\nfluid to indicate acute cholecystitis.\n\nPANCREAS: Patient is status post distal pancreatectomy. Previously seen\nhypoenhancing lesion adjacent to the pancreatic neck is better evaluated on\nrecent MRI.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Again seen is a 2.5 cm\nsimple cyst arising from the right upper pole. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Suture material is again seen\nin the right lower quadrant reflecting prior bowel resection. The colon and\nrectum contain fluid, without evidence of wall thickening. The appendix is\nnot visualized. Again seen are multiple omental/peritoneal nodules, not\nsignificantly changed compared with recent MRI. Tethering of bowel loops in\nthe right lower quadrant likely reflect peritoneal deposits (05:24). There is\nseptated ascites surrounding bowel loops, similar to prior. Fascial\nthickening in the lower mid abdomen is similar to prior.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Evaluation for infection is limited without IV contrast.\n2. The colon and rectum are filled with fluid, consistent with history of\ndiarrhea, without evidence of colonic wall thickening.\n3. Cholelithiasis, with no evidence of acute cholecystitis.\n4. Peritoneal metastatic disease and septated ascites are better evaluated on\nrecent MRI, however do not appear significantly changed.\n5. Small bilateral pleural effusions." }, { "input": "LOWER CHEST: Chronic appearing lower left rib fractures. Please refer to\nseparate report of CT chest performed on the same day for description of the\nthoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Accessory spleen adjacent to the hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple areas of cortical scarring throughout the right kidney. \nThere is a small exophytic simple cyst arising from the lower pole on the\nright. The left kidney is unremarkable in appearance. There is no evidence\nof suspicious renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is mild circumferential bladder wall thickening with increased\nurothelial enhancement, which should be correlated with urinalysis for signs\nof infection. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable in appearance. No adnexal\nmasses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Partially imaged catheters seen coursing through the right upper\nhemi-abdomen anterior to the liver. The abdominal and pelvic wall is within\nnormal limits.", "output": "1. Mild circumferential bladder wall thickening with increased urothelial\nenhancement, which should be correlated with urinalysis for signs of\ninfection.\n2. No other acute findings within the abdomen or pelvis.\n3. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nhypodensity in hepatic segment VIII measures 1.3 x 1.5 cm, previously 1.5 x\n1.4 cm, grossly unchanged (05:45, 8: 38). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.3 cm hypodensity in the left lower pole measures a indeterminate density,\nand may be a proteinaceous or hemorrhagic cyst. This is unchanged. Multiple\nother hypodensities scattered throughout both kidneys are too small to\ncharacterize, but most likely represent cysts and are unchanged. There are\nextrarenal pelvises noted bilaterally. There is no hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: Peritoneal deposits are again noted throughout the abdomen,\nprimarily in the right and left lower abdomen. A reference nodule in the\nright lower abdomen measures 2.1 x 3.0 cm, previously 2.9 x 5.3 cm and has\ndecreased in size (5:97). A second nodule adjacent to the ascending colon\nmeasures 1.5 cm, previously 1.8 cm (5:89). A nodule adjacent to the\ndescending colon now measures 1.4 cm, previously 1.5 cm (5:81). Overall the\nperitoneal deposits are decreased in size. There is a small hiatal hernia. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is diverticulosis without wall thickening or pericolonic\nfat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder wall is thickened with some perivesicular\nstranding and relative hyper enhancement of the mucosa (8:30). The left side\nof the bladder wall may be asymmetrically thickened (5:110). These are new\nfindings compared to prior. A 1.2 cm diverticulum from the right superior\nbladder is unchanged. There is no free fluid in the pelvis. A pessary device\nis noted.\n\nREPRODUCTIVE ORGANS: A hypoattenuating, expansile mass is again seen in the\nendometrium and measures up to 4.6 x 3.9 cm, previously 4.5 cm in appears\nsimilar to prior. The adnexae are unremarkable.\n\nLYMPH NODES: A left inguinal lymph node measures 1.8 x 1.9 cm, previously 1.6\nx 1.9 cm (5:122 closed a right inguinal lymph node measures 1.4 x 2.2 cm, and\nwas not prevously imaged (5:128). There is no pelvic or retroperitoneal\nlymphadenopathy. There is no mesenteric lymphadenopathy. As previously\nmentioned, there are multiple peritoneal implants.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are moderate with grade 1\nanterolisthesis of L5 on S1. There also bilateral moderate to severe\ndegenerative changes of the femoroacetabular joints.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Interval decrease in the size of multiple peritoneal implants as described\nabove.\n2. Enlarged left inguinal lymph node and enlarged right inguinal lymph node,\nplease note that this area was previously not imaged.\n3. Unchanged hypoattenuating mass in the uterus.\n4. Stable hypoattenuating lesion in the right hepatic dome is indeterminate.\n5. The bladder wall appears thickened and irregular with perivesical\nstranding. There may be asymmetric thickening on the left. These findings\nare consistent with cystitis in the correct clinical setting, please note that\ntumor involvement cannot be entirely excluded but is thought to be less likely\ndue to improvement of overall tumor burden." }, { "input": "LOWER CHEST: Sub 3 mm nodule in the right lung base (5: 5) is new since the\nprior examination. 3 mm subpleural nodules (5: 6, 8) are unchanged. Attention\non follow up is recommended. Punctate granuloma in the right lung base (05:12)\nis stable. There is minimal dependent atelectasis. There is a filling defect\nin the left lower lobe pulmonary arterial segmental branch, which is likely a\npulmonary embolus, however incompletely imaged. Recommend a dedicated PE\nstudy for further evaluation. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. The\nhypodensity in hepatic segment VII again measures 1.2 x 1.5 cm, grossly\nunchanged (05:11, 07:37). No additional lesions are identified. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\ncontains gallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Re-demonstrated is an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nA 1.5 cm hypodensity in the left lower pole previously measured 1.3 cm and is\nlikely a simple renal cyst. A 0.7 cm hypodensity in the lower pole of the\nright kidney is too small to characterize, but statistically this is likely to\nbe a cyst. Additional bilateral hypodensities scattered throughout the\nkidneys are too small to characterize. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Peritoneal deposits are again noted throughout the abdomen,\nparticularly in right lower quadrant. The largest conglomerate measures 2.3 x\n3.3 cm, previously 2.1 x 3.0 cm (5:65), which is slightly increased in size\nsince the prior exam. A second right lower quadrant nodule measures 3.2 x 2.0\ncm, previously 1.6 x 1.2 cm (5:61). An additional nodule adjacent to the\nascending colon measures 1.7 cm, previously 1.5 cm (05:26). A nodule adjacent\nto the descending colon now measures 0.9 cm, previously 1.4 cm (05:49). A\nleft upper quadrant nodule measures 3.2 cm, previously 2.7 cm (05:45). An\nadditional left upper quadrant nodule measures 1.2 cm (05:57), previously 0.9\ncm.\n\nA small hiatal hernia is again noted. Re-demonstrated is diverticulosis\nwithout wall thickening or pericolonic fat stranding. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. A \ndiverticulum off the right superior bladder is unchanged. There is no free\nfluid in the pelvis. A pessary device is noted.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and there is re-demonstration of a\nhypoattenuating, hypodense mass within the endometrium/uterus (5:66). The\nadnexa are unremarkable.\n\nLYMPH NODES: A partially imaged left inguinal node measures 1.3 x 1.6 cm,\npreviously 1.8 x 1.9 cm (5:93). A new 0.8 cm perirectal soft tissue mass is\nnoted (5:70), which could be a new lymph node or a peritoneal deposit. \nAttention on follow-up is recommended.\n\nVASCULAR: The aorta is tortuous. There is no abdominal aortic aneurysm.\nModerate abdominal aortic atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPunctate focus of sclerosis in the right femoral head is unchanged and\ncompatible with a bone island. Degenerative changes in the thoracolumbar\nspine with mild anterolisthesis of L5 on S1.\n\nSOFT TISSUES: Small fat containing umbilical hernia is unchanged.", "output": "1. Filling defect in the left lower lobe pulmonary arterial segmental branch,\nconcerning for a pulmonary embolus-partially imaged. Recommend dedicated PE\nstudy for further evaluation.\n2. Overall interval increase in size of peritoneal implants, as described\nabove.\n3. Stable indeterminate hypoattenuating lesion at the right hepatic dome.\n\nRECOMMENDATION(S): Recommend dedicated PE study for further evaluation of\nleft lower lobe pulmonary arterial filling defect.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:18 pm, 15 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: There is subsegmental atelectasis in the left lower lobe.. There\nis no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 6\nmm hypodensity in segment VII (series 4:14) as well as two 4 mm hypodensities\nin the dome of the liver are too small to characterize but statistically\nlikely represents cysts or biliary hamartomas. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended and filled with debris. There is a\nprobable small duodenal diverticulum (series 4:30). Small bowel loops are\notherwise unremarkable. There is significant colonic fecal loading. The\ncolon and rectum are otherwise unremarkable.The appendix is not visualized but\nthere is no secondary sign of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing hernia in the right groin which\nprojects lateral to the pubic tubercle likely representing a femoral hernia.", "output": "1. There is a probable fat containing right femoral hernia. Given the mild\ncompression of the right femoral vein and the fact of the hernia is lateral to\nthe pubic tubercle, this hernia is likely femoral rather than inguinal.\n2. Significant colonic fecal loading." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: No focal hepatic lesion is seen within limitations of this\nnoncontrast study. Findings consistent situs ambiguous are again seen. A CBD\nstent is in unchanged position from the prior study. The gallbladder is\nsignificantly decompressed in comparison to the most recent examination, and\ncontains several gallstones. There is probably unchanged mild intrahepatic\nbiliary ductal dilatation.\n\nPANCREAS: The midline pancreas is without evidence of focal lesion. There is\nno main pancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The right upper quadrant spleen and a large splenule are unchanged. \nA 1.0 cm calcified splenic aneurysm is again seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are normal in size. Multiple sub cm renal hypodensities\nlikely represent benign renal cysts. A retroaortic renal vein is again seen\non the left.\n\nGASTROINTESTINAL: The right-sided stomach is otherwise unremarkable. Findings\nconsistent with intestinal malrotation are unchanged. There is no evidence of\nobstruction. There is colonic diverticulosis without evidence of\ndiverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. Azygos continuation of the IVC is unchanged.\n\nBONES: Grade 1 retrolisthesis of L1 on L2 is unchanged. There is multilevel\nmild loss of vertebral body height at T10-T12.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decompression of the gallbladder containing gallstones without\ndefinite wall thickening or adjacent stranding.\n2. Redemonstrated situs ambiguous.\n3. Unchanged CBD stent with interval loss of intrahepatic pneumobilia, which\nsometimes can be seen in the setting of stent occlusion. Clinical correlation\nis recommended." }, { "input": "LOWER CHEST: There is a trace right pleural effusion with some associated\ncompressive atelectasis. Mild atelectasis at the left lung base. No\npericardial effusion. A 3.0 cm lesion is noted in the right breast,\ncorrelation with prior mammography is recommended.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small amount of simple perisplenic\nfluid, new from prior.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Bilateral renal hypodensities measuring up to 13 mm\nin the lower pole left kidney likely reflect simple cysts, incompletely\nassessed on the current exam.\n\nGASTROINTESTINAL: There is a small hiatal hernia. No evidence of small-bowel\nobstruction. The colon and rectum are unremarkable. The appendix is normal.\n\nPELVIS AND REPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus, larger\nin comparison to ___. Several of these fibroids have a cystic\ncomponent suggesting a degree of degeneration. There is a large peripherally\ncalcified fibroid extending from the rightward aspect of the uterus measuring\n7.8 x 5.4 x 5.7 cm. There is large volume complex pelvic fluid distributed\nevenly throughout the pelvic cavity. The endometrial stripe measures 7 mm. \nThere are prominent gonadal veins bilaterally, similar to prior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Sclerosis about the right greater than left sacroiliac joint is similar\nfrom prior.\n\nSOFT TISSUES: There is mild thickening about a fat containing umbilical\nhernia.", "output": "1. Non-specific complex ascites predominantly within the pelvis as described\nabove.\nNew trace right pleural effusion, new from prior.\n2. Substantially enlarged fibroid uterus, larger in comparison to ___. Many of the fibroids are undergoing cystic degeneration.\n3. Prominent gonadal veins, similar to prior.\n4. Normal appendix.\n5. A 3.0 cm lesion in the right breast, correlation with prior mammography is\nrecommended. If no prior study has been performed, further evaluation is\nrecommended with mammography and/or ultrasound.\n\nRECOMMENDATION(S): A 3.0 cm lesion in the right breast, correlation with\nprior mammography is recommended. If no prior study has been performed,\nfurther evaluation is recommended with mammography and/or ultrasound." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Again seen is diffuse mild\nintrahepatic biliary ductal dilatation with increased amount of pneumobilia\ncompared to most immediate prior exam on ___. patient status post 2\ncommon bile duct stents across the hepaticojejunostomy. Patient is status\npost cholecystectomy.\n\nPANCREAS: Patient is status post Whipple procedure. There is interval\ndecrease in the size of heterogeneous mass between the fiducial marker and a\nsurgical clip, now measuring 3.7 x 3.3 cm, previously 3.9 x 3.2 cm, which was\npreviously characterized as dilated pancreaticojejunostomy limb, exerting mass\neffect on the portal confluence on the SMV. As previously, there is atrophy\nof the remaining pancreas and diffuse dilation of the main pancreatic duct,\nunchanged from prior exam. Compared to prior exam, soft tissue mass adjacent\nto the SMA and SMV measure slightly smaller, now 2.9 x 2.6 cm, previously 3.3\nx 2.8 cm in ___. There is persistent hazy appearance of the\nsurrounding mesentery. Stable adenopathy or tumor infiltration along the\nright side of the SMA. Soft tissue fullness about distal margins of the\nstents is similar. Main portal vein is markedly attenuated, is likely\noccluded, similar to prior. Distal main portal vein, right portal veins are\npatent. Left portal vein is more attenuated than on prior, is patent. SMV is\nattenuated, stable. SMA is patent. Patent splenic vein. Stable dilatation\nof pancreatic duct.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Again seen is a 1.3 cm accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the inferior right kidney is too small to\ncharacterize by CT. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Patient is status post gastrojejunostomy. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted. Benign 2.2 cm\nintramuscular lipoma in the right thigh seen.", "output": "1. Soft tissue mass adjacent to SMA, SMV, portal confluence, which measures\nslightly smaller. Attenuated and probably occluded confluence of the portal\nvein, SMV, similar to prior. Soft tissue fullness about bowel side margin of\nthe stents is similar.\n2. Persistent intrahepatic biliary dilatation, similar to prior with interval\nincrease in the degree of pneumobilia compared to ___, consistent\nwith patent biliary stents." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis. Otherwise, imaged lung bases are\nwithin normal limits. There is no pleural effusion. Partially imaged heart\nis within normal limits for size. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is status post hepaticojejunostomy. The liver\ndemonstrates homogenous attenuation throughout. No concerning focal hepatic\nlesion identified. Mild intrahepatic biliary ductal dilatation with stable\nminimal pneumobilia. Two common bile duct stents across the\nhepaticojejunostomy are in unchanged position. Patient is status post\ncholecystectomy. Main portal vein remains significantly attenuated, likely\noccluded. The SMV is also attenuated, though similar to prior exam. The SMA\nand splenic vein are widely patent.\n\nPANCREAS: Patient is status post Whipple procedure. Mixed cystic/solid\npancreatic head mass between the fiducial marker and surgical clips, exerting\nmass effect on the portal confluence and SMV, measures 3.9 x 3.7 cm,\npreviously 3.7 x 3.3 cm (02:23) as on prior exam, there is atrophy of the\nremnant pancreas and moderate dilatation of the main pancreatic duct. Soft\ntissue mass adjacent to the SMA and SMV is stable in size, measuring 3.0 x 2.5\ncm, previously 2.9 x 2.6 cm (2:27). Persistent hazy appearance of the\nsurrounding mesentery is grossly unchanged. Mild-to-moderate adenopathy\nand/or tumor infiltration along the right aspect of the SMA is stable. There\nis mild soft tissue fullness along the distal margins of the CBD stents, which\nappears grossly unchanged since prior exam.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. 1.4 cm accessory spleen adjacent to the superior\npole of the spleen is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the lower pole of the right kidney, too small to\nfurther characterize, is similar to prior exam and most consistent with a\nsimple renal cyst. No new focal concerning renal lesions identified. No\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastrojejunostomy. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Mild degenerative changes of the imaged lumbosacral spine, most notable\nat L5-S1. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: A small fat-containing umbilical hernia is noted. The abdominal\nand pelvic wall is within normal limits.", "output": "1. No acute findings within the abdomen or pelvis to explain patient's\nsymptoms. Specifically, no evidence of intra-abdominal or intrapelvic\nabscess. No definite CT findings to suggest cholangitis, though if there is\npersistent concern, MRI is more sensitive and should be considered for further\nevaluation.\n2. Stable mixed solid/cystic mass in surgical bed, now measuring up to 3.9\ncm, with persistent mass effect on the portal confluence and SMV.\n3. Stable 3.0 x 2.5 cm soft tissue adjacent to the SMA and SMV.\n4. Persistent mild intrahepatic biliary ductal dilatation with stable degree\nof pneumobilia compared to ___, suggestive of patent CBD stents." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. A moderate left pleural\neffusion is new since the prior study. Trace pericardial effusion is not\nsignificantly changed compared to the prior study.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild intrahepatic biliary ductal\ndilation persists previously seen pneumobilia has resolved. \nHepaticojejunostomy demonstrate 2 common bile duct stents, unchanged in\nposition compared to the prior study. There is large volume ascites, new\nsince the ultrasound examination from ___.\n\nPANCREAS: Patient is status post Whipple. A mixed cystic and solid pancreatic\nhead mass between the fiducial markers and surgical clips measures 3.7 x 3.7\ncm, previously 3.9 x 3.9 cm in ___. There is severe atrophy of the\nremnant pancreas. Cystic lesions in the pancreatic body and tail measuring up\nto 2.3 cm in the tail of the pancreas, new since the prior study, may\nrepresent newly dilated side branches (series 2, image 21, series 601, image\n37). However, the pancreatic duct remains dilated to 6mm, unchanged from\nprior studies, so a new focus of tumor at the pancreatic tail cannot be\nexcluded. Mesenteric haziness around the pancreatic mass persists. An\nill-defined soft tissue mass inferior to the pancreatic mass appears unchanged\nsince the prior study, with thickening continued encasement of the distal SMA\nand proximal mesenteric branches (series 2, image 27), and obliteration of the\nportal SMV confluence (02:20, 26, 28).\n\nSPLEEN: The spleen is mildly enlarged measuring 13 cm. A 2.0 cm splenule is\nnoted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Whipple. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The portal vein confluence and the SMV are obliterated, similar to\nthe prior study. The splenic vein is widely patent. There is no abdominal\naortic aneurysm. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Moderate diffuse anasarca is noted. There is a small fat\ncontaining umbilical hernia.", "output": "1. Moderate left pleural effusion and large volume ascites are new since ___.\n2. Mixed cystic and solid pancreatic head mass is not significantly changed in\nsize. There is continued encasement of the distal SMA and several mesenteric\nbranches, and obliteration of the portal-SMV confluence.\n3. Cystic lesions in the pancreatic body and tail measuring up to 2.3 cm in\nthe tail of the pancreas, new since the prior study, may represent newly\ndilated side branches. However, the mildly dilated main pancreatic duct\nremains unchanged in caliber from prior studies. A new focus of tumor within\nthe pancreatic tail cannot be excluded.\n4. No distal abdominopelvic metastasis identified.\n5. Mild splenomegaly." }, { "input": "LOWER CHEST: Heart size is normal with small pericardial effusion, unchanged. \nA small left-sided pleural effusion with adjacent compressive atelectasis is\nunchanged in volume. There is also minimal right lung base atelectasis. The\nimaged lung bases are otherwise grossly clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Moderate intrahepatic biliary\ndilatation appears mildly progressed compared the prior examination. There is\nno periaortic hyper attenuation to suggest cholangitis. Right and left\nbiliary to CBD stents are unchanged in position. The gallbladder is\nsurgically absent. The portal vein is grossly patent, though the proximal\nportion appears mildly attenuated secondary to the pancreatic mass. Small\nvolume ascites appears similar in volume as compared the prior study. There\nis no organizing intra-abdominal fluid collection.\n\nPANCREAS: Patient is status post Whipple. A mixed solid and cystic pancreatic\nhead/proximal body mass with ill-defined contours measures roughly 57 x 53 mm\nin maximal axial dimension, appearing somewhat increased in size compared the\nprior examination where it measured roughly 54 x 42 mm utilizing similar\ntechnique. The main pancreatic duct remains dilated to 7 mm, similar. The\npreviously noted cystic lesion in the pancreatic body is no longer well seen,\nthough the cystic pancreatic tail lesion measuring 30 x 21 mm appears\nrelatively similar to the prior study. The pancreatic mass produces moderate\nattenuation of the proximal splenic vein, and encases a greater than 180\ndegree circumference of the portal, splenic, and superior mesenteric veins. \nThere is also unchanged confluent encasement of the SMA. The mass also abuts\nbranches of the celiac axis.\n\nSPLEEN: The spleen is enlarged measuring up to 14.3 cm in maximal dimension,\nwithout focal mass. An accessory spleen is noted in the splenic hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 6 mm right interpolar renal hypodensity is too small to characterize though\nlikely represents a cyst. There is no evidence of solid focal renal lesions\nor hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Whipple. The stomach is grossly\nunremarkable. The small bowel loops are normal caliber without evidence of\nobstruction. The colon and rectum are grossly unremarkable without focal\nareas of wall thickening. The appendix is not seen though there is no\nsecondary evidence of appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall volume free pelvic fluid continuing from the ascites.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring up to 5 cm in maximal\ntransverse dimension.\n\nLYMPH NODES: Mildly prominent porta hepatis lymph nodes measuring up to 8 mm\nin short axis appear grossly similar to the prior examination. Similar mildly\nprominent celiac axis lymph nodes also measure up to 8 mm in short axis are\nalso unchanged, not enlarged by CT size criterion. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are lumbar degenerative changes with moderate L4-L5 and severe L5-S1\ndisc space narrowing. There are mild bilateral hip joint degenerative\nchanges.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval increase in size of ill-defined mixed solid and cystic remnant\npancreatic head/proximal body mass measuring up to 57 x 53 mm in maximal axial\ndimension, appearing locally invasive with attenuation of the portal splenic\nvenous confluence and encasement of the SMA, as described above. Similar\ndegree of main pancreatic ductal dilatation with unchanged pancreatic tail\ncystic lesion, which may represent a prominently dilated side branch duct.\n2. Unchanged positioning of 2 biliary stents with slight interval increase of\nmoderate intrahepatic biliary dilatation, which could suggest stent\nmalfunction. No abnormal peritoneal enhancement to suggest ascending\ncholangitis.\n3. Unchanged small volume ascites and small left-sided pleural effusion.\n4. Otherwise no obvious source of infection. No organizing fluid collection.\n5. No new sites of metastasis identified.\n6. Unchanged splenomegaly." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent as\ndenoted by surgical clips.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended and filled with food. A small\numbilical hernia is noted. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis (series 6, image 66.)\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Extensive lymphadenopathy is seen in the retroperitoneal,\nmesenteric, pericolic, gastrohepatic, and pelvic lymph nodes. The largest of\nthe retroperitoneal lymph nodes is seen in the left periaortic chain and\nmeasures 1.5 x 1.6 cm (series 5, image 31). The largest of the mesenteric\nlymph nodes measures 2.8 x 1.7 cm (series 5, image 50.) The largest of the\npelvic lymph nodes is seen in the mesorectal chain measuring 1.1 x 1.2 cm\n(series 5, image 56).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is asymmetric sclerosis of the left SI joint,\nwhich is most likely due to degenerative changes. There are small bilateral\nhematomas in the subcutaneous abdominal soft tissues, likely from injections.", "output": "1. Extensive lymphadenopathy is seen in the intra-abdomen and intrapelvic\nlymph nodes, including retroperitoneal, mesenteric, pericolic, gastrohepatic,\nand pelvic lymph nodes. No evidence of colitis, typhlitis, or cystitis.\n2. Incidental findings, as described in detail above." }, { "input": "LOWER CHEST: There are new small bilateral nonhemorrhagic pleural effusions\nwith associated bibasilar consolidative opacities. There is a small\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size. There is no hydronephrosis. The\nureters are normal in caliber along their course to the bladder.\n\nGASTROINTESTINAL: A nasoenteric tube is seen within the stomach. The stomach\nis decompressed. Small bowel loops are normal in caliber without focal wall\nthickening. Oral contrast extends through the transverse colon. There is no\nextraluminal contrast. There is no evidence of bowel wall thickening. The\nappendix is not visualized but there are no secondary signs of appendicitis in\nthe right lower quadrant.\n\nLYMPH NODES: There is extensive mesenteric and retroperitoneal\nlymphadenopathy which is better assessed on prior contrast enhanced CT scan,\nbut appears overall similar compared to ___. There has however been\ninterval increase in the bilateral inguinal and pelvic sidewall adenopathy. \nEnlarging nodes include a 16 x 24 mm node adjacent to the cecum (series 2,\nimage 71), previously 9 x 13 mm and a 17 x 26 mm cluster of left external\niliac nodes (series 2, image 73), previously 10 x 16 mm. Also increased are\nbilateral inguinal lymph nodes measuring up to 20 x 29 mm on the left (series\n2, image 91), previously 7 x 14 mm.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. No atherosclerotic\ndisease is noted.\n\nPELVIS: There is a Foley catheter within the bladder. Air within the bladder\ndome less likely from prior instrumentation.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAgain seen, is asymmetric sclerosis of the left sacroiliac joint.\n\nSOFT TISSUES: There is a small fat containing paraumbilical hernia.", "output": "1. Normal CT appearance of the small and large bowel.\n2. Extensive lymphadenopathy as described above with enlargement of pelvic\nsidewall and inguinal lymph nodes compared to ___.\n3. Small bilateral pleural and pericardial effusions.\n4. New bibasilar consolidative opacities, concerning for pneumonia in the\ncorrect clinical setting." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypodensities too small to characterize but likely representing renal cysts\nare noted in the bilateral kidneys. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Adjacent to the pancreatic head\nand C sweep of the duodenum, there is a rounded structure measuring 2.3 x 1.9\nx 2.5 cm containing slightly hyperdense material. There may be a connection\nbetween this structure and the duodenum as noted on the coronal reformatted\nimages on series 604b, image 23.\n\nSmall bowel loops otherwise demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Rounded cystic structure located in the C-loop of the duodenum, measuring 2.3\nx 1.9 x 2.5 cm containing slightly hyperdense material. There may be a\nconnection between this structure and the duodenum, making a duodenal\ndiverticulum the most likely etiology. A choledochal cyst is another\nconsideration. Lack of intra-abdominal fat makes it challenging to\ndistinguish the organ of origin of this structure and hence a non urgent MRCP\nmay be considered for further evaluation.\n\nRECOMMENDATION(S): Non urgent ultrasound to evaluate etiology of cystic\nstructure located within the seen loop of the duodenum as described above." }, { "input": "LOWER CHEST: There is mild dependent bibasilar atelectasis. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is periportal edema likely secondary to volume resuscitation. Lack of\nhepatic venous enhancement may be technical though possibility of venous\nthrombosis difficult to exclude. The main portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a wedge-shaped hypodensity in the right kidney compatible\nwith infarct. In addition, areas of renal parenchymal scarring noted\nbilaterally likely the sequelae of prior infarct or infection. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Wedge-shaped hypodensity in the right kidney compatible with infarct. \nCorrelate for acuity.\n2. Non enhancement of the hepatic veins may be technical, recommend ultrasound\nto exclude thrombosis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:10 am, 5 minutes after\ndiscovery of the findings" }, { "input": "Delayed images demonstrate contrast opacifying the bilateral collecting system\nand the ileal conduit. There is no evidence of filling defects or urothelial\nlesions. A small amount of contrast extravasation is noted near the site of\nthe ureteral ileal anastomosis, in keeping with a leak. Contained contrast is\nseen surrounding the right ureteric stent which extends all the way to the\nanastomosis, suggesting that the right ureter is intact. Contrast is not seen\nsurrounding the left ureteric stent more distally, but an intact left\nanastomosis cannot be ruled out.\n\nPlease refer to CTU performed earlier today for description of additional\nfindings within the abdomen and pelvis.", "output": "Delayed contrast extravasation near the site of the ureteral ileal anastomosis\nis consistent with a leak. A leak from the left ureteral ileal anastomosis is\nfavored, although whether this is a small leak or a dehiscence cannot be\ndetermined.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:29 ___, 15 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings, including lung nodules.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits. The known hepatic varix\nincompletely evaluated on non-contrast exam.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Stable left renal\ncyst.There is no evidence of focal renal lesions within the limitations of an\nunenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. A diverting\nileostomy is seen in the left lower quadrant. A ileal conduit is seen in the\nright lower quadrant. A small bowel anastomosis and a ___ anastomosis\nare unremarkable. The appendix is not visualized.\n\nPELVIS: The patient is status post radical cystectomy and ileal conduit. This\nis identified in the right lower quadrant. Status post low anterior resection\nwith ___ anastomosis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic or locally recurrent disease in the abdomen and\npelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings, including lung nodules." }, { "input": "LOWER CHEST: Please refer to dedicated CT chest report on same day for\nintrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. The gallbladder is unremarkable.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenals are unremarkable.\n\nURINARY: Aside from a simple cyst in the lower pole of the left kidney (3:74),\nthe unenhanced kidneys are unremarkable.\n\nGASTROINTESTINAL: ___ anastomosis and small bowel anastomosis are again\nseen. Reversal of prior ileostomy. There is no intestinal obstruction or\nascites. An ileal conduit in the right lower quadrant is also present. A 4\nmm right omental nodule stable.\n\nPELVIS: Post cysto prostatectomy changes are again noted.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: No aggressive osseous lesions. Subcutaneous scar in left lower\nquadrant from an interval diverting ileostomy is noted.", "output": "Post ileostomy reversal without findings for metastatic disease." }, { "input": "Absence of IV contrast limits evaluation of solid organs and vascular\nstructures.\n\nLOWER CHEST: Interval worsening of multiple metastatic pulmonary nodules\npartially imaged at the lung bases. Please refer to the separately dictated\nCT of the chest for detailed evaluation.\n\nHEPATOBILIARY: Unenhanced liver appears unremarkable. Gallbladder is\nunremarkable. Common bile duct is normal in caliber.\n\nPANCREAS: Pancreatic contours are unchanged with diffuse atrophic changes.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: There is mild left adrenal gland hyperplasia.\n\nURINARY:There is no hydronephrosis. There is a left interpolar renal cortical\ncyst that has not changed.\n\nGASTROINTESTINAL: Stomach appears under distended, otherwise unremarkable. \nSmall bowel loops are normal in caliber. Status post rectal resection and\nanastomosis, appears intact. Post colostomy takedown. There is a right lower\nquadrant urostomy with a small small-bowel containing peristomal hernia.\n\nPERITONEUM: There is no free air or free fluid.\n\nLYMPH NODES: There are prominent pericecal lymph nodes measuring up to 0.7 cm\n(2:78). These have increased in size compared to the recent study, and remain\nnonspecific. There are no suspicious retroperitoneal or mesenteric\nadenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS: There are no suspicious pelvic adenopathy. Rectal resection and\nanocolonic anastomosis appears intact. Urinary bladder is resected with a\nright lower quadrant ileostomy tube in place.\n\nBONES:Osseous structures appear intact with no evidence suspicious mass\nlesions.\n\nSOFT TISSUES: There is a midline surgical scar. Scar from the colostomy\ntakedown in the left lower quadrant. There is a rounded nodule in the\nparastomal hernia sac (2:89) measuring 0.7 cm representing a prominent lymph\nnode.", "output": "1. Increased size of pericecal lymph nodes, which remain small and\nnonspecific. Attention on follow-up is recommended.\n2. Worsening metastatic disease within the chest. Please refer to the\nseparately dictated CT of the chest for detailed evaluation.\n3. Small bowel containing right parastomal hernia." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. A 3.2 cm\nsimple renal cyst on the left is unchanged. Multiple millimetric\nhypodensities are too small to characterize by CT, and unchanged from prior. \nThere is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Patient is status post rectal\nresection. The colonic anastomosis is intact. There is peristomal hernia of\nsmall bowel without evidence of obstruction.\n\nPELVIS: The urinary bladder has been resected. A right lower quadrant\nileostomy is intact as on prior. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Pericecal lymph nodes are less conspicuous than on prior, with no\nenlargement by CT size criteria. No retroperitoneal or intrapelvic\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes again demonstrated in the midline and left\nlower quadrant. A surgical clip is seen in the presacral tissue.", "output": "1. Decreased conspicuity of multiple pericecal lymph nodes. No\nlymphadenopathy by CT size criteria. No evidence for suspicious masses in the\nabdomen or pelvis.\n2. Small bowel parastomal hernia without evidence of obstruction.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. There is no evidence of pleural or\npericardial effusion. Coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is moderate intrahepatic biliary\nductal dilation. The common bile duct is dilated measuring up to 1.5 cm. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas is mildly atrophic, without evidence of focal lesions\nor pancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 3.3 cm cyst is seen in the upper pole of the right kidney. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized. The known VP\nshunt terminates in the midline upper pelvis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: A moderate T12 compression fracture is acute. A mild L4 compression\ndeformity is of uncertain chronicity. Chronic left-sided rib fractures noted.\n\nSOFT TISSUES: Clips are noted in the left inguinal region. A fat containing\nventral hernia is noted.", "output": "1. Patient is status post cholecystectomy with moderate intra and extrahepatic\nbiliary ductal dilation. Cannot exclude choledocholithiasis/cholangitis. \nClinical correlation is recommended. Consider further evaluation with MRCP.\n2. A moderate T12 compression fracture is acute. A mild L4 compression\ndeformity is of uncertain chronicity.\n\nRECOMMENDATION(S): Clinical correlation is recommended. Consider further\nevaluation with MRCP." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: 3 mm hypodensity in segment VI is too small to characterize\nbut unchanged compared to prior examinations. The liver demonstrates otherwise\nhomogenous attenuation throughout. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is unchanged mild\nright perinephric fat stranding, likely postsurgical in etiology..\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits.\nRETROPERITONEUM: Dystrophic calcifications in right lower abdominal and\npelvic retroperitoneum including dystrophic calcifications measuring up to 2.1\ncm are unchanged. There is unchanged mild stranding along the posterior right\nperitoneum (5:90). There is no evidence of recurrent mass..\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries. Unchanged tiny central\nfilling defect within the inferior mesenteric vein likely represents\nrecannulized vein with minimal residual thrombus.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Were there significant degenerative\nchange of the lumbar spine including severe bilateral lower lumbar facet\narthropathy. Abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of recurrent or metastatic disease.\n2. Postsurgical changes of the right retroperitoneum including unchanged mild\nstranding and dystrophic calcification.\n3. Please see separate CT chest dictation for thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\npreviously described subcentimeter hypodensity in segment VI is not\ndefinitively seen on today's examination. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. Postsurgical\nchange, dystrophic calcification and amorphous, nodular fat stranding\nimmediately inferior to the right kidney are unchanged from ___.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 on L5 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Postsurgical changes, dystrophic calcifications and amorphous fat stranding\nin the right lower quadrant are unchanged from ___. No evidence\nof recurrence." }, { "input": "LOWER CHEST: Linear atelectasis at the left lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter cyst within segment 5 is present dating back to ___. there is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: Stable sub 5 mm cystic lesion within the pancreatic body, likely a\nside branch IPMN. No pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Small\nparaumbilical hernia containing several nonobstructed loops of small bowel. \nStatus post right hemicolectomy. Status post sigmoid resection with\nanastomosis noted within the pelvis. The residual large bowel is\nunremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a mixed soft tissue density and fat containing mass\nanterior to the right psoas muscle which measures 18 x 36 mm, previously 13 x\n30 mm. There is also a soft tissue density lesion anterior to the left renal\nvein, which in retrospect may be present on the prior examination measuring 15\nx 21 mm. This appears new in comparison to the prior CT scan dated ___. There is asymmetric increased fat within the right posterior para renal\nspace with fascial thickening and enhancement as well as soft tissue\nnodularity which appears grossly similar in comparison to prior studies. This\nincludes some areas of calcific density. However, along the superior aspect\nof the posterior para renal space adjacent to the liver edge, there is a 13 x\n17 mm soft tissue nodule which has increased in size and conspicuity in\ncomparison to prior exams. Areas of nodular enhancement involving the psoas\nand iliacus muscles are not well identified on the current examination in\ncomparison to prior MRI.", "output": "1. Increasing area of soft tissue density within the retroperitoneum between\nthe left renal vein and pancreas suspicious for disease recurrence.\n2. Additional area of mixed fat and soft tissue density anterior to the right\npsoas muscle also appears slightly increased in size.\n3. Soft tissue nodule adjacent to the liver edge involving the transversalis\nfascia on the right, new or increased in size in comparison to previous.\n4. Otherwise stable appearance of increased fat within the right posterior\nperirenal space with fascial thickening and enhancement.\n5. Nodular areas of enhancement within the psoas and iliacus muscles are not\nwell identified on the current exam in comparison to prior MRI." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. An appendicolith is noted in the proximal\nappendix. There is a moderate amount of inflammation centered around the\nappendix which is significantly improved. There is no drainable fluid\ncollection within the right lower quadrant or adjacent to the catheter. Only\ntrace fluid is seen abutting the drainage catheter within the right lower\nquadrant abdomen. Patient reports continued small volume drainage from the\nright lower quadrant catheter.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nresidual inflammation or fluid in the left lower quadrant at the site of the\npatient's left lower quadrant pigtail drain. Right lower quadrant\ninflammation is significantly improved, however there is persistent mild\ninflammation centered around the appendix with proximal appendicolith. Trace\nfluid is seen around the right lower quadrant catheter, however there is no\ndrainable fluid collection. Following the CT scan the left lower quadrant\ndrain was removed without difficulty. Hemostasis was achieved.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. Two follicular cysts in the\nright ovary, measuring 2.2 x 1.6 cm and 1.2 x 1.2 cm are again noted. The\ndominant cyst previously measured 3.2 x 3.3 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild right lower quadrant inflammation centered about the appendix is\nsignificantly improved. There is trace fluid adjacent to the right lower\nquadrant catheter, but no drainable fluid collection. A persistent\nappendiculolith is seen at the proximal portion of the appendix. The right\nlower quadrant catheter will remain in place due to the persistent\ninflammation and persistent drainage within the right lower quadrant. This\nfinding was discussed with the surgical team managing the patient who agrees\nwith the plan.\n2. There is no significant inflammation or fluid in the left lower quadrant\nadjacent to the left lower quadrant drain and therefore the left lower\nquadrant drain will be removed." }, { "input": "LOWER CHEST: Patchy opacities within the lower lobes bilaterally. Please\nrefer to the chest CT with the same date for further evaluation of the\nintrathoracic structures.\n\nABDOMEN: The liver, spleen, pancreas, and adrenal glands are unremarkable. \nGallstone within the gallbladder neck. No evidence of acute cholecystitis. \nMultiple hypodensities are seen within the kidneys bilaterally, some of which\nare too small to characterize, others which are consistent with simple cysts. \nSome of these hypodensities appear slightly above water density, however this\nexamination is limited by streak artifact and noncontrast technique. No\nhydronephrosis.\n\nGASTROINTESTINAL: Small hiatal hernia. Enteric tube terminates within the\nsecond portion of the duodenum. Sigmoid diverticulosis. There is no\nintestinal obstruction or ascites.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: Prostate is enlarged measuring 6.8 x 5.9 cm. Foley terminating within\nthe bladder. Air within the bladder lumen, likely due to recent\ncatheterization. Circumferential bladder wall thickening and trabeculation,\nlikely due to chronic bladder outlet obstruction. There is no pelvic free\nfluid.\n\nVASCULAR: There is extensive atherosclerosis throughout the abdominal aorta. \nThe infrarenal abdominal aorta is ectatic.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen.", "output": "1. No evidence of malignancy within the abdomen or pelvis.\n2. Prostatomegaly with circumferential bladder wall thickening, likely due to\nchronic bladder outlet syndrome.\n3. Other incidental findings include infrarenal abdominal aortic ectasia,\ncholelithiasis, a small hiatal hernia, and diverticulosis.\n4. Patchy opacities within the lower lobes bilaterally. Please refer to the\nchest CT with the same date for further evaluation." }, { "input": "LOWER CHEST: Visualized lung fields demonstrates bibasilar atelectasis, left\ngreater than right, slightly improved from prior. There is however new small\nleft pleural effusion. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent. Small amount of\nperihepatic free fluid, unchanged from prior.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Re- demonstration of near complete replacement of both kidneys with\nhemorrhagic and nonhemorrhagic cystic lesions that appear grossly stable in\nsize when compared to prior CT dated ___. Gone back to ___ CT scan exophytic heterogeneous lesion arising from the lower pole of the\nright kidney measures 5.5 cm x 5.0 cm today, and it measured 5.0 cm x 4.3 cm\nin ___, and while this lesion may represent interval increase of partially\nhemorrhagic cyst, renal ultrasound is recommended to exclude solid mass. \nThere is no hydronephrosis bilaterally. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Few isolated loops of small\nbowel within the lower abdomen demonstrates mild nonspecific thickening,\nlikely reactive to surrounding ascites. No evidence of small-bowel\nobstruction. The colon and rectum are within normal limits. There is\nsmall-amount of ascites in the abdomen/pelvis, with adjacent mild stranding\nabout low bowel loops, sigmoid colon, not centered at the bowel loops, more\nprominent since prior. Few foci of free air in the mid abdomen, within normal\nlimits given presence of peritoneal dialysis catheter (series 3, image 58 and\n55).\n\nPELVIS: Bladder is decompressed around a Foley's catheter. Small amount of\nfree fluid in the pelvis. A peritoneal dialysis catheter is noted in the\nlower abdomen/upper pelvis, unchanged in position from prior.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes in the lumbar spine, sacroiliac joints. Benign\nbone island right proximal femur.\n\nSOFT TISSUES: There is a small fat containing left inguinal hernia.", "output": "1. Peritoneal dialysis catheter is noted, unchanged in position from prior.\n2. There is a small amount of free fluid in the abdomen and pelvis.\n3. Areas of mild stranding in the pelvis are nonspecific, may be related to\ncatheter use, superimposed infection cannot be excluded. Process did not seem\ncentered about bowel loops to suggest inflammatory or infectious enteritis.\n4. New small left pleural effusion\n5. Innumerable bilateral renal cysts, some are hemorrhagic, suggest polycystic\nkidney disease. Dominant 5.5 cm lesion in the lower pole right kidney has\nincreased since ___ when it measured 5.0 cm, renal ultrasound recommended to\nexclude neoplasm.\n\nRECOMMENDATION(S): Renal ultrasound" }, { "input": "Intrathoracic findings are separately reported.\n\nCT ABDOMEN: The liver is normal in size and contour. There is interval\ndevelopment of a wedge-shaped peripheral area of hypoenhancement in segment\nVIII of the liver involving the right hepatic dome, which is new from the\nprior CT. There are no suspicious liver lesions. The portal and hepatic veins\nare patent. There is no intra or extrahepatic biliary dilatation. The\ngallbladder is not visualized separate of large volume of intra-abdominal\nascites. The pancreas enhances homogeneously. The spleen and adrenal glands\nare normal. The kidneys enhance and excrete contrast promptly. There are no\nconcerning renal lesions. Sub cm hypodensities in the bilateral kidneys are\ntoo small to fully characterize but appear unchanged and likely represent\nrenal cysts.\n\nThere is no retroperitoneal or abdominal adenopathy. There is large volume\nintraperitoneal ascites with predominantly simple fluid density. No free air\nis present. The aorta and its major branches are patent and not dilated.\n\nThe patient is status post total colectomy with a ___ pouch. The stomach\nand proximal loops of small bowel are relatively collapsed. Enteric contrast\npasses to the level of the distal small bowel, which is mildly dilated with\ncontrast and air to the level of a loop of distal small bowel containing stool\nextending to the level of the ostomy in the patient's right lower quadrant. No\ntransition point is identified. There is no pneumatosis to suggest bowel\nischemia.\n\nCT PELVIS: The bladder is decompressed by a Foley catheter with air in the\nnondependent portion. The uterus is not visualized. There is no inguinal or\npelvic adenopathy.\n\n OSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesion\nidentified.", "output": "1. Interval development of a wedge-shaped area of hypoenhancement in segment\nVIII of the liver from ___ may represent infarct but, unlikely,\nabscess.\n2. Mildly dilated distal loops of small bowel to the level of the patient's\nright lower quadrant ostomy without an identifiable transition point most\nlikely represents ileus in the post-operative setting; however, early\nobstruction is not excluded.\n3. Large volume intra-abdominal ascites without loculated collection.\n4. Intrathoracic findings are separately reported." }, { "input": "LOWER CHEST: Please refer to the dedicated chest CT from the same day for a\ndescription of thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A small accessory spleen at the hilum is noted\n(series 2, image 58).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are subtle areas\nof hypoattenuation in both kidneys which appear to extend to the cortex,\nraising the possibility of pyelonephritis in the appropriate clinical setting\n(for example, in the left kidney on series 2, images 62, 68 and 73, and in the\nright kidney on series 601, image 37). No evidence of hydronephrosis or\nperinephric abnormality.\n\nGASTROINTESTINAL: Ingested enteric contrast reaches the distal small bowel. \nThe stomach is unremarkable. Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon is within normal\nlimits. The rectum has a small to moderate stool burden with a rectal tube in\nplace. The appendix is normal. No bowel obstruction. No fluid collections\nin the abdomen.\n\nPELVIS: The urinary bladder is underdistended with a Foley catheter in place\nand balloon inflated. Moderate amount air within the urinary bladder lumen is\npresumed related to Foley catheter placement. Bilateral ureteral jets of\nexcreted intravenous contrast are demonstrated. Trace free fluid in the\npelvis, but no organized fluid collections.\n\nREPRODUCTIVE ORGANS: The prostate gland is not enlarged.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. Enlarged\nbilateral external iliac lymph nodes measure up to 1.3 cm in short axis but\nappear to retain a fatty hilum (e.g. series 2, image 113), possibly reactive. \nNo inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. There are no atherosclerotic\ncalcifications in the abdominal aorta.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Minimal\nretrolisthesis of L5 on S1 is likely degenerative.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Subtle areas of hypoattenuation in both kidneys which appear to extend to\nthe cortex, raising the possibility of pyelonephritis in the appropriate\nclinical setting. Correlation with clinical symptoms and urinalysis is\nrecommended.\n2. Otherwise no evidence of source of infection in the abdomen or pelvis.\n3. Bilateral enlarged external iliac lymph nodes, which may be reactive.\n4. Trace free fluid in the pelvis.\n5. Please refer to the dedicated chest CT from the same day for a description\nof thoracic findings." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. There is no pleural\neffusion. Visualized portions of the heart are within normal limits.\n\nABDOMEN:\n\nHEPATOBILIARY: Diffuse hypoattenuation of the liver is consistent with hepatic\nsteatosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Scattered diverticulae in the sigmoid colon are\npresent, with no evidence of acute diverticulitis. There is mural\nstratification the ascending colon. The descending colon predominantly\ndecompressed and has a somewhat a featureless appearance. No evidence of\nactive inflammatory disease, specifically no evidence of mesenteric\nhypervascularity or mural thickening. Colon and rectum are within normal\nlimits. Appendix is normal. There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is mild to moderate\ncalcium burden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Patient appears to be status post supracervical\nhysterectomy. No adnexal abnormalities identified.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nThere is no fracture. Abdominal and pelvic wall is within normal limits.", "output": "1. Mural stratification of the ascending colon and featureless appearance of\nthe descending colon which can be seen in the setting of inflammatory bowel\ndisease. There is no evidence of active disease on this current examination.\n2. Diverticulosis, no evidence of acute diverticulitis.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits noting mild\nbibasilar atelectasis. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low attenuation, compatible hepatic\nsteatosis. Areas of relatively lower attenuation in segments 3 and 4B, which\nis likely due to more focal fat. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are symmetric in size with normal nephrograms bilaterally. \nNo focal renal lesion identified on either side. There is no hydronephrosis\nnor perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis is\nnoted in the sigmoid colon, without evidence of acute diverticulitis. \nOtherwise, the and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Height loss of the T12 vertebral body was seen in ___ but may\nhave slightly progressed since then. Chronic left eleventh and right ninth\nrib fractures are again noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite acute intra-abdominal process. No findings to explain\npatient's symptoms.\n2. T12 compression deformity was present in ___ although with slight\ninterval height loss since that time.\n3. Fatty liver.\n4. Diverticulosis without evidence of acute diverticulitis\n\nNOTIFICATION: The updated findings were discussed with Dr ___ , M.D. by\n___, M.D. on the telephone on ___ at 10:46 ___." }, { "input": "LOWER CHEST: Visualized lung fields show bilateral small pleural effusions.\nThere is no evidence pericardial effusion. Heart size is normal. \nIncidentally noted are pulmonary emboli within the right lower lobe segmental\npulmonary arteries\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout noting\nthat there is an 8 mm indeterminate lesion just posterior to the gallbladder\nand a 10 mm lesion just anterior to the gallbladder both of which are near the\nliver surface (05:29). These may be serosal in location which would be\nconcerning for serosal implants. This can be further evaluated with MRI if\nindicated.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder shows marked asymmetric wall thickening at the fundus. The wall is\nlow-density which would suggest submucosal edema. This would be an atypical\nappearance for fundal adenomyomatosis. There is gallbladder sludge.\n\nThere is a large amount of intra-abdominal ascites with abnormal thickening\nand enhancement on the right lateral peritoneum (05:43). In the cul-de-sac\nthe peritoneum is also thickened and shows abnormal enhancement more prominent\non the right (5:73). There is diffuse soft tissue infiltration of the\nomentum.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The bladder is decompressed . There is a large amount of free fluid\nwithin the pelvis\n\nREPRODUCTIVE ORGANS: No ovarian mass is identified. No adnexal mass is\nidentified. The uterus contains a few fibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Segmental right lower lobe pulmonary emboli.\n2. Large volume ascites with abnormal soft tissue infiltration of the omentum.\nOmentum would be amenable to CT-guided biopsy if indicated. Additionally,\nthere is abnormal peritoneal thickening and enhancement of the peritoneum of\nthe right lateral abdominal wall and the recto uterine cul de sac. These\nfindings are concerning for a metastatic disease although no primary lesion is\nidentified. Specifically, no ovarian or adnexal mass is identified although\nan ovarian neoplasm is still a consideration in the absence of a known or\ndiagnosed primary lesion.\n3. Marked asymmetric low density wall thickening at the gallbladder fundus. \nThe low density wall thickening is likely due to submucosal edema which may be\nfrom the ascites. The finding is atypical for gallbladder carcinoma and focal\nfundal adenomyomatosis is considered most likely although the CT is not\nclassic for this diagnosis either. This could be confirmed with MRI, see\nbelow.\n4. Indeterminate 8 mm liver lesion and 10 mm liver lesion are noted adjacent\nto the gallbladder at the surface of the liver. These may be subserosal in\nlocation in which case they could represent implants. Further evaluation with\nMRI should be considered.\n\nRECOMMENDATION(S): Consider MRI of the abdomen to further evaluate liver\nlesions. And gallbladder\n\nConsider CT-guided biopsy of the soft tissue infiltration of the omentum.\n\nNOTIFICATION: Presence of pulmonary emboli was discussed with Dr. ___.\nby ___, M.D. on the telephone on ___ at 5:29 ___, 4 minutes\nafter discovery of the findings. After discussion of findings, the patient was\ntransported to the emergency department and a verbal discussion of the\nfindings was conducted with Dr. ___ Emergency ___ senior\nresident." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Excreted IV contrast is seen within the renal\ncollecting systems, but has not yet progressed down the ureters, limiting\nevaluation for ureteral injury.\n\nGASTROINTESTINAL: Aside from a small hiatal hernia, the stomach is\nunremarkable. There is diffuse mild dilatation of small bowel loops without\nfocal transition point, consistent with postoperative ileus. There is sigmoid\ncolonic diverticulosis without evidence of diverticulitis. The appendix is\nnot visualized.\n\nThere is moderate pneumoperitoneum and small volume free fluid within the\nabdomen and pelvis. Some pockets of fluid and gas appear partially organized\nwith associated peritoneal thickening and enhancement, suggesting peritonitis.\nA representative collection in the right lower quadrant measures up to 6.0 x\n3.0 cm in axial dimension (3:94), and extends from just below the inferior\nright hepatic tip to the upper pelvis. An anterior mid abdominal collection\nmeasures to 10.7 x 2.4 cm (3:100) and is located amongst small bowel loops. A\nleft pelvic collection measures up to 5.4 x 2.7 cm (3:100). Oral is seen to\nthe level of the distal transverse colon, and there is no extraluminal oral\ncontrast to indicate bowel injury. Please note that evaluation for bowel\ninjury from the level of the splenic flexure distally is limited without oral\ncontrast.\n\nPELVIS: Urinary bladder is decompressed around a Foley catheter.\n\nREPRODUCTIVE ORGANS: Hyperenhancement of the lower uterine segment and fluid\nwithin the endometrial cavity is presumably related to recent endometrial\npolyp removal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous emphysema of the abdominal and pelvic wall is\nexpected in the setting of recent prior surgery. There is a tiny fat\ncontaining umbilical hernia.", "output": "1. Moderate pneumoperitoneum and small volume free fluid in the abdomen and\npelvis, with developing fluid collections as described above, and associated\nperitoneal enhancement compatible with peritonitis.\n2. No definite evidence of bowel or ureteral injury, although evaluation is\nlimited in the early postoperative setting and by the timing of oral and IV\ncontrast.\n3. Diffuse mild dilatation of small bowel loops without focal transition\npoint, consistent with postoperative ileus.\n4. Please see the separately submitted report of the same day CT Chest for\nfindings above the diaphragm.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:10 am, 5 minutes after\ndiscovery of the findings." }, { "input": "Suboptimal study, secondary to respiratory motion artifact. Within this\nlimitation:\n\nLOWER CHEST: Confluent parenchymal and ___ opacification,\npredominantly in the lateral segment of the right middle lobe, suggests\npneumonia. The remaining visualized lung fields are within normal limits. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Bilateral circumscribed adnexal hypodensities, measuring\n3.0 x 2.6 cm on the right and 1.7 x 1.1 cm on the left, are most consistent\nwith ovarian follicles. Otherwise, the uterus and bilateral adnexa are\nunremarkable.\n\nLYMPH NODES: Bilateral prominent inguinal lymph nodes, the largest on the\nright measuring up to 8 mm in short axis (5:78), none of which meet CT size\ncriteria for pathologic enlargement. There is no retroperitoneal or\nmesenteric lymphadenopathy. There is no pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Circumaortic left renal vein\nis noted. No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intraabdominal or intrapelvic process to explain patient's\nsymptoms.\n2. Confluent parenchymal and ___ opacification, predominantly in the\nlateral segment of the right middle lobe, suggestive of pneumonia.\n3. Prominent bilateral inguinal lymph nodes, none of which are pathologically\nenlarged by CT size criteria." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis, left greater than right. \nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed. There is minimal free fluid in\nthe pelvis, likely physiologic.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a bone island on the roof of the left acetabulum.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Cholelithiasis without surrounding inflammation or distention of the\ngallbladder to suggest cholecystitis. No acute intra-abdominal process\nidentified." }, { "input": "LOWER CHEST: Ground-glass opacities within the lower lobes bilaterally, likely\nreflective of pulmonary edema, as seen on the recent chest radiograph. \nAlternatively, this may represent aspiration or multifocal pneumonia. In\naddition, there is a 2.9 cm partially imaged right lower lobe lung nodule\n(series 3, image 1), which should be followed up with a chest CT. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is extremely nodular in appearance, which is a new\ncompared to ___. There is no evidence of focal lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 11 mm simple cyst within the upper pole of the left\nkidney. Otherwise, the kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of enhancing renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient is\nstatus post partial colectomy. There is a large amount of stool within the\nrectum, with associated thickening of the rectal wall but no surrounding fat\nstranding (series 2, image 95), which is raises concern for mild stercoral\ncolitis. The appendix is not visualized.\n\nPELVIS: The bladder is decompressed by a Foley and cannot be completely\nevaluated on this examination. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are numerous enlarged periaortic and aortic caval\nretroperitoneal lymph nodes. For instance an aortic caval lymph node at the\nlevel of the renal veins measures 1.4 cm in short axis (series 3, image 35). \nIn addition, a gastrohepatic lymph node is enlarged measuring 1.7 cm in short\naxis (series 3, image 28). There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. Bilateral internal iliac artery aneurysms are re-\ndemonstrated measuring up to 2.0 cm on the right, and 1.6 cm on the left.\n\nBONES: There is multilevel loss of vertebral body height within the lumbar\nspine, which is stable since ___. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing left inguinal hernia. Otherwise,\nabdominal and pelvic wall is within normal limits.", "output": "1. Large amount of stool within the rectum with associated mild thickening of\nthe rectal wall but no surrounding fat stranding, possibly representing\nstercoral colitis.\n2. Ground-glass opacities within the lower lobes bilaterally, likely\nreflecting pulmonary edema as seen on the recent chest radiograph. However,\naspiration or multifocal pneumonia is a consideration.\n3. 2.9 cm partially imaged right lower lobe lung nodule, which should be\nfollowed up with a chest CT.\n4. Extremely nodular appearing liver, which is new since ___,\nwhich should be correlated with any signs of cirrhosis.\n5. Numerous enlarged perihepatic lymph nodes, which are nonspecific but may be\ndue to underlying liver disease.\n6. Stable bilateral internal iliac artery aneurysms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The left lobe the liver extends very far laterally within the\nleft upper quadrant superior to the spleen. Within the lateral left hepatic\nlobe, there is a hypoattenuating lesion which is too small to completely\ncharacterize, but statistically likely a cyst or biliary hamartoma (02:16, and\n601b:24). Hypo attenuation in the medial aspect of segment IV adjacent to the\ngroove of the falciform ligament reflects a transient hepatic attenuation\ndifference related to perfusion. The liver otherwise demonstrates homogeneous\nattenuation throughout. There is mild intrahepatic biliary ductal dilatation\nwithout extrahepatic biliary ductal dilatation. The gallbladder is not\nwell-distended an apparent gallbladder wall thickening may be related to\nunderdistention.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA hypoattenuating lesion in the interpolar right kidney is too small to\ncompletely characterize, but statistically likely reflects a simple cyst\n(02:35). There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Evaluation of large and small\nbowel is limited by a paucity of intra-abdominal fat and a lack of oral\ncontrast. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. \nMinimal thickening of the cecal wall may be related to underdistention. The\nappendix is not definitively visualized, though a candidate is located on\nseries 300b, image 177. There is mild, ill-defined fat stranding in the\npelvis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted and unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Incidental note is made of an accessory right posterior hepatic\nvein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Evaluation of the large and small bowel is limited by a paucity of\nintra-abdominal fat and a lack of oral contrast. No evidence of appendicitis,\nthough the appendix is not definitively identified. Mild ill-defined fat\nstranding in the pelvis is nonspecific." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. Again seen is\ncalcification of the splenic artery overlying the body of the pancreas (2;\n23). There is no pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. A 7 mm stone is seen in the lower pole of the left kidney,\nsimilar to prior. Multiple cysts are seen in bilateral kidneys the largest is\nexophytic arising from the lower pole of the right kidney measuring 2.4 cm and\ncontains a thin calcified septation. A 2.2 cm cyst in the lower pole of the\nleft kidney may represent a dilated calyx and demonstrates rim calcification. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Extensive diverticulosis of the\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal. The rectum is seen extending 5 cm below the pubococcygeal\nline.\n\nPELVIS: There is a cystocele, with the bladder neck nearly 3 cm below the\npubococcygeal line. The distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. The vaginal apex is seen at the pubococcygeal line.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the lumbar spine. There is grade 1\nanterolisthesis of L4 on L5. There is grade 1 retrolisthesis of L1 on L2.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Pelvic floor dysfunction as described above.\n2. Numerous colonic diverticula without convincing evidence of diverticulitis.\n3. Stable 7 mm non-obstructing left renal stone." }, { "input": "The lung bases are clear. Limited imaging of the heart reveals no pericardial\neffusion or cardiomegaly.\n\nCT ABDOMEN: The liver enhances homogeneously. There are no focal liver\nlesions. The portal and hepatic veins are patent. There is no intra or\nextrahepatic biliary dilatation. The gallbladder is normal. The pancreas\nenhances homogeneously. The spleen and right adrenal gland are normal. The\nleft adrenal gland, if present, is not well evaluated due to metallic streak\nartifact from adjacent surgical clips/hardware. The patient is status post\nleft nephrectomy. The right kidney enhances and excretes contrast promptly.\nThere are no concerning renal lesions.\n\nThere is no retroperitoneal or abdominal adenopathy. No free air or free fluid\nis present. The aorta and its major branches are patent and not dilated. The\nduodenum is slightly prominent and fluid-filled without evidence of\nobstruction. There are multiple fluid-filled loops of small bowel in the\nabdomen, which are not pathologically dilated. There is no bowel wall\nthickening or evidence of focal obstruction. Mild mesenteric stranding is\npresent but no focal fluid collection is identified.\n\nCT PELVIS: There is extensive sigmoid diverticulosis. A small amount of\npelvic ascites limits evaluation for surrounding inflammatory change although\nthere is no abnormal bowel wall thickening or enhancement. There is no\ninguinal or pelvic adenopathy.\n\nOSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesion\nidentified. Multilevel degenerative changes are seen in the lumbar spine most\npronounced at the L1-2, L3-4, and L4-5 levels.", "output": "1. Multiple fluid filled loops of small bowel without dilation or abnormal\nbowel wall thickening. No evidence of focal obstruction. No focal fluid\ncollection.\n2. Extensive sigmoid diverticulosis with small amount of pelvic ascites but\nno evidence of inflammatory change of the bowel." }, { "input": "LOWER CHEST: Small bilateral effusions are similar to the prior examination.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains sludge and stones dependently, without\nwall thickening or pericholecystic fluid.\n\nPANCREAS: Mild fatty replacement of the pancreas noted. No concerning\npancreatic lesions or ductal dilatation. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are again noted to be atrophic. Bilateral cystic renal\nlesions are unchanged. 1.5 cm calcified lesion in the midpole of the right\nkidney is unchanged. No concerning renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Enteric tube terminates in the antrum of the stomach. \nPostsurgical changes are seen status post ileocecectomy. Dilated loops of\nsmall bowel are seen throughout the abdomen, many of which retain oral\ncontrast from the prior examination. Contrast is additionally noted in the\nrectum, descending, and proximal transverse colon, from rectal contrast\nadministration. Contrast pooling in the proximal colon is from a prior\ncontrast extravasation. No definite evidence for bowel obstruction. Findings\nare again consistent with ileus. Band-like adhesions noted (Image 29 and 30,\nseries 601) between small intestinal loops within the mid abdomen predispose\nthe patient for small bowel obstruction and therefore short interval follow-up\nradiographs to ensure resolution of the bowel dilatation are recommended. A\nfollow-up CT could also be performed based on clinical evaluation of the\npatient. Diverticulosis noted.\n\nPELVIS: Foley catheter noted in a decompressed urinary bladder. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Radiotherapy seeds noted in the prostate\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nSevere multilivel degenerative changes again noted. Sclerotic lesions\nthroughout the vertebrae and pelvis are unchanged.\n\nSOFT TISSUES: Fat containing periumbilical hernia noted. Diffuse stranding of\nthe subcutaneous tissues noted compatible with anasarca", "output": "Ileus pattern without definitive evidence for mechanical bowel obstruction at\nthis time. Interloop adhesions are present which predispose towards\nmechanical obstruction requiring short interval follow-up imaging to ensure\nresolution of the bowel dilatation.\n\nNOTIFICATION: Findings discussed with Dr. ___ by ___, M.D. at\n16:00 ___" }, { "input": "LOWER CHEST: Bibasal atelectasis, right greater than left. Trace right\npleural effusion.\n\nABDOMEN: Moderate volume simple ascites.\n\nHEPATOBILIARY: Morphologic features of cirrhosis. There are innumerable\nheterogeneously hypodense masses throughout both lobes of the liver in keeping\nwith biopsy proven hepatocellular carcinoma. The largest measures 3.6 cm in\nsegment 8 (axial series 201, image 44). The second largest measures 2.9 cm in\nsegment 6 (axial series 201, image 65). Lower density lesion within the left\nhepatic lobe near the dome (axial series 201, image 32) is of indeterminate\ndensity could represent a cyst or additional focus of disease. The hepatic\nand portal venous systems are patent. Hepatic arterial anatomy is\nconventional. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is nondistended with mild mural thickening. \nThere is a 4 mm radiopaque calculus in the region of the gallbladder neck. No\nspecific findings of ischemic bowel. In particular, bowel wall enhancement is\nmaintained. There is no pneumatosis or portal venous gas. No\npneumoperitoneum.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Borderline splenomegaly, measuring 12.4 cm.\n\nADRENALS: Nodular thickening of the left adrenal gland without discrete\nlesion. The right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Multiple ___ varices and gastric varices,\nsome of which are submucosal. The stomach is distended with areas of linear\nhigh attenuation which could reflect ingested contents or blood products. \nSmall sliding-type hiatus hernia. There is diffuse mural thickening and\nmucosal hyper enhancing involving the proximal small bowel as well as the\ncolon, likely reflecting portal enteropathy/colopathy. No distended bowel\nloops to suggest mechanical obstruction. Uncomplicated colonic\ndiverticulosis. The appendix is normal. Multiple anal varices are also noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Limited evaluation of the abdominal pelvic vasculature given\nrelatively late phase of study acquisition. However, the portal and hepatic\nvenous systems appear patent. The celiac trunk, SMA, and ___ are patent. \nMild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple hypodense masses scattered throughout both lobes of the liver. \nWhile it definitive imaging diagnosis of hepatocellular carcinoma cannot be\nmade on this single phase study, these findings would be consistent with\nmultifocal disease in the context of known biopsy-proven HCC.\n2. Cirrhotic liver with findings of portal hypertension, including ascites and\nportosystemic collaterals.\n3. Limited evaluation of the abdominal pelvic vasculature given relatively\nlate study acquisition. However, the major arterial and venous vessels are\npatent dense of occlusion/thrombosis or specific findings of ischemic bowel.\n4. No definite source of bleeding is identified, however material within the\nstomach may reflect ingested material versus blood products, particularly\ngiven the presence of multiple submucosal gastric wall varices. No evidence\nof hemoperitoneum." }, { "input": "CT abdomen without contrast: The liver is heterogeneous in density and\nnodular in contour compatible with cirrhosis. There is evidence of sequela of\nportal hypertension including small volume predominantly perihepatic ascites,\nsplenomegaly and varices formation. There are numerous scattered hepatic\nhypodensities, not fully characterized. There is no obvious biliary\ndilatation. Gallbladder is distended with possible layering sludge or tiny\nstones. No pericholecystic fat stranding.\n\nSpleen is grossly enlarged, measuring 18.5 cm, but otherwise unremarkable. \nPancreas and adrenal glands are grossly unremarkable. Hyperdense exophytic\n1.3 cm left upper pole renal lesion likely represents a proteinaceous or\nhemorrhagic cyst. Kidneys are otherwise grossly unremarkable without stone or\nhydronephrosis.\n\nStomach is unremarkable. Small bowel loops are normal caliber and\nunremarkable without evidence of obstruction. There is sigmoid predominant\ndiverticulosis without evidence for diverticulitis. Large bowel is otherwise\nunremarkable.\n\nThere are mild to moderate atherosclerotic calcifications along a normal\ncaliber abdominal aorta. There are scattered mildly enlarged porta hepatis\nlymph nodes measuring up to 12 mm in short axis, likely reactive to background\ncirrhosis. There are scattered top-normal retroperitoneal lymph nodes\nmeasuring up to 9 mm in short axis. There is no pneumoperitoneum. There is\nno loculated fluid collection. There is ill-defined fat stranding in the\nretroperitoneum min prevertebral distribution, with slight retroperitoneal fat\nstranding tracking into the pelvis.\n\nCT pelvis without contrast: Bladder is decompressed around a Foley catheter. \nRectal tube is in place. Prostate is grossly unremarkable. There is no free\npelvic air. There is no pelvic sidewall or inguinal lymphadenopathy.\n\nBones and soft tissues: There is endplate hypo attenuation at the L2-3 level,\nwhich in this clinical setting could reflect underlying early discitis at this\nlevel.", "output": "1. Cirrhotic appearing liver with sequela of portal hypertension including\nsplenomegaly, small ascites and varices formation.\n2. Numerous scattered hepatic hypodensities, not fully characterized.\n3. Small gallstones or sludge.\n4. 1.3 cm left upper pole dense renal lesion which likely represents a\nhemorrhagic or proteinaceous cyst.\n5. No organizing fluid collection or obvious infectious source given\nlimitations of a noncontrast exam. There is some retroperitoneal fat\nstranding which may be inflammatory, but no drainable fluid collection is\nseen.\n6. Endplate hypoattenuation and at the L2-3 level may reflect an additional\nsite of discitis osteomyelitis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 11:22 ___, 5 minutes after discovery of the\nfindings.\n The updated (impression#6) findings were discussed by Dr. ___ with\nDr. ___ on the ___ ___ at 8:58 AM, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: There is a moderate left and a small right pleural effusion,\nsimilar compared to the prior CT, with associated underlying atelectasis. \nPostsurgical changes are seen from prior coronary artery bypass surgery\nincluding metallic cerclage wires in the mediastinum. There has been a\ngastric pull up. Bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Mild intrahepatic biliary ductal dilatation appears similar\ncompared to the prior study. There is stable appearance of a 5.2 x 4.0 cm\nhypoattenuating lesion in the dome of the liver in segment VIII compatible\nwith either necrotic metastasis or biloma. Ill-defined lesions in the\ninferior tip of the right hepatic lobe are also similar in appearance. \nCentrally necrotic soft tissue nodule posterior to the main portal vein\nmeasuring 2.3 x 1.6 cm is not significantly changed, previously measuring 2.0\nx 1.8 cm, likely representing technical differences (5:60).\n\nMetallic biliary stent is unchanged in position and contains hypodense\nmaterial. A the inferior PTB D is similar in appearance and position draining\nthe right hepatic duct. The more superior PTB D has been retracted\napproximately 2.0 cm with 1 of the side ports now at the level of the ribs\n(05:52). Both biliary drains course through the right metallic stent with\nTIPS appropriately positioned in the duodenum. The gallbladder is collapsed\nand filled with contrast. There is mild perihepatic free fluid which\npartially surrounds the gallbladder.\n\nPANCREAS: The pancreas is atrophic. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Focal thickening of the left adrenal gland is unchanged. The right\nadrenal gland is normal in shape and size.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Status post esophagectomy with gastric pull up. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the colon is noted, without evidence of wall thickening and\nfat stranding. There is a small amount of ascites in the abdomen and pelvis,\nslightly decreased compared to the prior study\n\nPELVIS: . There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable left lower chronic rib fracture (healed). Degenerative changes are\nseen in the spine. Grade 1 anterolisthesis of L5 on S1 related to\ndegenerative facet hypertrophy. Stable T11 compression deformity.\n\nSOFT TISSUES: Diffuse anasarca.", "output": "1. The superior PTBD has been pulled back approximately 2.0 cm and the last\nside hole is within the body wall between the ribs. The inferior PTBD is\nunchanged in position.\n2. Hepatic mets are not significantly changed compared to the prior study.\n3. Similar appearance of a metastatic lesion posterior to the main portal\nvein.\n4. Small right and moderate left pleural effusions are similar.\n5. Slight interval decrease in the degree of ascites in the abdomen, now\nsmall.\n6. Diffuse anasarca." }, { "input": "LOWER CHEST: Please refer to the same-day CT chest exam for full description\nof intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 1.6 cm\nhypodensity in the right lower renal pole, likely simple cysts. A duplicated\ncollecting system is noted on the right with convergence along the mid ureter.\nThere is no evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: 2 enteric tubes are seen; one terminates in the stomach, and\nthe other extends to the gastroduodenal junction. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed by Foley catheter. There is no\ndistal hydroureter. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small foci of edema are seen in the anterior abdominal wall,\nlikely injection sites.", "output": "1. No acute CT findings in the abdomen or pelvis to correlate with patient's\nreported symptoms. Specifically, no evidence of small-bowel obstruction or\nintra-abdominal fluid collection concerning for abscess.\n2. A duplicated collecting system is noted on the right with convergence along\nthe mid ureter. No evidence of hydronephrosis." }, { "input": "LOWER CHEST: Visualized lung fields are notable for bibasilar atelectasis. \nThere is no evidence of pleural or pericardial effusion. Heart size is\ntop-normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 6\nmm hypodensity in segment III and a 3 mm hypodensity in segment IV a are too\nsmall to characterize on CT but were previously characterized on MRI as simple\ncysts. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 2.0 x 1.6 cm right hypodense adrenal nodule was previously\ncharacterized on MRI as an adenoma. There is a 5 mm nodule in the body of the\nleft adrenal, also characterized on MRI as an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. A 9 mm hypodensity in the interpolar\nregion of the left kidney is too small to characterize on CT. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications are seen within uterus, likely\nrepresenting calcified fibroids. No adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The distal abdominal aorta\nis mildly ectatic. Extensive atherosclerotic disease is noted. There are\nprominent left pelvic veins.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\n6 mm sclerotic lesion in the anterior anterior vertebral body of L5 and a 3 mm\nsclerotic lesion in the vertebral body of L2 likely represent bone islands. \nAdditional sclerotic lesions in the right wing of the sacrum an in the left\nlateral body of the iliac also likely represent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is\na 3 mm calcific lesion in the soft tissues overlying the left gluteal muscles.", "output": "1. No acute intra-abdominal findings to explain the patient's symptoms.\n2. Bilateral adrenal adenomas are better characterized on prior MR from ___." }, { "input": "LOWER CHEST: Lung bases are clear. The imaged portion of the heart is\nunremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally without focal concerning lesion. \nMild intrahepatic biliary ductal dilation likely reflect prior\ncholecystectomy. The main portal vein is patent.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: Spleen is normal in size without focal lesion.\n\nADRENALS: Both right and left adrenal gland appear normal.\n\nURINARY: Kidneys enhance symmetrically and excrete contrast promptly. There\nis no worrisome focal renal lesion, hydronephrosis or signs of pyelonephritis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is decompressed. The duodenum is unremarkable. \nThere is small bowel dilation which can be traced to a point of abrupt caliber\ntransition in the mid abdomen on series 601b, image 25. Distal to this point,\nthere is decompressed small bowel. There is minimal adjacent ascites. No\nfree air. The colon contains a mild fecal load with a thin wall and no signs\nof acute inflammation. Appendix not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal masses seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Small bowel obstruction, transition point in the mid abdomen, small volume\nascites.\n\nNOTIFICATION: Findings were discussed with Dr. ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. There is a small\nperiampullary duodenal diverticulum (5:29). Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. No adnexal\nabnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are mild multilevel degenerative changes in the visualized spine\nincluding mild anterolisthesis of L4 on L5. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute process in the abdomen or pelvis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Again, multiple metastatic lesions are noted scattered\nthroughout both lobes of the liver. Comparison is somewhat challenging due to\ndifferent scan techniques. On the whole, the appear to have decreased in\nsize. As an example, the largest previously seen lesion was in segment 7,\nnear the dome of the liver. It measured 2.4 x 2.6 cm. On today's\nexamination, that same lesion measures 1.4 x 1.7 cm.\n\nSimilarly, a previously seen lesion near the portal vein bifurcation which\nmeasured 1.7 x 2.2 cm now measures 1.4 x 1.1 cm.\n\nOtherwise the gallbladder and biliary tree are within normal limits.\n\nPANCREAS: The patient's primary pancreatic mass lesion is once again\nvisualized in the uncinate process. It measures approximately 1.4 x 2.2 cm. \nPreviously, it measured 1.9 x 2.8 cm. The primary lesion has also shown\ninterval decrease in size.\n\nThe lesion abuts the superior mesenteric vein over a less than 180 degrees,\nwithout definite extension or involvement.\n\nThe celiac trunk and its major branches as well as the superior mesenteric\nartery are not involved.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Visualized small and large bowel loops are within normal\nlimits.\n\nNo size significant mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: 3 new subcentimeter sclerotic foci are noted within\nthe sacrum. Although these are concerning for new metastases, they may also\nbe related to sclerotic change from treatment response of previously all cold\nlesions, given the remainder of the findings.", "output": "1. Response to therapy of both the metastatic liver lesions and the primary\npancreatic lesion, with decrease in size as detailed above.\n2. Three new subcentimeter sclerotic foci within the sacrum, which may either\nbe due to new metastatic lesions or treatment response of previously of occult\nlesions. Continued follow-up is recommended." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. A separate chest CT is performed\nand will be reported individually.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a nodular contour of the liver consistent with up\npseudo cirrhosis several ill-defined and less conspicuous focal hepatic\nlesions are again identified consistent with metastatic disease. There is a\ndecrease in the conspicuity of the lesions and also overall in the size of the\nlesions. For example the breast identifiable lesion in segment 4 a measures\non the current study 2 x 1.9 cm while it measured 2.4 x 2.7 cm previously. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: There is decreased conspicuity of the pancreatic head mass which on\nthe current study appears to measure 15 mm. Previously the mass was measured\nas 16 x 17 mm. The mass abuts the SMV with there is no distortion. The\nremainder of the peripancreatic vasculature is unremarkable. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa normal in size for the age of the\npatient.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: 2 focal osteoblastic lesions are again identified. Within the sacrum. \nThey appear more conspicuous and hyper dense when compared to the prior study\nwhich may represent treatment effect. The largest 1 is slightly increased in\nsize and measures now 9.7 mm while it only measured 7 mm previously. The\nsecond sacral lesion measures 7.9 mm while it measured 6.5 mm previously. \nAlso the small punctate foci within the lower lumbar spine appear slightly\nmore conspicuous on the current study.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval slight decrease in size and conspicuity of the hepatic metastatic\nlesions and pancreatic head mass. 2. Slight increase in size and conspicuity\nof the bone lesions as described above. In light of the overall decrease in\nthe hepatic burden an pancreatic head mass this increase conspicuity most\nlikely represent treatment effect. Short-term follow-up is recommended." }, { "input": "LOWER CHEST: A 3-mm right lower lobe perifissural nodule and left lower lobe\nnodule are unchanged (series 2, image 4, 1). No new pulmonary masses or\nsuspicious nodules are identified in the partially imaged lower lungs. A 7-mm,\nround epicardial lymph node appears new (series 2, image 5). Hypoattenuation\nof the cardiac blood pool suggests anemia. No evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:\nStreak artifact from the fiducial markers surrounding the two treated hepatic\nlesions limits accurate assessment of lesions size. Two fiducial markers\nspanning the biopsied and treated segment 8 lesion is overall unchanged or\nminimally decreased in size, now 1.6 x 1.2 cm (was 1.8 x 1.7 cm on ___\nwith surrounding hypoenhancement likely reflecting perfusional change (series\n4, image ___. The segment 6 lesion surrounded by 2 fiducial markers\nmeasures 1.9 x 1.8 cm and is minimally changed when accounting for differences\nin measurement technique (previously 2.2 x 2.1 cm on ___ (series 4, image\n32).\nNumerous other hypodense hepatic lesions persist with increased peripheral\nenhancement and definition since the pre-treatment scan. Some of these lesions\nare larger, others unchanged, and others are new. Index examples include: A\n2.7 x 2.2-cm segment 6 lesion previously measured 0.9 x 0.7 cm (series 4,\nimage 54); a 1 x 0.7 cm lesion abutting the falciform ligament is new (series\n4, image 28); a 0.7 cm segment 8 peripheral lesion is unchanged (series 4,\nimage 28). Intrahepatic ductal dilation persists.\n\nThe gallbladder is within normal limits and decompressed. No ascites.\n\nPANCREAS: Soft tissue hypoenhancing density in the region of the known\npancreatic uncinate tumor now measures 1 mm, previously 15 mm in ___ and\nwas not clearly FDG avid on the PET CT from ___ (series 4, image 50;\nseries 6, image 21). There is less than 180 degrees contact with the SMV,\nunchanged. The remaining pancreatic parenchyma enhances normally without\nevidence of main pancreatic duct dilation or distal atrophy. A 2-mm hypodense\nlesion in the pancreatic body was not definitely appreciated on prior exams,\npotentially side branch IPMN (series 6, image 19).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Slightly nodular medial limb of the left adrenal gland is unchanged\nsince at least ___ (series 6, image 39). The right adrenal gland is\nnormal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nA tiny left upper renal pole cortical hypodensity is too small to\ncharacterize. No concerning focal renal lesions. No hydronephrosis or\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nunremarkable. No bowel obstruction.\n\nPELVIS: The reproductive organs are unremarkable. No free fluid in the pelvis.\nThe urinary bladder is under-distended.\n\nLYMPH NODES: No evidence of retroperitoneal or mesenteric lymphadenopathy. \nNo evidence of pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No upper abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted. The main, left, and right portal veins appear patent. Hepatic veins\nare patent. The peripancreatic vessels are patent. The proximal segment of\nthe SMV just distal to the confluence with the portal vein still contacts the\nsoft tissue density of the pancreatic uncinate process with less than 180\ndegrees contact (series 4, image 50).\n\nBONES: S2 sclerotic lesions are overall unchanged from ___. Multiple\nsmaller sclerotic lesions are also overall unchanged (series 7, image 32, 45,\n46, 27, 29, 51, 55, 56,82, 91). No pathologic fracture.\n\nBackground multilevel degenerative changes are moderate with mild\nanterolisthesis of L3 on L4 and mild retrolisthesis of L1 on L2.\n\nSOFT TISSUES: The abdominal and pelvic walls are unremarkable.", "output": "1. Treated segment 6 and 8 hepatic lesions are overall unchanged if not\nminimally decreased since ___, difficult to precisely measure given streak\nartifact.\n\n2. Other numerous hepatic hypodense lesions which have not been treated show\nincreased peripheral enhancement and have either grown in size or remained\nunchanged. Of note, a 2.7 x 2.2-cm segment 6 lesion has grown substantially,\npreviously measuring 0.9 x 0.7 cm.\n\n3. An 1-cm lesion abutting the falciform ligament is new.\n\n4. Soft tissue density in the uncinate of the pancreas has slightly decreased\nand still abuts the SMV with < 180 degrees contact.\n\n5. Patent peripancreatic and hepatic vasculature.\n\n6. Osseous sclerotic lesions are overall unchanged without pathologic\nfracture." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is a moderate-size epigastric, fat containing hernia noted\nwithout bowel involvement.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple, immeasurable, well-circumscribed areas of hypoattenuation noted\nthroughout the liver that appear slightly larger and more numerous than in the\n___ study. Although these lesions are still too small to characterize, they\nare remain consistent with cysts. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. Innumerable gallstones noted without\ninflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There is no perinephric abnormality. \nMultiple bilateral renal calculi noted, with dominant conglomerate of stones\nremaining in the lower pole of the left kidney. There are bilateral simple\nrenal cysts, which are mildly enlarged when compared to ___.\n\nGASTROINTESTINAL: Small hiatal hernia noted. The stomach is unremarkable. \nAgain re- demonstrated is an asymmetric distribution of small bowel of the\nleft abdomen with fatty infiltration throughout multiple parts of the bowel\nwall, compatible with a history of Crohn's disease. Further, terminal ileum\nwall thickening and increased enhancement seen in some ileal loops that may be\nsuggestive of some acute disease. No fat stranding noted. However, there are\nmultiple enhancing, thin bands of soft tissue seen projecting from the\nterminal ileum to the cecum, raising the possibility of an enteroenteric\nfistula. MRE may be performed if further outlining or confirmation\nappropriate.\n\nDescending and sigmoid colon diverticulosis without signs of inflammation. \nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Mildly enlarged prostate noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Focal area of dissection of proximal right common iliac artery,\nstable from ___ exam.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Signs of possible acute on chronic inflammation at the terminal ileum with\ntethering from the terminal ileum to the cecum, raising the question of\nenteroenteric fistulas. This could be better characterized with MRE.\n2. Moderate size, umbilical hernia containing omentum.\n3. Slightly larger and more numerous liver hypodensities noted, consistent\nwith cysts.\n4. Chronic short focal area of dissection noted in proximal right common iliac\nartery, stable from ___ exam.\n5. Multiple renal cysts noted bilaterally as well as bilateral nephrolithiasis\nredemonstrated.\n\nRECOMMENDATION(S): Recommend MRE to further characterize inflammation and\npossible enteroenteric fistula at terminal ileum and cecum.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:17 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: There is right greater than left basilar atelectasis. Otherwise,\nthe visualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Re-demonstrated are multiple well-circumscribed hypoattenuating\nlesions throughout the hepatic parenchyma which are too small to characterize\nbut likely represent simple hepatic cysts or biliary hamartomas. The liver\notherwise demonstrates homogeneous attenuation throughout. No concerning focal\nlesions are identified. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder contains innumerable gallstones without\nwall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A punctate accessory spleen is seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is delayed nephrogram on the left with moderate left-sided\nhydronephrosis and proximal hydroureter with an obstructing 10 mm stone in the\nmidportion of the left ureter (601:40). Multiple other non-obstructing renal\ncalculi are seen within the left kidney. There is no the left-sided\npyelonephritis. There is left-sided perinephric fat stranding, with a small\namount of fluid which may represent an element of forniceal rupture. A\nwell-circumscribed hypodensity at the inferior pole of the left kidney\nmeasuring 3 cm is slightly larger as compared to the prior exam, and likely\nrepresents a simple renal cyst. Bilateral other smaller simple appearing\ncysts are seen. The right kidney demonstrates normal corticomedullary\ndifferentiation with normal nephrogram and without evidence of hydronephrosis,\nconcerning focal lesions or perinephric fat stranding.\n\nGASTROINTESTINAL: A small hiatal hernia is again seen. The stomach is\nunremarkable. Re-demonstrated is asymmetric distribution of small-bowel\nwithin the left abdomen secondary to fibrofatty proliferation and separation\nof bowel loops in the right lower quadrant as well as intramural fat\ndeposition throughout multiple parts of the colon compatible with chronic\ninflammatory bowel disease. As before, there is mild wall thickening and\nsegmental areas of mucosal hyperemia with adjacent prominence of the Vasa\nrecta within an approximately 30 cm segment of the terminal and distal ileum,\nsimilar in distribution to the prior study. Several skip areas of relatively\nnormal appearing small bowel are seen in this disease segment. Findings are\nconsistent with active on chronic inflammatory bowel disease similar in\nappearance to the prior exam. There is no fistula, abscess, or obstruction. \nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Re-demonstrated is a mildly enlarged prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Again seen is a focal area of dissection at the proximal right\ncommon iliac artery, stable as compared to the prior (02:52).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Re-demonstrated is a moderate to large fat containing\nperiumbilical hernia with associated fat stranding similar appearance to the\nprior exam (02:54).", "output": "1. Moderate left-sided hydroureteronephrosis with an obstructing 10 mm stone\nin the midportion of the left ureter. Small amount of perinephric fluid may\nrepresent an element of forniceal rupture.\n2. Multiple other non-obstructing renal calculi are seen within the left\nkidney.\n3. Evidence of active on chronic inflammation within the distal and terminal\nileum, compatible with patient's known history of Crohn's. There is no\nevidence of obstruction, abscess, or fistula. Similar in appearance as\ncompared to the prior study.\n4. Focal area of dissection in the proximal right common iliac artery,\nunchanged." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries. Moderate stenosis of the\norigins of the celiac axis and superior mesenteric arteries which remain\nwidely patent distally, (series 5, image 68), unchanged from prior. The\ninferior mesenteric artery is widely patent. Incidental note is made of a\ncircumaortic left renal vein.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases, otherwise the\nlungs are clear. There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS:The previously described ill-defined pancreatic lesion in the\npancreatic body on MRCP and on endoscopic ultrasound is not well demonstrated\non current CT. The main pancreatic duct demonstrates an abrupt cut off within\nthe distal pancreatic body with mild interval increase of upstream dilation of\nthe main pancreatic duct in the body and tail measuring up to 5 mm, (series 4,\nimage 25). Additionally there is atrophy of the pancreatic parenchyma. There\nis no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Inferolateral to the splenic hilum is a 1.6 cm\nsoft tissue nodule which enhances similarly to the spleen consistent with an\naccessory spleen.\n\nADRENALS: Extending from the medial limb of the left adrenal gland is stable\nhypoattenuating lesion which was previously characterized as an adrenal\nadenoma on MRCP dated ___. It approximately measures 1.6 x 0.7 cm in\naxial dimension, (series 2, image 24) slightly increased in size when compared\nto prior CT abdomen and pelvis dated ___ but unchanged when\ncompared to prior CT abdomen dated ___. The right adrenal gland\nis normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small hiatal hernia, otherwise the stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nLymph nodes: There are numerous well-circumscribed mesenteric and\nretroperitoneal lymph nodes that do not meet CT criteria for lymphadenopathy. \nNo pelvic or inguinal adenopathy is demonstrated.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The previously described ill-defined lesion within the pancreatic body on\nand endoscopic ultrasound is not well demonstrated on CT.\n2. The main pancreatic duct demonstrates an abrupt cutoff in the pancreatic\nbody with mild interval increase of upstream ductal dilation and pancreatic\nparenchymal atrophy. These findings remain suspicious for malignancy. No\nevidence for vascular invasion. No evidence for metastatic disease\n3. No evidence of lymphadenopathy in the abdomen and pelvis.\n4. No interval change in size of a left adrenal adenoma." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: For full description of the lung bases please refer to chest CT\nreport from the same day.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The patient is status post distal pancreatectomy. Previously\ndescribed soft tissue thickening surrounding the hepatic artery is decreased\nin size currently measuring 1.9 x 1.1 cm on series 3 ___ 40 compared to 3.2 x\n2.0 cm previously. Or where previously measured anterior to the common\nhepatic artery on series ___ for it measured 1.7 cm and currently measures\n0.8 cm. Soft tissue stranding previously observed surrounding the ___ is no\nlonger present.\n\nSPLEEN: The patient is status post splenectomy.. A 1.1 cm soft tissue nodule\nin the surgical bed is most consistent with a splenule. This is stable. \nThere is seen on series 4 ___ 112.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is a 1.5\ncm nodule in the left adrenal gland on series 4 ___ 111 which is stable and\nconsistent with an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid renal lesions, or hydronephrosis. A\npunctate hypodense lesion in the left kidney series 4 ___ 117 is too small to\ncharacterize but most consistent with a cyst. There are no urothelial lesions\nin the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Decrease in size of soft tissue density surrounding the common hepatic\nartery\n2. Soft tissue stranding surrounding the ___ has resolved. No new lesions seen\n3. Stable left adrenal adenoma\n4. For full description of the lung bases please refer to chest CT report from\nthe same day." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (05:52). There is\nmoderate stool burden throughout the colon and rectum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "1. Moderate stool burden throughout the colon and rectum.\n2. Small umbilical hernia containing fat." }, { "input": "CT OF THE ABDOMEN: LUNG BASES DEMONSTRATE DEPENDENT ATELECTASIS AND A BULLA\nINVOLVING THE RIGHT MIDDLE AND RIGHT LOWER LOBES.\n\nLIVER IS HOMOGENEOUS, NO FOCAL MASSES, NO DILATED INTRAHEPATIC BILIARY\nRADICLES. THE GALLBLADDER IS UNREMARKABLE. THE KIDNEYS, ADRENAL GLANDS, SPLEEN\nAND VISUALIZED LOOPS OF LARGE SMALL BOWEL APPEAR UNREMARKABLE AS DOES THE\nPANCREAS. THERE IS NO FREE FLUID, THERE IS NO ADENOPATHY. 1 NO OF A CIRCUM\nAORTIC LEFT RENAL VEIN 2\n\nCT OF THE PELVIS: SOME DIVERTICULOSIS, BOWEL LOOPS ARE OTHERWISE UNREMARKABLE,\nPROSTATIC ENLARGEMENT AND CALCIFICATION ARE UNCHANGED. THERE IS NO FREE FLUID.\nSMALL RIGHT INTERNAL ILIAC LYMPH NODES ARE UNCHANGED AND DO NOT MEET SIZE\nCRITERIA FOR PATHOLOGIC ENLARGEMENT.\n\nBONE WINDOWS DEMONSTRATE SIGNIFICANT DEGENERATIVE CHANGES. THERE IS A\nSCLEROTIC FOCUS AT L4 WHICH IS UNCHANGED COMPARED TO THE PRIOR EXAM. THIS\nPROBABLY REPRESENTS A BONE ISLAND, PLEASE CORRELATE WITH CURRENT BONE SCAN\nBEING PERFORMED TODAY.", "output": "1. NO EVIDENCE OF METASTATIC DISEASE IN THIS PATIENT WITH KNOWN PROSTATE\nCARCINOMA. NO CHANGE COMPARED TO THE EXAM OF ___.\n2. MULTIPLE CHRONIC CHANGES INCLUDING DIVERTICULOSIS, PROSTATIC ENLARGEMENT\nAND CALCIFICATION, SCLEROTIC FOCUS AT L4, BULLA INVOLVING THE RIGHT LUNG." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nappears top normal in size with mild to moderate coronary artery\ncalcifications seen.\n\nABDOMEN: The liver enhances normally without concerning focal lesion. The\nmain portal vein appears patent. There is persistent intrahepatic and\nextrahepatic biliary ductal dilation which appears slightly progressed from\nthe prior CT and MRI and is of unclear etiology. Differential considerations\ninclude CBD stricture, ampullary stenosis or dysfunction of the sphincter of\nOddi. The pancreas appears normal. No pancreatic ductal dilation or signs of\ninflammation. The spleen is normal in size. Adrenals are normal bilaterally.\nThe kidneys enhance symmetrically. No concerning renal lesion or\nhydronephrosis. There is a simple appearing cyst arising from the left\ninterpolar region measuring 14 mm. The abdominal aorta contains moderate\natherosclerotic calcification. There is no aortic aneurysm. There is no\nretroperitoneal lymphadenopathy. The stomach appears normal. There is mild\nfluid distention of the duodenum.\n\nPELVIS: Patient has undergone prior total proctocolectomy with end ileostomy\nin the left lower quadrant abdominal wall. Small bowel loops are dilated and\ncan be traced to a point of relative caliber transition in the right lower\nquadrant on series 2, image 70 and series 601, image 33. Fecalized content is\nseen just proximal to the transition point. Distal small bowel is fully\ndecompressed through the level of the stoma. There is a small bowel\ncontaining parastomal hernia. No bowel wall thickening. No free fluid or\nfree air.\n\nThe urinary bladder is decompressed. The uterus is unremarkable. There is no\nadnexal mass. No pelvic sidewall or inguinal adenopathy.\n\nBONES: No worrisome lytic or blastic osseous lesion. Facet arthropathy is\nnoted in the lower lumbar spine.", "output": "1. Small-bowel obstruction with transition point in the right lower quadrant\nlikely due to postsurgical adhesions.\n2. Status post total proctocolectomy with end ileostomy in the left lower\nquadrant body wall. Small peristomal small bowel containing hernia.\n3. Worsening intrahepatic and extrahepatic biliary ductal dilation which may\nbe due to CBD stricture, ampullary stenosis or sphincter of Oddi dysfunction. \nIf clinically warranted, an MRI may be performed to further assess on a\nnonemergent basis." }, { "input": "LOWER CHEST: Motion artifact limits evaluation of the lung bases. There is no\npleural effusion or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and contour. There is colonic diverticulosis without evidence\nof acute diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No CT findings within the abdomen or pelvis to account for the patient's\nsymptoms." }, { "input": "LOWER CHEST: There is diffuse cystic disease throughout the lung bases,\nconsistent with interstitial lung disease. There is no evidence of pleural or\npericardial effusion. There is extensive calcification of the aortic valve,\nmitral annulus and coronary arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout. There are 2 sub 5\nmm low-attenuation lesions in the neck of the pancreas (02:25), likely\nrepresenting side-branch IPMNS. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple simple cysts in the bilateral kidneys. Other\nsubcentimeter hypodense lesions are too small to characterize. The kidneys\nare of normal and symmetric size with normal nephrogram. There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Extensive\ndiverticulosis without evidence of diverticulitis. Large colonic stool\nburden. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A vaginal pessary is noted. No CT evidence of an uterine\nor ovarian mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Extensive multilevel degenerative changes of the imaged spine. There\nis grade 1 retrolisthesis of L3 on L4 and L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No findings to explain patient's symptoms. No evidence of an uterine or\novarian mass. Evaluation for endometrial carcinoma would be better evaluated\nwith ultrasound or biopsy.\n2. Extensive multilevel degenerative changes of the imaged spine including\ngrade 1 retrolisthesis of L3 on L4 and L4 on L5.\n3. Extensive calcification of the aortic valve, mitral annulus and coronary\narteries.\n4. Stable diffuse cystic disease throughout the lung bases, consistent with\nthe patient's known interstitial lung disease." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains contrast material which has been likely\ndue to vicarious excretion. There is no significant distention or wall\nthickening.\n\nPANCREAS: The pancreas is slightly atrophic and anteriorly displaced by the\naneurysmal sac similar to the prior study. Pancreatic parenchyma is\nsuboptimally assessed.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size. Note is made of\nretained contrast within kidneys from previous IV contrast administration\nsuggestive of renal dysfunction. There is a right-sided double-J catheter. \nThere is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Proximal small bowel loops are\nunremarkable. Small bowel loops in the pelvis are not well evaluated as\ncontrast had not reached them at the time of the scan, and due to surrounding\nfree fluid in the pelvis. Some of these loops may be slightly wall thickened,\nor possibly just underdistended. There is no evidence of pneumatosis. Large\nbowel is unremarkable within the limitations of the study.\n\nPELVIS: The urinary bladder is collapsed around a Foley catheter.\n\nThere is small amount of free fluid in the pelvis with some mildly increased\ndensity dependent component which may reflect debris or small amount of\nhemorrhagic component. There is no free intraperitoneal air.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nCoarse calcifications along the right lateral aspect of the urethra is again\nnoted and unchanged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:\nPatient is status post repair of an abdominal aortic aneurysm. The aneurysmal\nsac is stable in size measuring 6 x 8 cm. Small amount of postoperative air\nis noted within the sac. Patency of the aortic stent, mesenteric artery and\nrenal arteries could not be assessed in the absence of IV contrast.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild diffuse body wall edema.", "output": "1. Limited study for evaluation for mesenteric ischemia due to absence of IV\ncontrast. No pneumatosis is seen. Possible mildly thick walled small bowel\nin pelvis (nonspecific). Although specific features for bowel ischemia are\nnot identified, this is not excluded by this study.\n2. Status post aortic aneurysm repair. Small amount of air within the\naneurysm sac is likely postoperative. This noncontrast exam does not provide\nassessment for patency of vascular structures.\n3. New ascites with small amount of dependent increased density material may\nrepresent debris or small hemorrhagic component.\n4. Please see separate CT chest for details of intrathoracic findings." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post right hepatectomy for living donor\ntransplant. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: The portal, splenic and superior mesenteric veins are patent. There\nis no abdominal aortic aneurysm. There is no calcium burden in the abdominal\naorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not visualized. The appearance of the vaginal\ncuff is unchanged. Adnexa is within normal limits with dominant follicles in\nthe right ovary measuring up to 1.9 cm in size, which is seen normal\nphysiologic finding in a patient of this age.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Intrathoracic findings are separately reported." }, { "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Residual enteric contrast is seen in\nthe colon, which is normal in appearance. Appendix has normal caliber without\nevidence of fat stranding. There is minimal, if any, residual free air from\nthe patient's recent surgery.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are not visualized. There is trace\nfree fluid in the pelvis, likely physiologic.\nREPRODUCTIVE ORGANS: Uterus is not visualized. Adnexa is within normal limits.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. There is mild to moderate\nsubcutaneous fat stranding and no residual subcutaneous emphysema of the\npatient's umbilical laparoscopic port site, which is decreased from the prior\nCT. No focal fluid collection is seen. There is a small 3.7 cm fat containing\nsupraumbilical hernia with a stoma measuring 6 mm (08:37) without significant\nfat stranding.", "output": "1. Uncomplicated fat containing supraumbilical hernia.\n2. Decreased fat stranding at the umbilical port site without focal fluid\ncollection.\n\nNOTIFICATION:\nPreliminary findings were discussed by Dr. ___ with Dr. ___\ntelephone during initial review at 0523 on ___." }, { "input": "LOWER CHEST: There is moderate left greater than right dependent atelectasis\nin the bilateral lower lobes. There is no pleural pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel is normal in\ndiameter and wall thickness. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abdominal or pelvic process." }, { "input": "CT OF THE ABDOMEN AND PELVIS WITH IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nNo concerning hepatic mass is detected. There is no intra or extrahepatic bile\nduct dilation. The gallbladder is normal.\n\nThe pancreas demonstrates normal density and bulk. No pancreatic mass or duct\ndilation is detected.\n\nThe spleen size is normal. No splenic lesion is identified.\n\nThe adrenal glands are normal. the kidneys enhance symmetrically, and there\nis no collecting system obstruction. Arising from the interpolar aspect of the\nleft kidney is a 19 x 13 mm hypodense lesion, minimally changed since the\nearliest available comparison CT examination from ___, likely a\nbenign cyst. A 10 mm partially exophytic cortically based hypodense lesion\ncomatose is statistically likely a cyst, also appears stable since ___\n(series 2, image 22). No solid or new renal mass is identified.\n\nA small hiatal hernia is present (series 2, image 8). Focal gastric wall\nthickening adjacent to the gastroesophageal junction (series 2, image 11) may\nreflect focal underdistention but is difficult to differentiate from a focal\nmass (series 601b, image 30). Intra-abdominal and intrapelvic loops of small\nand large bowel are are normal. The appendix is normal (series 2, image 50).\n\nNumerous tiny retroperitoneal and pelvic sidewall lymph nodes are well under\ncross-sectional criteria for lymphadenopathy.\n\nThe abdominal aorta, celiac trunk, SMA, and renal arteries are patent and\nnormal in caliber. The portal and hepatic veins are patent.\n\nThe prostate is markedly enlarged, measuring 6.5 x 6.3 by 5.7 cm (series 2,\nimage 65, series 601b image 31), with moderate mass effect on the bladder.\n\nThere are no osseous lesions concerning for malignancy or infection.", "output": "1. Markedly enlarged prostate.\n2. Small pelvic and retroperitoneal lymph nodes are well under size criteria\nfor lymphadenopathy.\n3. Nonspecific focal thickening of the proximal stomach, adjacent to the\ngastroesophageal junction. While this could represent underdistention or\nperistalsis, underlying mass cannot be excluded. Correlation with any recent\nhistory of dysphasia is recommended, and EGD could be considered, especially\ngiven history of two malignancies (lung and prostate).\n4. Small hiatal hernia.\n\nNOTIFICATION: The impression was placed on the critical findings dashboard by\nDr. ___ on ___." }, { "input": "Optimal evaluation of organ pathology and vasculature is limited without the\nbenefit of intravenous contrast.\n\nLOWER CHEST: There is minimal bibasilar atelectasis. There is no pleural or\npericardial effusion. Aortic valve and coronary artery calcifications are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal gland is normal in size and shape. There is a\nlinear area calcification within a full appearing right adrenal gland,\npossibly indicative of prior adrenal hemorrhage.\n\nURINARY: The native kidneys are atrophic with nonspecific adjacent fat\nstranding. A transplanted kidney in the right pelvis appears grossly\nunchanged noting a metallic density at its upper pole. The known renal cell\ncarcinoma mass is not well characterized (03:49) within the confines of this\nunenhanced study. There is no hydronephrosis, hydroureter, or\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is diverticulosis without\nevidence of diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small,\ncalcified uterine fibroids are noted. There is no free fluid the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small, fat containing umbilical hernia. The upper\nabdominal contents, including the liver, abnormally protrude between the\ninferior ribs, but within the confines of the anterior abdominal wall (03:23).", "output": "1. No etiology is identified for the patient's symptoms.\n2. Known renal cell carcinoma is not well characterized within the confines of\nthis unenhanced study. It is better appreciated on MRI obtained ___." }, { "input": "LOWER CHEST: Several punctate nodules are seen in the right lower lobe (2: 3,\n4), unchanged from ___. No focal consolidations are noted. There is\nno evidence of pleural or pericardial effusion. Moderate coronary artery\ncalcifications are seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal gland is normal. A linear area of calcification is\nagain seen in the right adrenal gland, which may represent sequela of prior\nhemorrhage.\n\nURINARY: The native kidneys are atrophic, with nonspecific perinephric fat\nstranding, similar to prior. A transplanted kidney is again seen in the right\nlower pelvis and appears grossly unchanged. Fiducial markers in the upper\npole are unchanged. The biopsy confirmed renal cell carcinoma at the upper\npole of the transplanted kidney is not well visualized due to streak artifact\nfrom the clips. There is no hydronephrosis. There is no nephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal (2:52).\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Calcified fibroids are noted in the uterus. The\nbilateral adnexa are unremarkable.\n\nLYMPH NODES: There is no abdominal, pelvic or inguinal lymphadenopathy by CT\nsize criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "1. No acute findings in the abdomen or pelvis to correlate with patient's\nsymptoms.\n2. Known renal cell carcinoma in the upper pole of the transplanted kidney is\nnot well visualized on this exam.\n3. Extensive vascular calcifications." }, { "input": "LOWER CHEST: Mild bibasal atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable within the limits of the unenhanced\nstudy. There is no evident biliary dilation. The gall bladder is not\nvisualized.\n\nPANCREAS: Unremarkable. There is no peripancreatic stranding.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Both adrenals are diffusely bulky. There are stable calcifications\non the right.\n\nURINARY:\n\nThere is stable mild atrophy of the bilateral native kidneys.\n\nThe right lower quadrant transplant kidney appears overall similar to the\nprevious study and there is no hydronephrosis. The known interpolar cortical\nmass is not well-defined without IV contrast but appears grossly similar in\nsize to the previous MRI, estimated at 3.7 cm. There are mild postsurgical\nchanges in the right lower quadrant, unchanged from prior.\n\nGASTROINTESTINAL: Prominent lipomatous tissue around the ileocecal valve. \nOtherwise unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are multiple small calcified uterine fibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits aside from\na tiny fat containing periumbilical hernia.", "output": "No acute findings related to the right lower quadrant renal transplant to\naccount for the patient's pain. Known mass is not well evaluated in absence\nof IV contrast but appears grossly stable." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A\nsubcentimeter calcification is seen in the posterior right lobe, likely\nrepresenting a granuloma (05:56). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is unremarkable.\n\nPANCREAS: The pancreas is grossly unremarkable.\n\nSPLEEN: The spleen is normal in size. There are scattered calcified\ngranulomas in the spleen.\n\nADRENALS: The bilateral adrenal glands are not well visualized.\n\nURINARY: The kidneys are symmetric in size. No hydronephrosis or\nnephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small and large bowel loops\nare normal in caliber.\n\nPELVIS: The urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. A 2.0 cm right adnexal\ncyst is noted.\n\nLYMPH NODES: No pathologically enlarged abdominopelvic lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe, diffuse vascular\ncalcification is noted.\n\nBONES: Bones are severely demineralized. There is no aggressive osseous\nlesion or acute fracture.\n\nSOFT TISSUES: There is anasarca of the body wall. Injection granulomas are\nnoted in the bilateral gluteal regions.", "output": "1. No acute findings or source of infection identified in the abdomen or\npelvis, within the limitations of an unenhanced study.\n2. Anasarca of the body wall.\n3. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings." }, { "input": "LOWER CHEST: Limited evaluation of the lung bases notable for lower lobe\natelectasis. No pleural or pericardial effusion. Aortic valvular and\ncoronary calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nDiffusely hypodense liver is consistent with hepatic steatosis. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral subcentimeter renal hypodensities are incompletely\ncharacterized, largest measures 3.1 cm and is consistent with a simple cyst. \nThe kidneys otherwise are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Large stool\nburden within rectum. Few sigmoid and descending colonic diverticula are\npresent without evidence of acute diverticulitis. The appendix is not\nvisualized, however no secondary signs of acute appendicitis.\n\nPELVIS: The urinary bladder is distended with few left-sided bladder\ndiverticula and trabeculations (2:84) suggestive of bladder outlet\nobstruction. Few locules of air within the bladder may be related to recent\ninstrumentation. Distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: TURP defect is noted within the prostate. Seminal\nvesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Status post left inter trochanteric pin with associated beam hardening\nartifact slightly limiting evaluation of the pelvis. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence to explain patient's symptoms.\n2. Hepatic steatosis.\n3. TURP defect within prostate. Correlation with surgical history is\nrecommended.\n4. Mildly distended bladder with left-sided bladder diverticula, and\ntrabeculations, suggestive bladder outlet obstruction. Focal locules of air\nwithin bladder likely due to recent instrumentation.\n5. Large rectal stool burden.\n6. Sigmoid and descending colonic diverticula without evidence of acute\ndiverticulitis." }, { "input": "Bases are clear. There is no pleural effusion. Visualized portions of the\nheart and pericardium are within normal limits.\n\nCT of the abdomen: Evaluation of solid abdominal viscera is limited by lack of\nIV contrast. Within these limitations, small hypodensities are seen in the\nliver, which are too small to further characterize beeter seen on prior. The\ngallbladder is normal. There is no gallbladder wall thickening or\npericholecystic fluid. The adrenal glands, pancreas and spleen are normal.\nIncidental note is made of a small accessory spleen. The non contrast-enhanced\nkidney within normal limits, with no evidence of hydronephrosis or\nnephrolithiasis or ureterolithiasis.\n\nThe stomach is collapsed. There is no evidence of small bowel obstruction.\nThere is moderate fecal loading is seen throughout the colon. The appendix is\nseen and is normal. The abdominal aorta is of normal diameter. Patency cannot\nbe assessed on this examination. There is no free fluid. There is no free\nair. There is no retroperitoneal mesenteric lymph node enlargement by CT size\ncriteria.\n\nCT of the pelvis: The urinary bladder and terminal ureters are normal. An IUD\nis seen within the endometrial cavity and appears in adequate position. There\nis no pelvic free fluid. There is no inguinal or pelvic lymph node enlargement\nby CT size criteria. The rectum is normal.\n\nOsseous structures: No blastic or lytic lesion concerning for malignancy.", "output": "No evidence of nephrolithiasis, ureterolithiasis or hydronephrosis. No acute\nintraabdominal process." }, { "input": "Since the prior study there has been slight increase in size of the\nright-sided pleural effusion which now measures 6.5 cm in maximal depth in\ncomparison with 5.1 cm on the prior study. There is no left-sided pleural\neffusion. There are no concerning discrete pulmonary nodules identified.\n\nNote is again made of a drainage catheter in the right subhepatic space and\n___'s pouch with the fluid collection having decreased in size from 7 x\n2.9 cm to 1.5 x 5.8 cm (2:32). A small focus of gas is seen adjacent to the\ncatheter which may be secondary to catheter flushing. The residual\nlow-attenuation material surrounding the catheter tip may represent the wall\nof a thick-walled abscess cavity or semisolid phlegmon. Correlation with\ndrain output and catheter flushing is advised. \nAgain noted in the liver are stable disctrete low attenuation lesions with\npneumobilia also again identified. Unchanged position of a hepatic artery\nstent. Note is made of a nasoenteric feeding tube with the tip positioned in\nthe fourth part of duodenum. \nNote is again made of a minimally smaller 1.4 x 1.7 cm simple-appearing fluid\ncollection deep to the medial aspect of the left rectus muscle on (2:51). \nNormal appearance of the large and small bowel. The spleen remains at the\nupper limits of normal size measuring 12.9 cm. Satisfactory appearance of the\nadrenals and both kidneys on this non-contrast examination.\n\nCT OF PELVIS: There is no free fluid in the pelvis. Tubal ligation clips are\nnoted bilaterally. No enlarged pelvic side wall or inguinal lymph nodes are\nidentified. Stranding of the subcutaneous fat overlying the sacrum is more\nprominent on today's study and clinical correlation is advised to exclude an\nearly pressure ulcer.\n\nOSSEOUS STRUCTURES: Note is again made of bilateral pars defects at L5\n(2:56), but no concerning lytic or sclerotic bone lesions are identified.", "output": "Interval reduction in size of the right subhepatic fluid collection with\nsatisfactory position of a percutaneous drainage catheter. Correlation with\ndrain output is advised and the remaining surrounding low-attenuation material\nmay represent a thickened abscess cavity wall, residual inflammatory phlegmon\nor undrained semisolid material. \n\nFindings were discussed with ___ at 09:30 hours on ___.\n\nPreliminary report was conveyed by Dr. ___ at ___ hours on ___." }, { "input": "CT OF ABDOMEN:\nThere has been slight increase in size of the right-sided pleural effusion\nsince the prior study of ___. There is adjacent compressive atelectasis\nagain slightly more pronounced than on the prior study. No evidence of a\nleft-sided pleural effusion or a basal pericardial effusion. There are no\ndiscrete pulmonary nodules in the imaged lower pulmonary segments.\n\nThe patient is status post orthotopic liver transplant. Note is made of a\ncommon hepatic artery stent. A small focus of pneumobilia is identified in\nthe left lobe (2:21). A 2.3 x 1.8 cm low-attenuation focus peripherally in\nsegment VII is again identified and is grossly unchanged in size in comparison\nto prior CT. A second lesion measuring 1.6 x 1.2 cm in the superior aspect of\nthe caudate lobe is also stable. In the absence of intravenous contrast these\nlesions are not possible to further characterize. \nNote is made of a plastic ERCP common bile duct stent. Note is made of an\nenteral feeding tube which is coiled within the stomach with the tip\npositioned in the gastric antrum. The previously placed 10 ___ drainage\ncatheter in the right subhepatic space has been removed. There is a\npersistent 2.9 x 6.9 cm low-attenuation complex-appearing area in the right\nsubhepatic space (2:30). This area contains a tiny fleck of gas (2:27). The\nHounsfield values for the collection are between 15 and 20 Hounsfield units,\nindicative of complex or semisolid fluid material. Of note, a rounded fluid\ncollection in the mid abdomen just superior to the umbilicus has decreased in\nsize from 2.7 x 3.5 cm in the prior study to measure 1.7 x 1.6 cm (2:49). No\nnew fluid collections are identified in the abdomen or pelvis. The spleen\nremains bulky measuring 13 cm in long axis. Normal appearance of both kidneys\non this non-contrast examination. No adrenal nodules are identified.\n\nCT OF PELVIS: Bilateral clips are seen in the pelvis in keeping with tubal\nligation. There is no free fluid in the pelvis. Normal appearance of the\nuterus and bladder. There is mild calcification of the abdominal aorta, but\nno evidence of aortic aneurysm.\n\nOSSEOUS STRUCTURES: A sclerotic area with superior endplate depression is\nnoted in L4 in keeping with a degenerative change, possibly a Schmorl's node. \nFindings are unchanged from the study of ___. No concerning lytic or\nsclerotic bone lesions are identified. Note is made of a bilateral pars\ndefect involving the L5 vertebra, likely long standing (301b:39).", "output": "Persistent fluid collection in the right subhepatic space appears\ncomplex and has decreased in size since the prior CT-guided drain placement. \nThis collection would be amenable to percutaneous aspiration and/or drain\nplacement depending on fluidity of the contents. \n\nFindings were discussed with the referring service by Dr. ___ at 01:50 hours\non ___." }, { "input": "LOWER CHEST: 4 mm nodule is seen in the right lung base (2:5). There is no\nevidence of pleural or pericardial effusion. The cardiac size is normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder demonstrates a focus of\nadenomyomatosis in the gallbladder fundus (02:31).\n\nPANCREAS: The pancreas demonstrates fatty replacement, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastric bypass. The visualized small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. No evidence of obstruction. Scattered colonic diverticulosis is\nnoted without evidence of acute diverticulitis. Otherwise, the colon and\nrectum are within normal limits. The appendix is normal. Subjacent to the\nmesh repair site and superficial abscess is a small lobulated fat focus of fat\nwith extensive stranding, likely fat necrosis with surrounding fat stranding,\nwhich is concerning for early-stage infection (2:61, 602:51).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen along the visualized spine.\n\nSOFT TISSUES: Patient is status post incisional hernia repair. At the repair\nsite, there is a rim enhancing fluid collection measuring 6.2 x 5.2 x 6.3 cm,\nconcerning for abscess (2:69). There is associated surrounding inflammatory\nfat stranding.", "output": "1. 6.2 x 5.2 x 6.3 cm subcutaneous fluid collection along the anterior\nabdominal wall incision site, concerning for abscess.\n2. Directly subjacent to the abscess and mesh repair site within the\nperitoneum is a small focus of fat necrosis which has not yet coalesced into a\nfluid collection, concerning for early infection.\n3. A 4 mm right lower lobe pulmonary nodule.\n4. Post gastric bypass.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:50 am, 1 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. There is no biliary dilatation. \nThe gallbladder is unremarkable.\n\nPANCREAS: The pancreas is unremarkable. No pancreatic ductal dilatation is\nidentified.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: A 1 cm right adrenal nodule is unchanged from prior. The left\nadrenal gland is unremarkable.\n\nURINARY: Multiple subcentimeter cortical renal hypodensities are\nre-demonstrated and too small to characterize, unchanged from prior. No\nhydronephrosis is identified.\n\nGASTROINTESTINAL: No bowel obstruction is identified. No ascites is seen.\n\nPELVIS: There is no free fluid in the pelvis. The uterus is surgically\nabsent.\n\nLYMPH NODES: No abdominal or pelvic lymphadenopathy demonstrated.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: No worrisome osseous lesions are seen.\n\nSOFT TISSUES: A small bowel containing umbilical hernia is re-demonstrated and\nunchanged.", "output": "1. No findings identified to suggest gastric outlet obstruction.\n2. No bowel obstruction or acute findings in the abdomen or pelvis.\n3. Please refer to same-day CT chest for characterization of intrathoracic\nfindings." }, { "input": "LOWER CHEST: Atelectatic/consolidative changes are present at the left lung\nbase.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is absent.\n\nPANCREAS: Sequelae of necrotizing pancreatitis, with stable pockets of\nwalled-off necrosis, measuring 3.5 x 7.2 cm and 2.4 x 3.8 cm, unchanged. \nThere is however a new organizing collection in the left mid abdomen measuring\n8.8 x 3.9 cm (03:37). There is worsening peripancreatic fat stranding, and\nreactive peripancreatic and mesenteric lymph nodes. A small amount of ascites\nis seen tracking down the left paracolic gutter and along Gerota's fascia.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is atrophic.. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: An enteric tube is present, with the tip in the second-third\nstage of the duodenum. There is circumferential thickening at the splenic\nflexure, likely reactive. Otherwise, the visualized small and large bowel\nloops in the upper abdomen are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: Stable aneurysmal dilatation of the abdominal aorta measuring up to\n4.5 cm at the retrocrural region. Moderate atherosclerotic disease is noted. \nMultiple venous collaterals are again seen in the upper abdomen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Sequelae of necrotizing pancreatitis, with stable regions of walled-off\nnecrosis. Worsening inflammatory changes in the left upper quadrant.\n2. New organizing collection in the left mid abdomen measuring 8.8 x 3.9 cm.\n3. The remainder of the examination is stable." }, { "input": "LOWER CHEST: Visualized lung fields are notable for left lower lobe opacity. \nHeart is normal in size. No pericardial effusion. No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The gallbladder is top-normal in size\nwith mild mucosal wall hyperemia. No definite gallstone identified. 0.6 x 0.8\ncm peripherally enhancing rounded lesion at the level of the cystic duct is\nconsistent with the enhancing cystic duct. The proximal common bile duct\ndemonstrates subtle peripheral hyper enhancement. The common bile duct\nmeasures 0.6 cm and is within normal limits. No intrahepatic biliary duct\ndilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No hiatal hernia. The stomach is unremarkable. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. Moderate amount of stool\nthroughout the colon. The appendix is not visualized, however no secondary\nsigns of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus with a 2.9 x 2.1 cm exophytic left fundal\nfibroid. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: 0.5 cm sclerotic lesion within the left iliac wing and 0.3 cm right\niliac wing sclerotic lesions are most consistent with bone islands. There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Subtle mucosal hyper enhancement of the common bile duct and likely cystic\nduct is consistent with cholangitis which could be confirmed with MRCP. No\nintra or extrahepatic biliary duct dilatation.\n2. No definite evidence for cholecystitis\n3. Left lower lobe opacity may represent atelectasis or pneumonia in the\nproper clinical setting.\n\nRECOMMENDATION(S): Consider dedicated MRCP for further evaluation." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nProgressively enhancing hypodensity measuring 16 x 14 mm in the hepatic dome\ncharacterized as an atypical hemangioma on MRI is unchanged. Additional\nhypodensity in segment ___ and ___ are unchanged. There are no new focal\nhepatic lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNumerous subcentimeter cortical hypodensities are too small to fully\ncharacterize, but most likely represent cysts and are unchanged. No\nsuspicious renal lesion or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is now status post hysterectomy. In the left\nportion of the vaginal cuff is a 4.6 x 2.8 cm soft tissue structure with a\npunctate calcification (2:105).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Soft tissue to the left of the vaginal cuff is likely related to\npostoperative change and correlation with clinical examination and continued\nattention on follow-up is recommended. No evidence of metastatic disease in\nthe abdomen or pelvis.\n2. Please see the separately dictated CT chest report from the same date for a\ndescription of thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings, including multiple pulmonary\nnodules.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are stable hypoattenuating hepatic lesions, in segment 8 measuring 1.5\ncm with punctate calcifications and which fills in most consistent with a\nhemangioma, and a hypodensity in segment 4A measuring 8 mm (07:53). There are\nno new or suspicious hepatic lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNumerous bilateral subcentimeter renal hypodensities are too small to\ncharacterize but unchanged. Multiple slightly hyperattenuating cysts are\nnoted, including 9 mm in the right upper pole and 1 cm in the left inferior\npole, unchanged. No new or suspicious renal lesions. No hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are surgically absent. Soft\ntissue along the vaginal cuff measuring up to 4.5 x 2.3 cm is similar in size\n(7:108). No new or increasing soft tissue in the deep pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Stable soft tissue along the left vaginal cuff, likely postsurgical.\n3. Please refer to the separately dictated CT chest report from the same date\nfor description of thoracic findings, including multiple pulmonary nodules." }, { "input": "LOWER CHEST: Please refer to the separately dictated CT of the chest for\ndetailed evaluation.\n\nHEPATOBILIARY: There is a subcentimeter well-defined hepatic hypodensity\nwithin segment 3, too small to characterize likely a hamartoma or cyst. \nAdditionally, there is an angular area of hypoenhancement with punctate foci\nof calcifications within segment 8 medially measuring 1.1 cm. This fills in\non the later phase images. It drapes around the middle hepatic vein. It is\nlikely a hemangioma. Portal vein and hepatic veins are patent. There is no\nbiliary ductal dilatation. Gallbladder appears unremarkable.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious mass lesions.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY:There is no hydronephrosis or nephrolithiasis. There are no\nsuspicious renal masses. There are scattered millimetric renal cortical\nhypodensities, too small to characterize, likely representing cysts.\n\nGASTROINTESTINAL: Stomach is unremarkable. Small bowel loops are normal in\ncaliber. There is moderate amount of stool throughout the colon. There are\nscattered colonic diverticulosis without diverticulitis.\n\nPERITONEUM: There is no free air or free fluid. There is no peritoneal\nstranding.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric adenopathy. There is a\nprominent left external iliac lymph node measuring up to 0.7 cm.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches. Venous structures are patent.\n\nPELVIS: Uterus is enlarged measuring 14 x 9 x 10 cm. There are multiple\ncalcified masses along the subserosal surface of the uterus likely\nrepresenting uterine fibroids. There is also large heterogeneously enhancing\nuterine mass involving the endometrial cavity and myometrium measuring 8 x 8.4\nx 8.9 cm. This appears to invade greater than 50% through the myometrium\nalong the posterior and right uterine walls with no subserosal invasion. This\nis biopsy-proven leiomyosarcoma. The cervix demonstrates heterogeneous\nenhancement as well.\n\nBONES:There are degenerative changes at L4-L5. There are no acute osseous\nabnormalities or suspicious osseous lesions.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Findings of leiomyosarcoma of the uterus with endometrial involvement and\nmyometrial involvement greater than 50% of wall thickness but no extrabserosal\nextension. No suspicious adenopathy noted.\n2. Indeterminate segment 8 hypoenhancing hepatic lesion with punctate areas of\ncalcifications is probably a atypical hemangioma.\n\nRECOMMENDATION(S): Comparison to prior imaging of the liver to confirm\npresence of atypical hemangioma or MRI of the liver.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 17:05 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Stable appearance of a 1 cm hypoenhancing lesion in segment 4A\nof the liver, which is too small to characterize. There is a 1.8 cm lesion in\nsegment 4A/8 of the liver near the dome, with the suggestion of peripheral\nnodular enhancement, which could represent a hemangioma, however remains\nincompletely characterized on the current study. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n7 mm hypoenhancing focus in the interpolar region of the left kidney and other\nscattered millimetric areas in the right kidney, too small to characterize,\nhowever likely represent cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is re-demonstration of a large, heterogeneously enhancing\nuterine mass involving the endometrial cavity and myometrium, measuring\napproximately 8.5 x 10.5 cm, stable. The mass invades greater than 50% of the\nmyometrium along the right lateral, anterior and posterior aspects of the\nuterus, with extension up to the serosa. There is no definite extension\nbeyond the serosa. Calcified uterine fibroids.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged appearance of the known uterine leiomyosarcoma, with greater than\n50% extension through the myometrium. No definite extension beyond the\nserosa.\n2. Indeterminate hypoenhancing liver lesions in segment 8 and 4 A, possibly\nrepresenting hemangiomas, however remain incompletely characterized on the\npresent study." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nHEPATOBILIARY: Hepatic enhancement is homogeneous with no suspicious masses. \nPortal vein and hepatic veins are patent. There is no biliary ductal\ndilatation. Gallbladder is unremarkable.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious masses.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY:There is no hydronephrosis or suspicious renal masses.\n\nGASTROINTESTINAL: Stomach is under distended. There is a moderate size\nperiampullary duodenal diverticulum. Small bowel loops are not dilated and do\nnot demonstrate wall thickening. Appendix is normal. Large bowel\ndemonstrates scattered diverticulosis without diverticulitis. There is no\nlarge bowel wall thickening.\n\nPERITONEUM: There is no free air or free fluid. There is no peritoneal\nstranding.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches.\n\nPELVIS: Uterus is normal in size for age. There are no adnexal masses. \nRectum and urinary bladder are unremarkable.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "No acute intra-abdominal process." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is trace\nposterior pleural thickening or effusions at the lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nhypoattenuating lesion in the inferior aspect of segment V is too small to\ncompletely characterize, but unchanged compared to ___. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\ncontains gallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. Prominence of the right ureter\nis unchanged, though no stone or obstructing lesion is seen. Surgical clips\nare noted in the left pelvis. The uterus is enlarged and contains small\nfibroid. When compared with the prior CT exam from approximately 16 months\nago, the dilated tubular structure in the left adnexae concerning for\npyosalpinx appears similar in overall size though there is increased mural\nhyperemia and thickening. Left ovary cannot be visualized. There is a small\namount of anterior free fluid with apparent thickening of the adjacent\nperitoneum with hyper enhancement concerning for peritonitis. This finding is\nnew from prior. In the right adnexa, there is a fluid-filled tubular\nstructure which is concerning for hydrosalpinx, not clearly seen on the prior\nstudy. The right ovary is not clearly visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The right common iliac artery appears proximally occluded, similar\nto the prior examination. There is prominent collateralization with distal\nreconstitution. Retrograde filling demonstrates high-grade stenosis of a long\nsegment of the right common iliac distal to the occlusion. There is no\nabdominal aortic aneurysm. Otherwise mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Findings suggestive of bilateral hydrosalpinx, left greater than right with\nassociated peritoneal thickening and hyper enhancement on the left. Ovaries\nnot assessed. Correlate with pelvic ultrasound.\n2. Right common iliac artery occlusion with distal reconstitution, chronic.\n3. Cholelithiasis without evidence of cholecystitis.\n\nRECOMMENDATION(S): Pelvic ultrasound to better assess ovaries." }, { "input": "Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nThe liver is unremarkable. The spleen is within normal limits. Adrenal glands\nare unremarkable. Gallbladder demonstrates high-density dependent biliary\nsludge. There is no intrahepatic or extrahepatic biliary ductal dilation.\n\nThere is interval development mild proximal pancreatic duct dilation measuring\nup to 3 mm in greatest diameter extending from the pancreatic head through the\nmid body. There is an hypoattenuating area involving the pancreatic head/neck\njunction measuring 1.2 x 1.2 cm in greatest AP by transverse ___ (image\n40, series 11).\n\nBilateral native kidneys are stable, which are atrophic with cystic changes. \nTransplant in the left lower quadrant is stable without hydronephrosis.\n\nThe visualized portions of the gastrointestinal tract demonstrates diffuse non\ndilated but mildly prominent small-bowel air-fluid levels without a discrete\ntransition point. Duodenal diverticulum is again noted. There is colonic\ndiverticulosis without evidence diverticulitis. There is suboptimal\nevaluation of the distal large bowel which is diffusely collapsed. The\nappendix is not visualized, however there are no pericecal inflammatory\nchanges to suggest appendicitis.\n\nInterval postsurgical changes in the pelvis are visualized from surgical\nresection of the previously visualized large pelvic mass. There is a moderate\namount of intra-abdominal and intrapelvic ascites. No discrete intrapelvic\nmass is identified, however evaluation for subtle masses are suboptimal\nsecondary to intrapelvic free fluid.\n\nThere is nondependent gas within the urinary bladder, likely from prior\ninstrumentation. There is soft tissue gas involving the pelvic and lower\nabdominal subcutaneous tissues with midline abdominal ventral surgical stables\nwhich are likely postsurgical in etiology. There is diffuse body wall\nsubcutaneous edema.\n\nScattered retroperitoneal lymph nodes are stable.\n\nNo acute fracture or suspicious osseous lesions are identified.", "output": "1. Interval acute postsurgical changes from recent intrapelvic mass surgical\nresection.\n2. Moderate amount of intra-abdominal and intrapelvic ascites without any\ndiscrete organized fluid collection to suggest abscess at this time.\n3. Findings most consistent with diffuse small bowel ileus without evidence\nto suggest mechanical small bowel obstruction at this time. Continued\nradiographic follow-up is recommended.\n4. A 1.2 x 1.2 cm hypodense lesion in pancreatic head/neck junction, which\nmay represent an IPMN. Further evaluation is recommended with nonemergent\nMRCP." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter hypodensity in the upper pole of the right kidney is too small\nto characterize by CT. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix measures 9 mm,, with hyperemia\nof the wall and mild fat stranding, though evaluation for fat stranding is\nlimited due to paucity of intra-abdominal fat. A 6 mm density within the\nproximal appendix likely represents a fecalith (601:24).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute uncomplicated appendicitis. No drainable fluid collections." }, { "input": "LOWER CHEST: Small left and trace right effusions noted. Trace pericardial\neffusion noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Left adrenal lipoma is unchanged.\n\nURINARY: The kidneys are of normal and symmetric size. 1.2 cm cyst projects\nposteriorly from the lower pole of right kidney 1.1 cm cyst projects\nsuperiorly from the upper right kidney. There is no hydronephrosis. Punctate\ncalcification in the lower pole of the left kidney again noted, likely\nrepresenting a small nonobstructing stone. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: Foley catheter noted in a decompressed urinary bladder. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nCompression deformity of L2 is unchanged.\n\nSOFT TISSUES: Stranding along the flanks is compatible with the given history\nof ecchymoses fat containing periumbilical hernia noted.", "output": "1. No evidence for retroperitoneal hematoma or other acute intra-abdominal\nfinding.\n2. Punctate nonobstructing stone in the lower pole of the left kidney,\nunchanged." }, { "input": "LOWER CHEST: There is a small left pleural effusion with associated\natelectasis. There is minimal emphysematous change at the lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: Ill-defined mass in the hepatic hilum, not well seen on the\ncurrent examination. The liver is otherwise homogeneous in attenuation. A\ncommon bile duct stent is unchanged in position ending in the right lobe. \nOverall degree of moderate primarily left intrahepatic biliary duct dilation\nwith foci of pneumobilia, mildly decreased when compared to ___. The\nleft portal vein is not well seen, and was severely attenuated on the prior\nexamination.\n\nPANCREAS: The degree of pancreatic duct dilation is unchanged from prior. No\npancreatic lesion is identified.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 4.5 x 2.3 x 3.5 cm air-containing fluid\ncollection located adjacent to the inferior aspect of the spleen. Additional\nwalled-off perisplenic fluid collection more superiorly measuring 4.2 x 8.3 x\n5.7 cm (series 4, image 9).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient has undergone total abdominal colectomy with end\nileostomy. There is free intra-abdominal air, more than expected for prior\nsurgery. There is moderate volume intra-abdominal ascites with associated\nperitoneal enhancement. There is no evidence of small bowel obstruction. \nThere is a moderate hiatal hernia.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Retroperitoneal lymph nodes measuring up to 7 mm have minimally\ndecreased compared to prior. Diffuse omental nodularity, better seen\npreviously, owing to new intra-abdominal ascites. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes in the lumbar spine.\n\nSOFT TISSUES: There is diffuse anasarca. Surgical staples are noted along the\nanterior abdominal wall. There is a right lower rectus sheath hematoma\nmeasuring 4.3 x 7.8 x 7.7 cm (series 4, image 59).", "output": "1. Two walled-off perisplenic fluid collections, measuring 4.5 x 2.3 and 4.2 x\n8.3 cm.\n2. Small to moderate right rectus sheath hematoma.\n3. Intra-abdominal free air, more than expected for one week postoperative.\n4. Moderate intra-abdominal ascites with associated peritoneal enhancement,\nconsistent with peritonitis..\n5. Intrahepatic hilar mass not well seen on the current examination. \nIntrahepatic biliary duct dilation, mildly decreased from prior.\n6. Omental nodularity, not well seen on the current examination, due to\nobscuration by\n7. Intra-abdominal ascites.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:19 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Scarring/atelectasis visualized at the right lung base. There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. There is inflammation centered at the base of the cecum. In the\nexpected region of the appendix at the base of the cecum is a rounded 1.3 cm\nstructure (301:136) which has the appearance of an inflamed diverticulum. \nHowever, wrapping around this structure is a relatively thin tubular\nconfiguration of air (301:34). No definitive wall seen around this air which\ncould represent contained perforation or gangrenous distal appendix. There is\nno drainable collection or other region of extraluminal air. There is wall\nthickening at the base of the cecum. Small adjacent subcentimeter lymph nodes\nare noted, likely reactive. No appendix identified elsewhere.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple prominent mesenteric lymph nodes are visualized in the\nright lower quadrant, likely reactive in nature. There is no retroperitoneal\nor mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes are visualized in the lumbar spine with\nDISH in the lower thoracic spine. There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Abnormality centered at the base of the cecum which is secondarily inflamed. \nA rounded 13 mm outpouching at the expected region of the appendix with\nadjacent tubular configuration of air. Given location and lack of prior\nappendectomy, findings most likely represent acute appendicitis, with a\ngangrenous tip. Stump appendicitis with micro perforation would have been\npossible if history of prior appendectomy. Less likely cecal diverticulitis\nwith microperforation based on location and lack of visualization of an\nappendix.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:20 pm." }, { "input": "Limited assessment due the absence of IV contrast.\n\nCHEST:\n\nLimited assessment of the lung bases are clear. The visualized heart is mildly\nenlarged. Atherosclerotic coronary artery calcifications seen. No pleural or\npericardial effusion. Evidence of prior cardiac surgery.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous. No intra or extrahepatic biliary\nduct dilatation. No focal lesions seen however limited evaluation due to\nabsence of IV contrast. The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: Diffuse fatty infiltration is seen throughout the pancreas without\nfocal lesions, peripancreatic fluid collection or fat stranding..\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric size. There is no evidence\nof stones, or hydronephrosis. A 1.7 x 1.9 cm (previously 1.4 x 1.3 cm)\nhypodense lesion is seen within the upper pole of the left kidney and\nrepresents a cyst. (3: 42). No additional solid or cystic renal lesions seen.\nNo pelvocaliceal dilatation, perinephric stranding or abscess. No hydroureter.\n\nGI: The esophagus, stomach, small bowel, colon are within normal limits\nwithout focal wall thickening, mass lesion, fat stranding, or obstruction. The\nappendix is not seen however no evidence of acute appendicitis. No ascites,\nfree intraperitoneal air, or abdominal wall hernias.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: The abdominal aorta demonstrates moderate atherosclerosis. Minimal\nincrease in small focal infrarenal aortic aneurysm with maximal diameter of\n3.0 x 2.7 cm (03:57) (previously 2.6 x 2.6 cm when measured in a similar\nfashion). No intramural hematoma. Coarse calcification is seen at the origin\nof the celiac axis and SMA. Single renal arteries are seen bilaterally. A\ntortuous right common iliac artery noted. The common iliac arteries have a\nmaximal diameter of 1.2 cm on the right (3: 71) and 1.3 cm on the left (3:60)\nwhich is unchanged from prior study.\n\nPELVIS:\n\nThe urinary bladder is moderately distended and within normal limits. The\ndistal ureters are unremarkable. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis. Coarse calcification\nis seen throughout the prostate which measures 3.8 x 5.3 x 4.4 cm (AP x TV x\nSI).\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Mild anterolisthesis of L4 on L5\nis noted. A densely sclerotic lesion is seen within the left acetabulum\nconsistent with a bony island and is unchanged since ___.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Minimal increase in size of focal infrarenal aortic aneurysm with maximal\ndiameter of 3 cm.\n3. Stable tortuous right common iliac artery.\n4. Mild decreased size of a left renal cyst." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. The heart is enlarged with\nevidence of prior cardiac surgery. Valvular calcifications noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A 1.9 cm simple cyst\nis seen in the upper pole of the left kidney, similar in size compared to\nprior study. No evidence of additional focal renal lesions within the\nlimitations of an unenhanced scan. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder contains an outpouching anteriorly which may be a\nurachal remnant. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post CyberKnife surgery for prostate\ncancer with fiducial seeds in the enlarged prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Infrarenal abdominal aortic aneurysmal dilation measuring 3.2 x 2.7\ncm is relatively unchanged compared to prior study. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Mild degenerative changes with disc space narrowing and facet joint\narthropathy. Mild anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Stable focal infrarenal aortic aneurysmal dilation with maximal diameter of\n3.2 cm.\n3. Anterior bladder wall outpouching at midline may represent a urachal\nremnant, diverticulum." }, { "input": "LOWER CHEST: Visualized lungs are notable for minimal left lower lobe and\nright middle lobe atelectasis. No pleural effusion or pneumothorax. The\nheart is mildly enlarged. No pericardial effusion. Coronary artery\ncalcifications are noted.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 1.8 x 1.9 cm cyst is noted in the interpolar region of the left\nkidney. The kidneys otherwise are of normal and symmetric size. There is no\nevidence of focal renal lesions within the limitations of an unenhanced scan. \nThere is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Cyberknife fiducials are present within the prostate. \nThe seminal vesicles are unremarkable.\n\nLYMPH NODES: No mesenteric lymphadenopathy. A new retrocaval lymph node\nmeasures 0.9 cm in short axis (02:34). Stable subcentimeter left common iliac\nnode does not meet CT size criteria for enlargement. No pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: Stable infrarenal abdominal aortic aneurysm measuring 3.1 x 2.7 cm\n(02:50) (previously 3.1 x 2.7 cm). Moderate atherosclerotic disease is noted.\n\nBONES: 0.2 cm densely sclerotic lesion within the posterior left twelfth rib\nand 0.4 cm lesion within the left superior acetabulum, and right superior\nramus are unchanged since ___. There is no evidence of worrisome\nosseous lesions or acute fracture. Patient is status post median sternotomy.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New 0.9 cm retrocaval lymph node is worrisome for nodal involvement by\nprostate cancer.\n2. Stable infrarenal abdominal aortic aneurysm measuring 3.1 cm." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is no calcium burden in the\nabdominal aorta and great abdominal arteries. There is prominent compression\nat the origin of the celiac axis with hook shaped appearance with poststenotic\ndilatation, which may represent median arcuate ligament syndrome. SMA,\nbilateral renal arteries and ___ are widely patent.\n\nLOWER CHEST: There is minimal bibasal atelectasis.\n\nABDOMEN:\nHEPATOBILIARY: There is non mass like increased attenuation of the liver\nsurrounding the gallbladder, compatible with increased perfusion. . There is\nno evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder demonstrates wall edema,\nincreased in prominence compared to the same-day examination now with\nsurrounding fat stranding. No radiopaque gallstones are seen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again there is a wedge-shaped cortical defect of the right interpolar\nkidney, which has changed in morphology compared to the earlier examination\nand appears chronic. There is no delayed nephrogram. In the distal most\nportion of the superior right renal artery, there is suggestion of a\nthrombosed dissection of the distal portion of this artery, which remains\npatent, which appears to supply the infarcted portion of the right\ninterpolar/upper pole kidney (602b:47). On coronal view, there is subtle,\npossible beading of this portion of the right renal artery (601b:64).\n\nGASTROINTESTINAL: Visualized small bowel loops demonstrate normal caliber,\nwall thickness and enhancement throughout. Visualize colon is normal limits. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Increasing gallbladder wall edema, pericholecystic fat stranding and\nincreased hepatic perfusion around the gallbladder fossa, suspicious for acute\ncholecystitis, particularly given rapid progression compared to earlier same\nday examination.\n2. Persistent peripheral wedge-shaped cortical defect of the right interpolar\nkidney, consistent with chronic infarct. There is a partially thrombosed\ndissection of a patent distal upper right renal artery which supplies the\ninfarcted portion of the kidney, with subtle beaded appearance of the artery,\nwhich may suggest fibromuscular dysplasia as an etiology.\n3. High-grade stenosis at the origin of the celiac axis with poststenotic\ndilatation. Much of this is likely fixed stenosis given inspiration phase,\nhowever component of median arcu-ate ligament syndrome is possible.\n\nRECOMMENDATION(S): Surgical consultation for evaluation of probable acute\ncholecystitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 7:56 ___, 10 minutes after discovery of\nthe findings." }, { "input": "Thoracic findings are included on a separate report to be issued by the\nthoracic imaging service. Note is made of a 4 mm nodule in the left lung\nbase.\n\nCT abdomen with contrast: Several hepatic hypodensities are once again present\nall of which have mildly increased in size since ___ with the largest\nmeasuring 1.9 cm in segment 2, previously having measured 1.3 cm. While some\nof these lesions remain too small to fully characterize, these likely\nrepresent cysts or biliary hamartomas. The liver otherwise enhances\nhomogeneously without new lesion. The portal vein is patent. There is no intra\nor extrahepatic biliary ductal dilatation. The gallbladder is unremarkable.\n\nThere is mild prominence of the proximal main pancreatic duct with a\ntransition point in the distal pancreatic body where the main pancreatic duct\nbecomes more dilated measuring up to 7 mm in diameter. No definite mass is\nseen at this transition however, the pancreatic parenchyma is hypodense at the\ntransition point. The pancreatic tail parenchyma is atrophic with mild\nsurrounding peripancreatic fat stranding. The adrenal glands are unremarkable.\nThere is an indeterminate 7 mm hypodensity in the spleen (04:41). There are\nseveral bilateral renal hypodensities measuring up to 6.5 cm in the right\ninterpolar kidney and these have increased in size since ___ where it this\nlesion measured 3.9 cm. These are compatible with simple renal cysts. A few\nother hypodensities remain subcentimeter in size, but likely also represent\ncysts. The kidneys otherwise present symmetric nephrograms and excretion of\ncontrast without focal solid lesion, hydronephrosis or perinephric\nabnormality.\n\nThere is a small segment of the jejunum demonstrating mild wall thickening and\nmesenteric fat stranding (4:74). The stomach, duodenum and remainder of the\nsmall bowel is otherwise grossly unremarkable without evidence of obstruction.\nNote is made of scattered diverticulosis in an otherwise unremarkable large\nbowel.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment. \nThere are several subcentimeter mesenteric and retroperitoneal lymph nodes,\nnone of which meet CT size criteria for enlargement. There is trace,\nnonspecific fat stranding of the central mesentery which is likely secondary\nto the inflamed segment of jejunum. There is no ascites or pneumoperitoneum.\nThere is a trace fat containing umbilical hernia.\n\nCT pelvis with contrast: The rectum, uterus and bladder are grossly\nunremarkable. There is a 2.7 cm left adnexal cyst. There is no free pelvic\nfluid or air. There is no inguinal or pelvic sidewall lymphadenopathy by CT\nsize criteria.\n\nOsseous structures: There are scattered degenerative changes of the imaged\nthoracolumbar spine. Vertebral body hemangiomas are noted in the T11, T12 and\nL5 vertebral bodies. Inferior endplate compression deformity of the T12\nvertebral body is of unclear chronicity.", "output": "1. Dilatation of the pancreatic duct to roughly 7 mm with transition point at\nthe distal pancreatic body associated with ill defined parenchymal\nhypodensity. Findings are concerning for neoplasm. Surrounding\nperipancreatic fat stranding may indicate superimposed pancreatitis. Further\ncharacterization by a multiphasic CTA or MRCP is recommended.\n2. Segment of the jejunum demonstrating wall thickening and perienteric fat\nstranding which could represent either enteritis or leukemic infiltration.\n3. 2.7 cm left adnexal cyst should be further evaluated by pelvic ultrasound.\n4. New 4 mm nodule at the left lung base should be monitored as clinically\nindicated.\n5. Indeterminate 7 mm hypodensity in the spleen can be monitored on followup\nimaging.\n6. Inferior endplate compression deformity of the T12 vertebral body of\nunclear chronicity.\n7. Interval increase in size of simple appearing hepatic and renal cysts.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 5:35 ___, 10 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: A 6 mm nodule is seen in the anterior right lung base. A 4 mm\nnodule is seen in the left lung base, unchanged a 5 mm nodule is partially\nimaged in the right posterior lung base. Visualized lung fields are otherwise\nwithin normal limits. There are trace pleural effusions bilaterally. A port is\nnoted, which terminates beyond the cavoatrial junction.\n\nABDOMEN:\n\nHEPATOBILIARY: Hypodensities are again noted in the left hepatic lobe\nconsistent with hepatic cysts or biliary hamartomas, unchanged from prior\nexam. Otherwise, the liver demonstrates homogenous attenuation throughout. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: There is abrupt cutoff of pancreatic duct with ill-defined\nhypodensity in the body of the pancreas, which may represent a mass, enlarged\nfrom ___. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n2 large exophytic cysts are seen off the lower pole of the right kidney. \nMultiple other cysts and hypodensities too small to characterize but likely\nrepresenting renal cysts are seen in the bilateral kidneys. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticula are\nnoted throughout the colon. There is a 5 cm segment of concentric wall\nthickening within the sigmoid colon in the left lower quadrant with\npericolonic fat stranding without surrounding free air or a pericolonic\nabscess. The remainder of the colon and rectum are normal in appearance.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A 3.5 x 2.6 cm left adnexal cyst is unchanged from prior\nexam. The reproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are noted throughout the spine. A hemangioma is noted in\nL5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 5 cm segment of wall thickening and adjacent fat stranding in the sigmoid\ncolon associated with numerous diverticula compatible with acute\ndiverticulitis. No evidence of perforation or abscess. Additional scattered\ndiverticuli throughout the colon without a non the site of acute\ndiverticulitis.\n\n2. Abrupt cutoff of pancreatic duct in the region of the pancreatic body with\nadjacent ill-defined hypodensity was also noted on the prior CT dated ___, compared to the prior CT there is progressive upstream\npancreatic parenchymal atrophy and ductal dilation. As suggested previously\nfurther characterization by a multiphase CT angio or MRCP is recommended, if\nnot already performed.\n\n3. Lung nodules in the bilateral lung bases are new compared to the chest CT\ndated ___. Further evaluation by dedicated chest CT to be considered.\n\nRECOMMENDATION(S):\n1. Further evaluation of presence of additional lung nodules by a dedicated\nchest CT to be considered.\n2. Multiphase CTA or MRCP is recommended to further evaluate cause for abrupt\ncut off and upstream dilation of the pancreatic duct with a suspicious\nhypodense mass in the pancreatic body a finding that was also noted on the\nprior CT dated ___, if this has not already been investigated.\n\nNOTIFICATION: Findings were communicated to Dr. ___ at 4:54 a.m. on\n___ by phone 2 min after the time discovery." }, { "input": "LOWER CHEST: There is interval development of atelectasis of the right lower\nlobe and increasing mild to moderate right-sided pleural effusion.\nSubsegmental atelectasis is seen at the left lung base, adjacent trace pleural\neffusion.. The heart is again enlarged. Central line tip in the right\natrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Mild periportal edema is again noted. \nThe gallbladder is within normal limits. A small amount of perihepatic free\nfluid is again seen, similar to previous. There are no organized fluid\ncollections.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. The main pancreatic duct is prominent, similar to previous. \nPancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral native kidneys are enlarged contain multiple cysts, in\nkeeping with polycystic kidney disease. Several cysts in the right kidney\nappears enlarged compared to the prior CT scan from ___, with\nspontaneously hyperattenuating internal contents, concerning for interval\nbleed. Additionally, the right collecting system is dilated and\nhyperattenuating, concerning for blood clots within of the right proximal\nureter. Few punctate calcifications along the expected course of the right\nureter are probably similar compared with ___, unlikely to\nrepresent small renal stones, distal right ureter is difficult to follow. \nMultiphasic postcontrast imaging was not performed which limits evaluation,\nbut there is no evidence to suggest active extravasation.\n\nA transplant kidney is again noted in the right lower quadrant and\ndemonstrates a normal nephrogram. Several tiny subcentimeter cortical\nhypodensities are again noted which are too small to characterize but\nunchanged compared to ___. Additionally, there is interval\ndevelopment of small pockets of air within the calices. There is no\nhydronephrosis or periureteric stranding.\n\nGASTROINTESTINAL: The stomach appears unremarkable. An enteric tube is in\nplace. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement. Residual oral contrast is seen within in the colon.\n\nPELVIS: There is interval placement of a Foley catheter within the bladder. \nThe bladder is collapsed. A small amount of free fluid is again noted within\nthe pelvis, similar compared to ___. there is stable presacral,\npelvic mild stranding, indeterminate, possibly from fluid overload.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. The major mesenteric vessels are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is re-demonstration of diffuse anasarca.", "output": "1. Several cysts are seen in the right kidney which have enlarged since ___ with hyperattenuating internal contents, suggestive of interval\ndevelopment of hemorrhagic cysts. Additionally, the right proximal ureter\nappears dilated and hyperattenuating, concerning for clots.\n2. Interval increase in bilateral pleural effusions and basilar atelectasis\nsince ___.\n3. Small pockets of gas are seen within the calices of the right transplant\nkidney. Although this can be explained by recent Foley catheter insertion and\nreflux, emphysematous pyelitis should be considered, correlation with\nurinalysis is recommended. No CT evidence of pyelonephritis or air within\nrenal parenchyma.\n4. Persistent mild perihepatic and pelvic free fluid without evidence of\norganized fluid collections.\n5. Diffuse anasarca.\n\nRECOMMENDATION(S): Correlation with urinalysis and urine culture is\nrecommended to rule out a urinary tract infection.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:17 pm, 20 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Patchy opacities at the bilateral lung bases likely represent\natelectasis, however infection cannot be entirely excluded.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic biliary\ndilatation, similar compared to prior. The common bile duct is prominent\nmeasuring up to 12 mm, also unchanged. The gallbladder is distended with\nfluid, however there are no inflammatory signs to suggest acute cholecystitis,\nsimilar compared to prior.\n\nPANCREAS: There is uniform prominence of the main pancreatic duct, unchanged\ncompared to prior. No focal lesions. No peripancreatic stranding.\n\nSPLEEN: Heterogeneity within the spleen is likely perfusional. No\nsplenomegaly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are enlarged with innumerable cysts bilaterally,\ncompatible with polycystic kidney disease. Multiple surgical clips and\npunctate calcifications are seen within the native kidneys bilaterally. Some\nof the cysts appear hyperdense, however there are overall unchanged compared\nto prior. No perinephric stranding. A right lower quadrant renal transplant\nis seen with multiple small hypodensities, which are too small to\ncharacterize, but likely represent simple cysts. The transplant kidney\nappears atrophic, but there is no evidence of hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost left hemicolectomy. A normal appearing colonic anastomosis is seen\nwithin the central abdomen. Apparent wall thickening affecting the proximal\ncolon may be related to underdistention, however colitis could have a similar\nappearance. There is moderate stool burden, decreased compared to prior. \nTrace free fluid along the right pericolic gutter is unchanged compared to\nprior, and may be postsurgical. The appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable in appearance. No adnexal\nmasses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Diffuse sclerosis of the visualized bones likely relates to renal\nosteodystrophy. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: Stranding within the midline anterior abdominal wall is likely\npostsurgical, decreased compared to prior..", "output": "1. Status post left hemicolectomy. Apparent wall thickening affecting the\nproximal colon is may be related to underdistention, however colitis can have\na similar appearance.Trace free fluid along the right pericolic gutter,\nunchanged.\n2. Unchanged mild biliary and pancreatic ductal dilatation, which may be due\nto ampullary stenosis. Distended gallbladder without evidence of acute\ncholecystitis.\n3. Polycystic kidney disease. Right lower quadrant renal transplant appears\natrophic, but no evidence of hydronephrosis. Diffuse sclerosis of the bones\nlikely reflects renal osteodystrophy.\n4. Patchy opacities at the bilateral lung bases, likely atelectasis, however\ninfection cannot be entirely excluded." }, { "input": "LOWER CHEST: Opacity is seen in the right lung base, which may reflect\nconsolidation versus collapse. A small pericardial effusion is noted,\nunchanged from prior exam. The intracardiac blood pool is hypodense,\nsuggestive of anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The kidneys are greatly enlarged with multiple cysts throughout,\nconsistent with known polycystic kidney disease. A transplant kidney is again\nnoted in the right iliac fossa, which is normal in appearance. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Free fluid\nis noted in the pelvis, consistent history of peritoneal dialysis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing abdominal hernia at the site of\nthe PD catheter entrance into the abdominal cavity. The abdominal and pelvic\nwall is within normal limits. A small amount of fluid and air is seen in the\nabdominal cavity, consistent with history of peritoneal dialysis. Within\nlimits of this noncontrast exam, no peritoneal thickening is seen.", "output": "1. No definite evidence of peritonitis on this noncontrast exam.\n\n2. Opacity in the right lung base, which may reflect consolidation versus\ncollapse.\n\n3. Large kidneys with multiple cysts, consistent with known polycystic kidney\ndisease.\n\n4. Unremarkable right iliac fossa transplant kidney.\n\n5. Small pericardial effusion, unchanged from prior exam.\n\n6. Hypodense intracardiac blood pool, suggestive of anemia.\n7. Small amount of dense fluid in pelvis, non-specific." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The common duct bile duct is dilated\nto 1.1 cm with abrupt cut off near the ampulla (609:22). There is no obvious\nmass. This is similar to ___. There is mild intrahepatic\nbiliary ductal dilatation. The gallbladder is distended without gallstones or\ngallbladder-wall thickening.\n\nPANCREAS: The main pancreatic duct is dilated up to 7 mm in the proximal body.\nThere is a slight taper toward the tail. The pancreas has normal attenuation\nthroughout, without evidence of focal lesions there is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys contain innumerable hypodense cysts and measure 16 cm on\nthe right and 14 cm on the left. This is compatible with the patient's known\npolycystic kidney disease. A transplant kidney is seen in the right\nhemipelvis. There is no hydronephrosis. A subcentimeter hypodensity too\nsmall to characterize. There is a normal nephrogram.\n\nGASTROINTESTINAL: A percutaneous drain through the left abdominal wall\nterminates in the left abdomen. There is a moderate amount nonhemorrhagic\nascites extending into the pelvis as described below. Locules a of free\nintraperitoneal air are compatible with the patient's recent surgery. An\nenteric tube terminates in the stomach body. Small bowel loops demonstrate\nnormal enhancement in caliber. A diverting ileostomy is noted in the right\nlower abdominal wall. There is no parastomal hernia. Residual contrast is\nseen within the colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall volume nonhemorrhagic free fluid with peritoneal enhancement and a\nlocule of air in the right hemipelvis.\n\nREPRODUCTIVE ORGANS: There is a 2.2 cm left adnexal cyst. The uterus is\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse anasarca. Skin staples are in place along the\nmidline of the abdominal wall.", "output": "1. Moderate volume nonhemorrhagic ascites throughout the abdomen and pelvis\nwith focal peritoneal enhancement in the right hemipelvis, which may represent\nfocal peritonitis.\n2. Status post partial colectomy with a diverting ileostomy. Expected\npostsurgical changes including small volume pneumoperitoneum. There is no\nevidence of bowel obstruction.\n3. Enlarged, polycystic native kidneys with a transplant kidney in the right\nhemipelvis without evidence of hydronephrosis.\n4. Mild intra and extrahepatic biliary ductal dilatation, as well as mild\npancreatic ductal dilatation with an abrupt cut off at the ampulla without\nobvious mass. This may be due to ampullary stenosis, however small ampullary\ntumors are not readily visible on CT. Recommend correlation with liver\nfunction tests regarding biliary obstruction. If clinically indicated, an\nMRCP with diffusion-weighted imaging can be obtained to further evaluate this\nfinding.\n5. 2.2 cm left adnexal cyst\n6. Please see the separately dictated chest CT report from the same date for\nintrathoracic findings.\n\nRECOMMENDATION(S):\n1. MRCP with diffusion-weighted imaging can be obtained to further evaluate\nCBD and pancreatic ductal dilatation with abrupt cutoff at the ampulla if\nclinically indicated." }, { "input": "LOWER CHEST: Atelectasis at the bilateral lung bases. No focal\nconsolidations. No pleural or pericardial effusion.\n\nABDOMEN:\nThere is a small volume of ascites throughout the abdomen.\n\nHEPATOBILIARY: The liver is cirrhotic in appearance. There are no arterially\nhyperenhancing lesions demonstrating washout to raise suspicion for HCC. An\nill-defined focus of hyperenhancement at the liver dome does not appear to\nwashout, likely a transient hepatic attenuation difference (series 3, image\n18). Additional nonenhancing hypodense lesions throughout the liver are\ncompatible with cysts or biliary hamartomas, unchanged compared to prior. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits. There is nonocclusive thrombus within\nthe proximal main portal vein (series 603, image 88). Multiple\nesophagogastric varices are visualized.\n\nPANCREAS: The pancreas is atrophic, however there are no focal pancreatic\nlesions. No ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen is mildly enlarged measuring 13.0 cm. No focal splenic\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 7 mm nonobstructing stone within the lower pole of the\nleft kidney (series 2, image 48). Punctate hypodensity within the lower pole\nof the right kidney is too small to characterize, likely a simple cyst. \nOtherwise, the kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of enhancing renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate-sized hiatal hernia predominantly\ncontaining fat. Otherwise, the visualized stomach, small, and large bowel are\nunremarkable in appearance.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Note is made of bilateral gynecomastia. There is a small fat\ncontaining umbilical hernia. Otherwise, the abdominal and pelvic wall is\nwithin normal limits.", "output": "1. Cirrhotic appearing liver, but no suspicious liver lesions.\n2. Small nonocclusive thrombus within the main portal vein. The acuity of\nthis is unclear as prior examinations were performed without IV contrast. \nSequela of portal hypertension include small volume ascites, splenomegaly, and\nmultiple esophagogastric varices.\n3. 7 mm nonobstructing stone within the lower pole of the left kidney." }, { "input": "LOWER CHEST: Please refer to the dedicated CT chest report from the same day\nfor above the diaphragm findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic biliary\nductal dilatation. The common bile duct patulous and measures up to 10 mm but\nthen tapers to normal size distally. No definite calcified obstructing stone\nis identified. The gallbladder appears collapsed. No ascites. The main,\nleft, and right portal veins appear patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality. The bladder is partially distended with bilateral ureteral\ncontrast jets visualized. Mass-like heterogeneity within the lumen anteriorly\nmay represent contrast mixing with urine (Se 2, Im 102).\n\nGASTROINTESTINAL: A hiatal hernia small. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. There is extensive\ncolonic diverticulosis of the sigmoid colon. There is moderate colonic stool\nburden. No bowel obstruction The rectum is within normal limits.\n\nPELVIS: No free fluid in the pelvis.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Extensive atherosclerotic disease is\nnoted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Extensive\nmultilevel degenerative changes of the lumbar sacral spine are noted with\nsignificant loss of intervertebral disc height most prominent at L5-S1, L1-L2,\nand T12-L1. There is severe levoconvex scoliosis of the lumbar spine,\nassociated with degenerative changes as above. Dystrophic calcifications\nwithin the soft tissue of the bilateral thighs are noted and may be related to\nprior injections.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild intrahepatic and extrahepatic biliary dilatation without evidence of\nobstructing mass or stone.\n2. Small hiatal hernia.\n3. Extensive degenerative disease in spine.\n4. Extensive colonic/sigmoid diverticulosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Diffuse coronary artery\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is wall thickening,\nmucosal hyperenhancement and wall edema of the terminal ileum with involvement\nof the base of the cecum. In addition an additional 12 cm loop of distal\nileum in the right lower quadrant also demonstrates wall thickening and\nhyperemia, suggestive of infectious enteritis or inflammatory bowel disease. \nThe appendix is filled with air and with slightly hyperemic walls, secondarily\ninvolved in the inflammatory process. There is fat stranding and fluid at the\nmesenteric root and within the bowel loops (2; 58).\n\nPELVIS: Bladder appears unremarkable. The distal ureters are unremarkable. \nThere is small amount free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Enlarged fibroid uterus, largest measuring 11.0 x 9.5 cm\n(2; 76) as well as a large fibroid within the cervix measuring 3.8 x 2.6 cm\n(602; 52). No adnexal abnormalities.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Distal and terminal ileitis with small amount of adjacent fluid and\nstranding concerning for infectious or inflammatory etiology. There is\nminimal adjacent involvement of the base of the cecum and reactive\ninflammation of the appendix as well.\n2. Enlarged fibroid uterus, largest measuring 11.0 cm.\n3. Dense coronary artery calcifications are noted." }, { "input": "CT COLONOGRAPHY: There is a moderate amount of fluid seen throughout the\ncolon.. The fluid displaces with repositioning.\n\nNo suspicious lesions are seen. There is no evidence of polyps or mass. (If\nthere is a suspicious lesion, describe location including segment of colon,\nwall location, morphology and size.) There is no evidence of stricture or\ninflammatory disease.\n\nCT ABDOMEN WITHOUT IV CONTRAST: A 3 mm nodule is seen in the right middle lobe\non series 8 for, ___ 3. The liver, gallbladder, spleen, adrenals, kidneys,\nand pancreas are within normal limits. The stomach and bowel loops are\nunremarkable. There is no free fluid, free air, or adenopathy.\n\nCT PELVIS WITHOUT IV CONTRAST: The bladder and rectum are within normal\nlimits. There is no free fluid\n\nBONE WINDOWS: There are no suspicious osseous lesions.\n\nMultiplanar reformatted images and 3D endoluminal navigation performed in the\nantegrade and retrograde direction were utilized to confirm the above\nfindings.\nLOWER CHEST: Lung bases within normal limits. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenal glands are not well visualized.\n\nURINARY: The kidneys are of normal and symmetric size.There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Rectal tube in place. \nModerate amount of colon content. No polyps seen the colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The bladder is collapsed. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Small calcified uterine fibroid\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of concerning osseous lesions or acute fracture.", "output": "1. no significant polyp or mass identified (greater than 1 cm). The\nsensitivity of CT colonography for polyps greater than 1 cm is 85-90%. The\nsensitivity for polyps 6-9mm is about 60-70%. Flat lesions may be missed with\nCT Colonography. Moderate amount of colonic content may limit the study." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN: The liver, gallbladder, spleen and pancreas are unremarkable. \nBilateral adrenal adenomas again noted, measuring up to 2.4 cm on the left. \nPunctate calcification in the left renal pelvis may be vascular or small\nnonobstructing calculus. No hydronephrosis. The kidneys are unremarkable\naside for a few hypodense lesions are too small to characterize.\n\nGASTROINTESTINAL: A sigmoid diverticulum with surrounding soft tissue\nstranding is seen, consistent with acute sigmoid diverticulitis, with no\nevidence of abscess or free air. The appendix is surgically absent.\n\nPELVIS: The patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the thoracolumbar spine.", "output": "1. Acute sigmoid diverticulitis without abscess.\n2. Stable bilateral adrenal adenomas. No imaging findings of pancreatitis or\nevidence of malignancy in the abdomen and pelvis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:06 pm, 1 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions with associated\ncompressive atelectasis, new compared to prior CT of the abdomen/pelvis from\n___. A battery pack is partially imaged in the left anterior\nchest wall.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. No\nfocal lesion is identified. There is no intra- or extrahepatic biliary ductal\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: There is moderate fatty atrophy of the pancreas. No focal lesion is\nidentified. Pancreatic duct is not dilated.\n\nSPLEEN: Spleen is normal size.\n\nADRENALS: Bilateral adrenal glands are unremarkable.\n\nURINARY: Bilateral kidneys are symmetric in size. There is no focal renal\nlesion or hydronephrosis.\n\nGASTROINTESTINAL: An enteric tube terminates in the stomach. There is\nvariable mild dilatation of small bowel loops, measuring up to 3.5 cm in\ncaliber, improved from prior, likely mild postoperative ileus. Since the\nprior CT of the abdomen/pelvis from ___, the patient is status\npost sigmoid resection (for anastomotic leak after Altemeier procedure for\nrectal prolapse) and left lower quadrant end colostomy. The cecum and\nascending colon are mildly dilated, similar to prior. Appendix is not\nvisualized.\n\nPELVIS: A drain entering the right lower quadrant terminates in the presacral\nregion. There is a small amount of fluid in the left pelvis and presacral\nregion. More inferiorly, there is an elongated, rim-enhancing fluid\ncollection extending from the inferior presacral region to the level of pelvic\nfloor, anterior to the anal canal, measuring 2.2 x 3.1 x 6.9 cm (7:53 and\n4:83-91). The bladder is decompressed by a Foley catheter.\n\nREPRODUCTIVE ORGANS: Uterus is surgically absent. There is no adnexal mass.\n\nLYMPH NODES: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVASCULAR: There are mild atherosclerotic calcifications of the abdominal aorta\nwithout aneurysmal dilatation. The celiac artery and SMA either share a\ncommon origin, or have takeoffs in close proximity to one another.\n\nBONES: No suspicious osseous lesion is identified.\n\nSOFT TISSUES: Mild subcutaneous tissue edema is noted in bilateral thighs and\nabdominal wall. There are incisional changes along the anterior midline lower\nabdominal and pelvic wall.", "output": "1. Interval sigmoid resection and left lower quadrant end colostomy since the\nprior CT of the abdomen/pelvis from ___. Elongated,\nrim-enhancing fluid collection extending from the inferior presacral region to\nthe level of pelvic floor, anterior to the anal canal, measuring 2.2 x 3.1 x\n6.9 cm. This fluid collection is located inferior to the pelvic drain.\n2. Variable mild dilatation of small bowel loops, improved from prior, likely\nmild postoperative ileus.\n3. New small bilateral pleural effusions.\n\nNOTIFICATION: The findings were discussed with ___. by\n___, M.D. on the telephone on ___ at 3:33 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A\n3.0 cm simple cyst near the hepatic dome is unchanged (2:53). Additional\nscattered subcentimeter hypoattenuating lesions are too small to characterize,\nbut are unchanged from prior. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains gallstones without\nwall thickening or evidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic in appearance. Multiple bilateral simple\ncysts are again seen. There is no hydronephrosis or nephrolithiasis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. A small bowel anastomosis is\nagain seen in the left mid abdomen (2:83), with dilatation of a portion of\nproximal small bowel, similar to prior. Diverticulosis of the sigmoid colon\nis noted, without evidence of wall thickening and fat stranding. There is no\nevidence of gastrointestinal obstruction. The appendix is normal.\n\nPELVIS: The urinary bladder is mostly collapsed, and contains excreted\ngadolinium contrast from same day MR head study. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications are noted the prostate. The\nseminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Saccular aneurysmal dilatation of the upper abdominal aorta at the\nlevel of the diaphragm, just above the celiac axis measures up to 3.6 cm\n(2:63), unchanged. Saccular aneurysmal dilatation of the infrarenal abdominal\naorta up to 3.2 cm (6:42) is unchanged. Moderate atherosclerotic disease is\nnoted.\n\nBONES: Previously seen lytic lesion in the right L2 pedicle now demonstrates\nsclerosis (2:76). Sclerotic foci in the L3 vertebral body (2:82), left sacrum\n(2:113) and left iliac bone (2:111) are unchanged and may represent bone\nislands. No new worrisome osseous lesions are identified.\n\nSOFT TISSUES: There is a moderate periumbilical hernia containing a\nnonobstructed loop of bowel. Lipomas are again seen in the left gluteus\nmaximus muscle and a right adductor muscle (2:142).", "output": "1. Compared to ___, there has been interval evolution of the\npreviously noted lytic lesion in the right L2 pedicle, which now demonstrates\na more sclerotic appearance but similar size. No new worrisome osseous\nlesions identified.\n2. No evidence of new metastatic disease in the abdomen or pelvis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Two\nadjacent subcentimeter hypodensities in segment 7 are too small to\ncharacterize, but statistically likely represent cysts (03:13). There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring up to 13.8 cm. There is a large\nheterogeneously enhancing mass in the spleen that measures up to 13.4 cm. A\nsmall region of the lesion appears adherent to the adjacent body wall (4:99). \nNo associated calcifications.\n\nADRENALS: The adrenal glands appear diffusely thickened, without evidence of a\ndiscrete nodule.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Several fiducial markers are noted in the prostate gland.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Dominant large splenic mass measuring up to 13.4 cm with a small focus that\nappears to be adherent to the adjacent body wall, suspicious for a primary\nsplenic neoplasm. Differential considerations include lymphoma or possibly\nangiosarcoma (although this is rare). Other benign entities would be less\nlikely given size and morphology, and if this developed over a short interval.\n2. No abdominal lymphadenopathy or other evidence of abdominopelvic\nmetastases.\n\nRECOMMENDATION(S): If the plan is for splenectomy, then no further imaging or\npercutaneous sampling is indicated. However, if the patient is deemed a poor\nsurgical candidate, further evaluation with MRI or PET-CT could be considered\nfor better characterization." }, { "input": "LOWER CHEST: Ground-glass opacities in the lower lobes are presumably\natelectasis. There is a suggestion of 1-2 mm nodule in the right lower lobe\n(2:1). The heart is mildly enlarged with mild coronary calcifications. There\nis no pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. 3.9 x 5.0 cm\nheterogeneous lesion arising from the interpolar region of the left kidney is\nsuspicious for a neoplasm (02:29). There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal (02:57).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable apart\nfrom calcifications in the prostate likely the sequela of prior inflammation..\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The descending thoracic aorta demonstrates fusiform aneurysmal\ndilation near the hiatus measuring 4.0 cm. The abdominal aorta is lobulated\nwith multifocal areas of aneurysm. Suprarenal abdominal aorta demonstrates\nfusiform dilatation measuring up to 4 cm. The infrarenal abdominal aneurysm\nis saccular and measures up to 4.9 cm in diameter. Patient is status post\nstenting of the left external iliac artery. Moderate atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nRight iliac bone sclerotic focus is likely a bone island.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "1. No acute intra-abdominal or intrapelvic abnormalities.\n2. 3.5 x 5.0 cm heterogeneous mass arising from the left kidney, suspicious\nfor neoplasm. Further evaluation with renal MRI with intravenous contrast is\nrecommended.\n3. Suprarenal and infrarenal abdominal aortic aneurysms measuring up to 4.9 cm\nin diameter. Further evaluation with nonemergent dedicated CTA or MRA is\nrecommended, if not performed previously.\n4. Status post left external iliac artery stenting.\n5. Possible 1-2 mm right lower lobe nodule. See recommendations section\nregarding the need for imaging follow-up.\n\nRECOMMENDATION(S):\n1. Dedicated renal MRI for further assessment of the right renal mass\nsuspicious for neoplasm.\n2. Consider CTA or MRA of the abdomen for further assessment of the abdominal\naortic aneurysms.\n3. For incidentally detected nodules smaller than 6mm in the setting of an\nincomplete chest CT, no CT follow-up is recommended. See the ___ ___\nSociety Guidelines for the Management of Pulmonary Nodules Incidentally\nDetected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: Small nonhemorrhagic left pleural effusion and dependent\natelectasis is new since ___. There is no pericardial effusion. \nPre-existing aneurysm of the descending thoracic aorta measuring 4.4 cm is\nunchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Again seen is a\nheterogeneous renal mass arising from the upper pole of the left kidney\nmeasuring 5.6 cm. However, there is new hyperdense rim around the left renal\nmass, suspicious for hemorrhage. There is no hydronephrosis. There is no\nnephrolithiasis. Fat stranding in the perinephric fat is noted around the\nleft renal mass, new since prior exam.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal (601:36).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: As previously noted, there is suprarenal and infrarenal saccular and\nfusiform abdominal aorta, measuring up to 4.6 cm. Mild ectasia of the celiac\naxis is stable. Patient is status post stenting of the left common and\nexternal iliac artery. The most distal portion of the left common iliac\nartery is mildly aneurysmal measuring 1.7 cm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSubcentimeter sclerotic focus in the right ilium likely represents a bone\nisland (601:39).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits besides a\nsmall fat containing umbilical hernia.", "output": "1. New, small amount of hemorrhage around the pre-existing 5.6 cm left renal\nmass.\n2. Small pleural effusion and minimal atelectasis in the left lower lobe,\nlikely related to the new renal mass hemorrhage.\n3. Additional changes as above, including abdominal aortic aneurysm." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodensity within segment ___ is too small to characterize but\nstable from the prior examination and likely a cyst. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. \nPunctate bilateral renal hypodensities are too small to characterize but\nlikely cysts. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\nGASTROINTESTINAL: A small axial hiatal hernia is noted. Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.\nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. Appendix contains air, has normal caliber\nwithout evidence of fat stranding. There is no evidence of mesenteric\nlymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES:There is no evidence of worrisome lesions. Subtle fat\nstranding is noted surrounding a small fat-containing umbilical hernia\n(2:47-48).", "output": "1. Subtle fat stranding is noted surrounding a small fat-containing umbilical\nhernia. Findings may represent a strangulated fat-containing umbilical hernia\nversus intermittent herniation of bowel.\n2. Colonic diverticulosis without evidence of acute diverticulitis.\n\nNOTIFICATION: Findings were updated and emailed to the ED QA nurses at 9:10am\non ___." }, { "input": "The visualized lung bases are clear. The heart is normal in size and there is\nno evidence of pericardial effusion.\n\nABDOMEN:\n\nThe liver is mildly nodular in contour and decreased in attenuation,\ncompatible with fatty infiltration. No focal suspicious liver lesions are\nidentified. There is a 3 mm hypodensity seen within segment VIII of the liver,\ntoo small to characterize (6:17). The portal venous system is patent. There is\ndilation of the intrahepatic biliary ductal system. There is no evidence of\nextrahepatic biliary dilation. The spleen is enlarged, measuring up to 15.1 cm\nin diameter (7:29). Multiple esophageal and splenorenal varices are noted,\nsuggestive of portal hypertension. The gallbladder, pancreas, and bilateral\nadrenal glands are normal. The kidneys enhance symmetrically and are without\nsuspicious solid mass. Multiple tiny bilateral renal hypodensities are too\nsmall the characterize but likely cysts.\n\nThe stomach demonstrates mildly thickened gastric rugae, likely secondary to\nvenous collaterals. The visualized loops of small and large bowel are normal\nin caliber and without evidence of wall thickening. There is no\nretroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum. The celiac trunk and SMA are grossly\npatent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.", "output": "1. Mildly nodular and fatty liver, compatible with the patient's known\ncirrhosis. No focal liver lesions are identified.\n\n2. Evidence of portal hypertension, including splenomegaly and the formation\nof esophageal and splenorenal varices.\n\n3. Dilated intrahepatic biliary ductal system. No evidence of extrahepatic\nbiliary dilatation." }, { "input": "LOWER CHEST: Nodular atelectasis in the middle lobe, unchanged. Please review\nsame day dedicated chest CT report.\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged segment 2 and segment 6 subcentimeter biliary\nhamartomas. No suspicious lesion. No ductal dilation. Unremarkable\ngallbladder.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: The spleen is smaller in size measures 9 cm (previously 10.5 cm). The\npreviously seen splenic infarcts have improved with better splenic profusion. \nLobular splenic contour, unchanged.\n\nADRENALS: Unremarkable.\n\nURINARY: 18 mm interpolar simple right renal cyst. No nephrolithiasis or\nhydronephrosis. No hydroureter.No suspicious lesion.\n\nGASTROINTESTINAL: No intestinal obstruction. Unremarkable appendix. Sigmoid\ndiverticulosis. Moderate sigmoid stool burden.\n\nPELVIS: Unremarkable bladder and seminal vesicles. Prostate hypertrophy. \nStool filled rectum.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Patent aorta and major branches. Mild arteriosclerosis. Incidental\nnote of a retro aortic left inferior renal vein.\n\nBONES AND SOFT TISSUES: Thoracolumbar degenerative changes. No suspicious\nlesion. Small fat containing umbilical hernia, unchanged.", "output": "1. Improved splenic infarcts.\n2. No new suspicious abdominopelvic lesions.\n3. Sigmoid diverticulosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Again noted is diffuse hepatic steatosis. There are unchanged\nsubcentimeter l hypodense lesions scattered throughout the liver that are too\nsmall to characterize. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Again noted is a 1.5 cm hypodense area in the peripheral the spleen\nrepresenting sequela of prior infarct.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 4 mm nodular hyperdensity in the upper pole of the right kidney (601b:45),\nthat enhances similarly to the kidney parenchyma is stable back from ___ and likely corresponds to a lobulation. There is an unchanged\n1.9 cm hypodense nonenhancing lesion in the interpolar region of the right\nkidney suggestive of a cyst. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. A circumaortic left renal vein is redemonstrated.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. No evidence of lymphoma in the abdomen or pelvis" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensities likely represent simple hepatic cysts. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: A 1.5 cm hypodense focus in the peripheral spleen likely represent\nsequela of prior trauma or infarct. The spleen is not enlarged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.9 cm simple cyst is noted in the interpolar region of the right kidney. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is moderately enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. A retroaortic left renal vein is again noted.\n\nBONES: Bilateral mixed lytic and sclerotic lesions in the iliac bones (series\n4, image 97) are unchanged a benign morphologies.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. No evidence of malignancy within the abdomen and pelvis." }, { "input": "Lungs: Please see the report of the CT chest performed on the same day for\nmore details.\n\nLiver: The liver is homogeneous with a smooth contour. No suspicious liver\nlesion. A few scattered subcentimeter hypodensities are seen throughout the\nliver, such as in segment 6, series 3, image 61, too small to characterize,\nbut likely cysts. These are stable since ___. Diffuse mild fatty\ninfiltration of the liver.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\nis unremarkable.\n\nSpleen: There is scarring of the spleen, likely due to prior sequelae of\nlymphoma. It is not enlarged. Stable hypodensity at the upper pole measuring\n15 mm.\n\nPancreas: Unremarkable. No pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: There is a stable 2.2 cm hypodensity in the midpole of the right\nkidney, likely cortical cyst. No hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nReproductive organs: The prostate is unremarkable.\n\nGastrointestinal: Moderate fecal loading within the colon, more so in the\nrectum and sigmoid. The bowel is within normal limits. No evidence of bowel\ndilatation or obstruction.\n\nVascular: Mild atherosclerotic calcifications of the abdominal aorta.\n\nLymph nodes: No size significant lymph nodes.\n\nBone and soft tissues: Stable sclerotic lesions are seen within the iliac\nbones, similar to ___. No suspicious bone lesion. Moderate degenerative\ndisc disease is seen throughout the lumbar spine.", "output": "1. No evidence of intra-abdominal recurrence.\n\n2. Diffuse mild fatty infiltration of the liver." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: A 1 cm area of hypoenhancement is seen in hepatic segment ___\n(04:47) with mild peripheral enhancement. A similar-appearing oval area of\nhypoenhancement measuring 1.2 x 0.4 cm is seen near the hepatic dome (04:43). \nNo additional lesions are identified. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Both kidneys demonstrate cortical irregularities consistent with\nprior scarring. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis or organized fluid collections.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative disc disease in the lumbosacral spine. \nThere is bilateral spondylolysis at L5-S1 without significant anterolisthesis.\nMild anterolisthesis is noted at L4-5 secondary to degenerative facet changes.\nAdditionally, there is mild retrolisthesis of of L2-3. The patient is status\npost hardware fixation for a right proximal femoral fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Two hypoenhancing lesions within the liver measuring up to 1.2 cm in\ndiameter, with mild peripheral hyper enhancement, concerning for small hepatic\nabscesses in the appropriate clinical context. These are too small to be\ndrained.\n2. No evidence of free fluid or fluid collections within the abdomen and\npelvis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:10 ___, 50 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 2 cm\nhepatic cyst in segment 5 is unchanged. A subcentimeter hypodensity in\nsegment ___ at the dome is also unchanged but remains too small to\ncharacterize and may represent a cyst. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is mild focal thickening of the\ngallbladder wall at the fundus. The gallbladder is not distended. No\ngallstones identified. There is no evidence of wall inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\nscattered colonic diverticula without evidence of acute diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. There is a 2.5 cm\ncystic lesion in the left hemipelvis is unchanged compared to the prior study.\nThere is no right adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is tortuous and there is extensive\natherosclerotic disease. There is no aneurysmal dilatation. Mesenteric\nbranches are patent to the extent visualized.\n\nBONES:\nThere is diffuse osteopenia and extensive degenerative changes in the lumbar\nspine. There is grade 1 anterolisthesis at L3-L4. Note is made of marrow\nheterogeneity and coarse trabeculations within the left more than right iliac\nbone and sacrum. No expansile lytic or destructive bone lesion identified.\nRight hip prosthesis is partially imaged and appears grossly intact. \nFractures are again seen in the left pubic bone and inferior pubic ramus with\nvisible fracture lines. Compared with previous study, there is patchy\nsclerosis in the upper sacrum likely reflecting healing fracture. Left medial\nacetabular fracture also remains visible. Note is also made healing\nleft-sided lower rib fractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No significant soft tissue abnormality in the abdomen and pelvis. In\nparticular, no evidence of intra-abdominal malignancy.\n2. Focal thickening of the gallbladder wall at the fundus may represent\nadenomyomatosis. Correlation with ultrasound is recommended.\n3. Stable 2.5 cm cystic lesion in the left hemipelvis may represent a an\nadnexal cyst. Confirmation with pelvic ultrasound is recommended.\n4. Multiple fractures several of which are visible on prior imaging including\nleft acetabular fracture, left pubic/superior and inferior pubic rami\nfractures, left rib fractures. Sacral sclerosis more prominent than prior\nlikely reflects healing fracture.\n5. Diffuse abnormal trabecular pattern in the pelvis of uncertain etiology,\npossibly relating to multiple fractures on a background of demineralization." }, { "input": "LOWER CHEST: Trace bilateral effusions noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 0.7\ncm biliary hamartoma versus cyst noted in hepatic segment VI. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypoattenuating lesion in the midpole of the left kidney is too\nsmall to characterize, likely a cyst. No concerning renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Diverticulum noted at the fundus of the stomach. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is very mild diverticulosis without evidence for acute\ndiverticulitis.\n\nPELVIS: Thickening of the bladder wall is likely related to chronic outlet\nobstruction. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Bladder wall thickening is most likely related to chronic outlet obstruction\nthe setting of prostatic hypertrophy, however may be seen in the setting of\ncystitis. Please correlate with urinalysis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is fatty in attenuation. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: A subcentimeter hypodensity in the spleen is too small to\ncharacterize, but unchanged. Spleen measures 15.0 cm, decreased in size,\npreviously 21.0 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic. Subcentimeter hypodensities in the\nright kidney are too small to characterize but unchanged. Left kidney\nenhances and excretes contrast normally. There is no hydroureteronephrosis. \nThere are no suspicious left renal lesions. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is no bowel obstruction. There is diverticulosis of\nthe sigmoid colon. Appendix is not visualized. No intra-abdominal free fluid\nor free air.\n\nPELVIS: The bladder is partially distended. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Again seen, is a partially necrotic uterine fibroid with\ncoarse calcifications measuring 6.4 x 8.1 cm. Cystic right adnexal lesion\nmeasures approximately 1.7 x 1.3 cm, not significantly changed.\n\nLYMPH NODES: There has been interval decrease in size of peripancreatic and\nportacaval lymph nodes compared to prior. Largest portacaval lymph node now\nmeasures 10 x 15 mm, previously 20 x 21 mm. Retroperitoneal lymphadenopathy\nhas also decreased.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. There is approximately 50% narrowing at the takeoff of the\nceliac trunk.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the lumbar spine including grade\n1 anterolisthesis of L4-5.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. No acute intra-abdominal or pelvic process. Unremarkable CT appearance of\nthe gallbladder.\n2. Interval decrease in size of mesenteric and retroperitoneal lymphadenopathy\nand splenomegaly.\n3. Partially necrotic calcified fibroid, unchanged.\n4. Stable hypodense right adnexal lesion, likely an ovarian cysts, follow-up\npelvic ultrasound in ___ year as recommended previously.\n\nRECOMMENDATION(S): Pelvic ultrasound in ___ year.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:06 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodense lesion in segment 2 is too small to characterize but\nlikely represents a biliary hamartoma or cyst and is unchanged compared to\nprior (2; 59). There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged measuring 14.1 cm with normal\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic, similar to prior. Bilateral\nsubcentimeter hypodense lesions are too small to characterize but likely\nrepresents renal cysts, similar to prior. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus again demonstrated, similar to prior. \nStable subcentimeter right adnexal lesion, likely an ovarian cyst (2; 105).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Calcifications are noted at the origin of bilateral renal\narteries, the SMA and celiac axis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis L4-L5 is likely degenerative in unchanged from prior. \nMild multilevel degenerative changes are noted, most notable at L3-L4.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No lymphadenopathy noted in in the abdomen or pelvis.\n2. Mild splenomegaly similar to prior.\n3. Fibroid uterus again demonstrated. Stable hypodense right adnexal lesion,\nlikely an ovarian cyst. Consider follow-up with pelvic ultrasound as\npreviously recommended.\n\nRECOMMENDATION(S): Pelvic ultrasound as previously recommended" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nPaucity of mesenteric fat limits evaluation. Within this limitation:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nconcerning focal hepatic lesions identified. No evidence of intrahepatic or\nextrahepatic biliary ductal dilatation. Pneumobilia predominantly in the anti\ndependent portions of the liver is mild-to-moderate, likely secondary to prior\nWhipple procedure. Patient is status post cholecystectomy.\n\nPANCREAS: The patient is status post Whipple procedure for chronic\npancreatitis with expected postsurgical anatomy. The remaining pancreas is\natrophic with scattered coarse calcifications compatible with sequelae of\nchronic pancreatitis. The main pancreatic duct is top-normal in caliber. No\nperipancreatic fluid collections.\n\nSPLEEN: The spleen is not visualized.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 7-mm hypodense lesion in the left midpole is unchanged and likely a\nparapelvic cyst (series 2, image 82). Subcentimeter hypodensities in the\nright lower renal pole are too small to accurately characterize on CT but are\nalso unchanged and most likely cysts (series 2, image 79, 83). No evidence of\nnew focal renal lesions, hydronephrosis, or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended with ingested food contents an oral\ncontrast. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. No\nbowel obstruction or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is within normal limits.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy is identified,\nother detailed evaluation is limited due to paucity of mesenteric fat. No\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic disease is\nnoted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes in the lumbosacral spine are most pronounced at L5-S1\nwith a moderate disc protrusion indenting the anterior thecal sac at this\nlevel (series 2, image 98; series 602b, image 37). Retrolisthesis of L5 on S1\nis mild.\n\nSOFT TISSUES: Mild thickening of the skin in the right gluteal region\npersists but is less pronounced compared to the prior exam (series 2, image\n128).", "output": "1. No specific CT evidence of metastasis in the abdomen or pelvis.\n2. Persistent mild thickening of the right gluteal region skin, improved from\nprior exam. Correlate with clinical assessment.\n3. Expected post-Whipple procedure appearance with sequelae of chronic\npancreatitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild intrahepatic biliary ductal\ndilatation is unchanged. The gallbladder is within normal limits. Replaced\nleft hepatic artery noted.\n\nPANCREAS: The patient is status post Whipple. Ductal dilatation in the\nremnant pancreas is unchanged. Coarse pancreatic calcifications are sequelae\nof chronic pancreatitis.\n\nSPLEEN: The spleen is absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypoattenuating renal lesions are too small to characterize,\nstatistically most likely to represent cysts. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Replaced left hepatic artery\nnoted. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Skin thickening over the right gluteal musculature has improved.", "output": "1. Normal no evidence for intra-abdominal metastatic disease.\n2. Stable postsurgical changes status post Whipple.\n3. Improvement skin thickening over the right gluteal musculature." }, { "input": "LOWER CHEST: Please refer to the separately reported chest CT from the same\nday for thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is not visualized. Is\nwithin normal limits. Replaced left hepatic artery noted.\n\nPANCREAS: Patient is status post Whipple. The remaining pancreas has normal\nattenuation throughout, without evidence of focal lesions or pancreatic ductal\ndilatation. Coarse calcifications seen in the pancreas indicating chronic\npancreatitis. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Stable bilateral subcentimeter cortical hypodensities, the largest of\nthem in the interpolar area of the left kidney measuring 0.8 cm. The kidneys\nare of normal and symmetric size with normal nephrogram. There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Replaced left hepatic artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of metastatic disease in the abdomen and pelvis.\nPatient is status post Whipple. Pancreatic calcifications suggesting chronic\npancreatitis.\nPlease refer to separately reported chest CT from the same day for further\nthoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The patient has had prior Whipple procedure. The remaining distal\npancreas remains atrophic. Coarse calcification in the pancreatic tail is\nunchanged.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cortical hypodensities are too small to accurately\ncharacterize on CT but are similar to prior, probably cysts. No\nhydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic stool\nburden is moderate. The colon and rectum are within normal limits. No bowel\nobstruction.\n\nPELVIS: The urinary bladder is distended. The distal ureters are unremarkable.\nNo free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland appears enlarged.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic disease is\nnoted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. L5-S1\ndegenerative changes are moderate with mild retrolisthesis of L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastasis in the abdomen or pelvis.\n2. Post-Whipple changes and coarse calcification in pancreatic tail appear\nstable.\n3. Prostatomegaly." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder surgically absent\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not seen although surgical clip at the base of\nthe cecum suggests prior appendectomy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Calcific densities anterior to the right psoas are again noted and\nlikely phleboliths, demonstrated lateral to the ureter on prior\ncontrast-enhanced CT from ___.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute findings. No evidence of nephrolithiasis or hydronephrosis.\n\n2. Status post cholecystectomy." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout on\nthis noncontrast scan There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: There is no pancreatic ductal dilatation. The pancreas is normal in\nattenuation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are normal in size. There is no evidence of nephrolithiasis\nor hydronephrosis involving either kidney. No ureteral stone is identified. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber. The colon and\nrectum are within normal limits. The appendix is not visualized. No\nsecondary signs of appendicitis are demonstrated.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Similar to multiple prior exams are small hyperdensities anterior\nto the right psoas muscle measuring up to 8 mm which could represent dropped\ngallstones or venous phleboliths.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of nephrolithiasis or hydronephrosis in either kidney.\n2. Unchanged from multiple prior exams are calcific densities measuring up to\n8 mm seen anterior to the right psoas muscle just lateral to the right ureter.\nAs has been previously suggested, these may represent phleboliths or\npotentially dropped gallstones." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Patient is status post cholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. The previously visualized\ncalcific densities along the right psoas muscle are re- demonstrated. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. Otherwise,\nthe abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process within the limitations of a noncontrast\nexamination. Specifically, no evidence of nephrolithiasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia, similar compared to prior. \nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nThe colon and rectum are within normal limits. The appendix appears\nsurgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small, fat containing umbilical hernia", "output": "1. No nephrolithiasis, hydronephrosis, or other etiology to explain the\npatient's reported symptoms.\n2. Small hiatal hernia." }, { "input": "LOWER CHEST: There is mild left lower lobe atelectasis. There is a trace left\npleural effusion. No pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits\nwith vicarious excretion of contrast vs possible biliary sludge within the\ngallbladder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status post recent\nlaparoscopic appendectomy with wall thickening in the cecum consistent with\nrecent postoperative changes. Foci of intraperitoneal air is also compatible\nwith recent postoperative changes (2; 80). There is a small amount of free\nfluid within the peritoneal cavity with extensive thickening of the\nperitoneum, especially within the pelvis, suggestive of inflammation. There\nis no disproportionate amount of fluid adjacent to the cecum.\n\nThere is interval development of multiple dilated loops of small bowel\nproximally in the left upper quadrant measuring up to 4.6 cm with non-dilated\nsmall bowel distally. Oral contrast is seen within the colon, diluted with\nintraluminal fluid. Possible transition point is noted in the left lower\nabdomen inferior to a port site (2; 65), however a definite etiology of the\ntransition is not found. There is also fluid and air within the ascending and\ntransverse colon but the descending colon and sigmoid colon are decompressed. \nThese findings may be compatible with partial small bowel obstruction versus\nileus.\n\nThe appendix is surgically removed. Suture material is noted in the right\nlower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis, with significant adjacent peritoneal\nthickening suggestive of inflammation.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Numerous prominent mesenteric lymph nodes are likely reactive\nmeasuring up to 0.7 cm in short axis (2; 51), similar to prior. There is no\nsignificant retroperitoneal lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous air within the anterior abdominal wall, primarily\non the right is consistent with recent surgery.", "output": "1. Dilated loops of small bowel within the left upper quadrant with non\ndilated distal small bowel loops with question of a transition point in the\nleft lower abdomen adjacent to a prior port site without definite cause of\ntransition evident. There is progression of oral contrast into the colon.\nThis may suggest partial small bowel obstruction.\n2. There is a small amount of free fluid within the abdomen and pelvis with\nextensive thickening of the peritoneum especially within the pelvis suggestive\nof inflammation or infection. No disproportionate stranding or fluid is noted\naround the cecum. No rim enhancing fluid collections.\n3. Trace left pleural effusion with mild left lower lobe atelectasis." }, { "input": "Detailed evaluation of the solid organs, soft tissues, and vessels is limited\nwithout the use of intravenous contrast. Within this limitation:\n\nLOWER CHEST: Ground-glass opacities in the lingula could be atelectasis, but\nis concerning for aspiration in the setting of nausea and vomiting (series 2,\nimage 3, 1). No pleural effusion or pericardial effusion. The heart is\nnormal in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. No\nevidence of focal lesions within the limitations of an unenhanced scan. No\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas is markedly atrophic. The pancreas has normal\nattenuation throughout, without evidence of focal lesions within the\nlimitations of an unenhanced scan. No pancreatic ductal dilatation. No\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A left 3.6 cm\nparapelvic cyst is unchanged (series 601, image 34). No hydronephrosis,\nnephrolithiasis, or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended with fluid. Dilated loops of\nproximal small bowel with a transition point in the distal small bowel in the\nright upper abdomen and decompressed small enlarged bowel loops is consistent\nwith a high-grade small-bowel obstruction (Series 601, image 21). The small\nbowel just proximal to the transition point has fecalized material. \nSmall-bowel wall however still appears to enhance normally and is of normal\nthickness. There is minimal stranding around the small bowel in the pelvis\n(series 601, image 31). No organized fluid collection. No pneumatosis or\npneumoperitoneum. Colonic diverticulosis is diffuse and severe. The rectum\nis unremarkable.\n\nPELVIS: The urinary bladder is underdistended limiting evaluation. Probable\nfat within the wall of the dome of the urinary bladder suggests sequelae of\nchronic inflammation, unchanged (series 601, image 32). No free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears surgically absent. No adnexal masses.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Multilevel\ndegenerative changes in the lower thoracic spine are severe. Degenerative\nchanges at L5-S1 is severe. Multiple levels of mild broad-based disc bulges\nin the lumbar spine, unchanged. Degenerative changes in the bilateral SI\njoints are moderate.\n\nSOFT TISSUES: A fat containing umbilical hernia is small (Series 602, image\n37). There is another small fat containing ventral hernia just superior to\nthe umbilicus (series 602, image 37, 38). 11 mm nodular lesion in the right\nretroareolar region could be a dilated duct or lesion; dedicated mammography\nwould be required to further evaluate (series 2, image 4).", "output": "1. High-grade distal small-bowel obstruction with transition point in the\nright upper abdomen.\n2. Ground-glass opacities in lingula concerning for aspiration given provided\nclinical history, although atelectasis is in the differential.\n3. Probable sequelae of chronic bladder in inflammation, similar to prior.\n4. Small fat containing umbilical and periumbilical hernias.\n\nNOTIFICATION: The findings and impression were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 5:46 am, 1 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: New small right pleural effusion with trace left pleural effusion\nwith compressive atelectasis. Mild cardiomegaly is re-demonstrated.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. Status post cholecystectomy\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Mild fullness of the left adrenal gland is unchanged. Right adrenal\ngland is unremarkable.\n\nURINARY: No hydronephrosis or nephrolithiasis. Re-demonstrated left\nparapelvic cyst. Other scattered hypodensities are too small to characterize.\n\nGASTROINTESTINAL: Enteric tube partially coiled within the body of the\nstomach. The stomach is mildly distended. Beginning in the mid jejunum\nextending for a long distance, there is marked thickening of the dot with\nfecalized material and diluted contrast measuring up to 5.3 cm with a\ntransition point in the right upper quadrant consistent with a high-grade\nsmall bowel obstruction. No pneumatosis. Small bowel wall appears to enhance\nnormally. The distal small bowel is normal caliber and the large bowel is\ndecompressed. Scattered colonic diverticula.There is mesenteric edema in the\nright upper quadrant near the site of transition.\n\nPELVIS: Bladder is unremarkable. Remaining pelvic contents are unremarkable.\n\nPERITONEUM/RETROPERITONEUM: Mild mesenteric edema. No frank ascites. No\npneumoperitoneum.\n\nLYMPH NODES: No adenopathy\n\nVASCULAR: Aorta is normal caliber. Mild atherosclerotic calcifications of the\naorta. The portal vein is patent.\n\nBONES: Degenerative change of the spine. No suspicious osseous lesions.\n\nSOFT TISSUES: Midline abdominal incision with cutaneous staples.", "output": "1. High-grade distal small-bowel obstruction with transition point in the\nright upper quadrant, similar location to the prior study, however the degree\nof distention and the length of distension is greater than on the prior study.\n2. New small right pleural effusion with trace left pleural effusion with\ncompressive atelectasis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:03 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Small right pleural effusion, slightly decreased in size compared\nto the previous study. Atelectatic changes at both lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. Left\nparapelvic and cortical renal cysts are unchanged. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. Postsurgical inflammatory changes are seen in the mesentery. \nA surgical drain is seen terminating in the omentum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The patient is post midline laparotomy. In the subcutaneous\ntissues along the laparotomy site, there are non-organized\ninflammatory/phlegmonous changes seen along the length of the surgical\nincision, with multiple tiny pockets of subcutaneous gas. Additionally, the\nwound appears dehiscent below the surgical staples. Inflammatory fat\nstranding is also present in the adjacent omentum.", "output": "1. Marked inflammatory/phlegmonous changes deep to the laparotomy incision,\ncompatible with a wound infection. While the phlegmonous changes appear to be\norganizing, no discrete abscess is identified.\n\nRECOMMENDATION(S): The findings were discussed with ___, M.D. by\n___ ___, M.D. on the telephone on ___ at 11:29 am, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Left parapelvic cysts again demonstrated. Cortical hypodensities are\ntoo small to characterize. There is no evidence of focal renal lesions within\nthe limitations of an unenhanced scan. There is no hydronephrosis. There is\nno nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Along the incision site along the anterior abdominal midline,\nthere is relative thickening of the soft tissues most notably on series 2,\nimage 45, likely representing postsurgical seroma. In addition, there is\nhyperdense material along the medial aspect of the left rectus muscle along\nthe incision line which could represent suture or calcification. No definite\nevidence for retained sponge.", "output": "Postsurgical changes along the anterior abdominal wall may reflect the\npresence of a small seroma and calcification or suture material along the left\nrectus muscle. Difficult to exclude a small foreign body in the correct\nclinical setting. Please correlate clinically.\n\nNOTIFICATION: Findings were discussed with Dr. ___ at the time\nof initial review." }, { "input": "Lung bases: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusions seen.\n\nAbdomen: The liver enhances normally without concerning focal lesion. The\nmain portal vein is patent. No biliary ductal dilation. The gallbladder\nappears normal. The pancreas enhances normally. The spleen is normal in\nsize. Adrenals are normal bilaterally. The kidneys enhance symmetrically. \nBilateral simple appearing renal cysts are noted the largest arising from the\nanterior right midpole measuring 8.5 x 7.7 cm. No hydronephrosis or worrisome\nrenal lesion. The abdominal aorta is mildly calcified and normal in course\nand caliber. No retroperitoneal lymphadenopathy. No free air or free fluid. \nThe stomach and duodenum appear normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. There\nis a small ventral periumbilical hernia containing the anterior wall of a\nsmall bowel loop seen best on series 2, image 94, a Richter type hernia\nwithout evidence of complication. The appendix is normal. The colon contains\na mild fecal load without evidence of obstruction. Diverticulosis is seen\nwithout diverticulitis. There has been interval partial sigmoid resection. \nThe rectum is unremarkable. The prostate appears mildly enlarged. The\nurinary bladder is not fully distended though the wall appears somewhat\nthickened which could reflect infection in the correct clinical setting. \nPlease correlate clinically. There is a small left fat containing inguinal\nhernia. A smaller right fat containing inguinal hernia is seen. No pelvic\nsidewall or inguinal adenopathy. No pelvic free fluid.\nBones: No worrisome lytic or blastic osseous lesion. Right hip arthroplasty\nnoted.", "output": "1. Normal appendix. No bowel obstruction.\n2. Relative thickening of the urinary bladder which could reflect incomplete\ndistension though infection not excluded. Please correlate clinically.\n3. Small bowel Richter hernia uncomplicated.\n4. Colonic diverticulosis without diverticulitis. Interval partial sigmoid\nresection." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings, including bilateral patchy\nairspace opacities.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A\ntiny subcentimeter hypodensity in the anterior aspect of segment VIII is too\nsmall to be characterized. No suspicious hepatic lesions are seen within\nlimitations of noncontrast exam. A punctate calcification in the liver most\nlikely represents a granuloma. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a percutaneous gastrostomy tube. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. Appendix is normal.\n\nPELVIS: The bladder is largely decompressed by a Foley catheter. The tip of\nthe catheter is projecting into the bladder wall (602:87). Air within the\nbladder is likely related to the catheter. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 7.1 x 4.2 cm lipoma interdigitating between the\ngluteal musculature and the anterior compartment musculature on the right.", "output": "1. No evidence of acute infectious process, hemorrhage, obstruction, or\nischemia within the limitations of noncontrast study.\n2. The tip of the Foley catheter is protruding into the bladder wall. \nConsider repositioning.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings, including extensive bilateral patchy\nairspace opacities." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.9 cm hypodense lesion is seen along the periphery of the liver at the\nhepatic dome in the left lobe, that is not fully characterized, but which is\nmost likely benign. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA hypodensity likely representing a renal cyst is seen in the upper pole of\nthe left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The terminal\nileum is distended with fluid. There is colonic diverticulosis without\nevidence of acute diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder is under distended. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Normal appendix. No bowel obstruction or bowel wall thickening." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is wall\nthickening involving the mid transverse colon to the splenic flexure. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Colonic wall thickening of the mid and distal transverse colon, concerning\nfor either infectious or inflammatory colitis." }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nModerate pneumobilia and intrahepatic biliary ductal dilatation is most\nprominent within the left hepatic lobe, mild on the right. A stent is seen\npassing from the common hepatic duct to the duodenum, as well as from the\nduodenum into the main pancreatic duct. The common bile duct appears dilated\nto 1.4 cm (7:104). The common bile duct demonstrates uniform wall\nenhancement, likely a sequela of recent ERCP and stenting. There are no focal\nhepatic lesions. The gallbladder is distended, containing a 1.0 cm stone near\nthe neck, without evidence of gallbladder wall thickening or pericholecystic\nfluid.\n\nPANCREAS: The pancreas mildly atrophic throughout, without evidence of focal\nlesions. A stent traverses the ampulla into the pancreatic duct, terminating\nwithin the body the pancreas. The main pancreatic duct measures 0.6 cm at its\nwidest diameter. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.5 cm parapelvic cyst on the left renal pelvis. There are two\nsimple renal cysts measuring 1.5 and 1.1 cm in the interpolar region of the\nleft kidney. There is no evidence of stones, focal renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is transmural wall thickening at the medial aspect of\nthe duodenum in the region of the ampulla. The mass measures approximately 4.0\nx 1.3 cm (10:28). The thickened wall abuts the head of the pancreas, with\nindistinct fat planes. Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Diverticulosis of the sigmoid colon\nwithout evidence of diverticulitis, as well as small diverticulum noted on the\ntransverse and ascending colon. The appendix is resected. There are tiny\nsubcentimeter mesenteric lymph nodes, not pathologic by size criteria.\n\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus demonstrates heterogeneous attenuation, with a\nintrauterine of calcification likely representing a fibroid. The endometrial\nstrip is thickened to 1.5 cm (11:68), a dedicated pelvic ultrasound is\nrecommended to further evaluate.\nThe bilateral adnexae are within normal limits.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries. The celiac axis\nnarrows at the origin but is patent (11:56), with a normal right hepatic\nbranch off the common hepatic artery. The there is a noncalcified plaque\nwithin the SMA, located 1.6 cm distal to origin (7:104, 11:58).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative change at L4/L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Hypoenhancing mass within the medial wall of the duodenum in the\nperiampullary region measuring 4.0 x 1.3 cm, abutting the head of the\npancreas with indistinct fat planes. No osseous or hepatic metastases, no\nlymphadenopathy.\n2. The common bile duct and main pancreatic duct are dilated with stents in\nappropriate position, with residual pneumobilia and enhancement of the common\nbile duct wall, likely from stenting and recent ERCP.\n3. Thickened endometrial stripe to 1.5 cm. This thickness of the endometrium\nis abnormal in a post menopausal woman and further evaluation by a dedicated\npelvic ultraosund is recommended.\n4. Narrowing of the celiac axis at the origin, and a noncalcified plaque\nwithin the SMA 1.6 cm distal to the origin causing mild luminal narrowing.\n5. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings.\n\nRECOMMENDATION(S): Dedicated ultrasound to better evaluate thickened\nendometrial stripe." }, { "input": "LOWER CHEST: There is a small right and trace left pleural effusion. There is\nright greater than left basilar atelectasis. There is right middle lobe\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The gallbladder is surgically absent. \nThere is no intra or extrahepatic biliary duct dilation. Note is made of mild\nhyperenhancement of the common hepatic duct wall which is likely postsurgical.\n\nPANCREAS: The patient is post Whipple procedure with expected postsurgical\nappearance. There is a small amount of ascites at the surgical site and\ntracking anteriorly. There is stranding in the retroperitoneum as well as the\nanterior mesentery, likely postsurgical. There is no rim enhancing fluid\ncollection. The pancreatic body and tail are atrophic with persistent\npancreatic ductal prominence. No focal lesions are seen. Surgical drains are\nseen one located in the left upper quadrant the other with the tip in the left\nlower abdomen.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are mildly atrophic. There are two cysts noted within the\ninterpolar left kidney the larger measuring 1.9 cm. Note is made of\nperipelvic cysts in the left kidney.\n\nGASTROINTESTINAL: There is no bowel obstruction. A gastrojejunostomy tube is\nappropriately positioned. There is no small or large bowel wall thickening. \nNote is made of diverticulosis of the sigmoid colon. Appendix is not\nvisualized. A single focus of air is noted within the anterior abdomen,\nwithin the realm of expected post surgically.\n\nPELVIS: There is suggestion of some hypodense debris layering within the\nbladder. There is no free fluid in the pelvis. Surgical clip noted in the\nright lower quadrant.\n\nREPRODUCTIVE ORGANS: Uterus is notable for a calcified fibroid at the fundus. \nThere is a similar appearance of the endometrium with thickening up to 1.1 cm.\nRight and left ovary grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is extensive\natherosclerotic disease. The SMA and celiac trunk are patent. The portal\nvein is patent. The SMV is patent.\nNote is made of gastric varices.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Surgical sutures noted along the anterior abdominal wall. There\nis mild anasarca.", "output": "1. Expected postsurgical changes after Whipple. No intra-abdominal fluid\ncollection.\n2. Small ascites.\n3. Mild thickening and hyperenhancement of the common hepatic duct, likely\npostsurgical.\n4. Persistent thickening of the endometrial stripe up to 1.1 cm, an abnormal\nfinding in postmenopausal patients, a non-emergent pelvic ultrasound is\nrecommended for further characterization.\n5. Small right and trace left pleural effusion.\n\nRECOMMENDATION(S): Non-emergent pelvic ultrasound." }, { "input": "LOWER CHEST:\nImaged lung bases demonstrate mild bibasilar atelectasis without parenchymal\nconsolidation or pleural effusion. The heart is normal in size with no\npericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas demonstrates atrophy, but no surrounding stranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are normal in symmetric in size and enhancement. Contrast\nexcretion is prompt. Parapelvic cysts are noted bilaterally.\nGASTROINTESTINAL: The stomach appears thick-walled, but is likely a function\nof underdistention. There is a small hiatal hernia. The small bowel is\ndecompressed with no obstruction or surrounding stranding. The appendix is\nnormal, as are the colon and rectum.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is heavy calcium\nburden in the abdominal aorta and great abdominal arteries, particularly the\nSMA.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is trace pelvic free fluid which\nis simple.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES:\nThere is a left-sided total hip replacement and a right hip gamma nail.\nDegenerative changes of the lumbar spine are worst at L5-S1. Facet arthropathy\nis noted throughout the lower lumbar spine. Small fat containing umbilical\nhernia is noted.", "output": "1. Small hiatal hernia. No other identifiable cause for epigastric pain.\n2. Heavy atherosclerotic calcification of the abdominal aorta and major\nbranches, particularly the SMA." }, { "input": "LOWER CHEST: The imaged lung bases notable for emphysema. Minimal\nsubsegmental left basal atelectasis noted. There is dense coronary artery\ncalcification. The distal esophagus appears slightly fluid-filled with a\nsmall hiatal hernia noted.\n\nABDOMEN: The liver appears unremarkable. Gallstones are seen layering within\nthe gallbladder which is otherwise unremarkable. The pancreas appears fat\nreplaced and atrophic. The spleen is normal. Adrenals are unremarkable. \nRenal vascular calcification noted. Otherwise the kidneys appear normal. The\nabdominal aorta is densely calcified though normal in caliber. No\nretroperitoneal hematoma or adenopathy. The stomach and duodenum appear\nnormal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is normal. The colon appears unremarkable through the level of the\nsplenic flexure. Distal to the splenic flexure, there is colonic wall\nthickening and pericolonic fat stranding concerning for acute colitis. A\nstool ball measuring 5.2 x 6.0 x 10.9 cm is noted in the rectum. Presacral\nedema is noted. The uterus appears atrophic and with vascular calcifications.\nUrinary bladder is decompressed around a Foley catheter. Streak artifact\nthrough the pelvis from bilateral hip hardware noted.\n\nBONES: Bones are diffusely demineralized without worrisome lytic or blastic\nosseous lesion. Left hip arthroplasty is noted. A right hip gamma nail is\nalso in place.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute colitis involving the left colon. Findings likely ischemic,\ninfectious or inflammatory, though stercoral colitis difficult to entirely\nexclude.\n2. Cholelithiasis without evidence of acute cholecystitis.\n3. Severe atherosclerosis.\n4. Additional nonemergent findings as described above." }, { "input": "LOWER CHEST: A linear opacity of the left lower lobe is likely compatible with\natelectasis or scarring. Otherwise, the visualized lung fields are within\nnormal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver attenuation is heterogeneous, predominantly of lower\nattenuation than the spleen, measuring approximately 60 Hounsfield units. The\nperiphery of the liver appears of normal attenuation. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is contracted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. A cyst of\nthe superior spleen measures approximately 1.6 cm (02:16). An ill-defined\nhypodensity inferior to this cyst measures approximately 1 cm (601:39).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The VP shunt is partially imaged, extending through the right\nparacolic gutter, and out of the field of view.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. The partially imaged VP shunt extends through the right paracolic gutter\nand out of the field of view. Please note patency of the shunt cannot be\nassessed on this modality.\n2. Heterogeneous liver attenuation, likely compatible with fatty infiltration.\nNo focal hepatic lesions.\n3. Nonspecific, ill-defined splenic hypodensity, measuring 1 cm." }, { "input": "LOWER CHEST: Other than mild bibasilar atelectasis, the visualized lower lungs\nare within normal limits. No evidence of pleural or pericardial effusion.\n\nABDOMEN:\nEvaluation of the upper abdomen is slightly limited secondary to artifact.\n\nHEPATOBILIARY: Focal areas of hypodensity in segment 4, adjacent to the\nfalciform ligament (series 2, image 24) and at the portal confluence (series\n2, image 21) most likely represent focal increased fat. The liver otherwise\ndemonstrates homogenous but decreased attenuation throughout consistent with\nhepatosteatosis. No evidence of hepatic laceration. No evidence of\nsubcapsular hematoma. No suspicious focal hepatic lesions. No evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits without calcified stones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. An incidental splenule at the inferior tip is\nnoted. No evidence of splenic laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. No bowel obstruction. No drainable\nintra-abdominal fluid collection. No suggestion of mesenteric fat stranding.\n\nRETROPERITONEUM: No evidence to suggest psoas hematoma or retroperitoneal\nhematoma.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. A 4 mm left\npara-aortic retroperitoneal lymph node is noted (series 2, image 32). No\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes at T11-T12 are mild with anterior osteophyte formation\nand chronic mild anterior wedging.\n\nSOFT TISSUES: Moderate left flank and lower abdomen gluteal soft tissue fat\nstranding is demonstrated. A small 1.9 x 1 cm hyperdense ovoid focus in the\nleft soft tissue fat at the level of the left superior iliac crest just\nsuperficial to the scan is consistent with a small hematoma (series 2, image\n65). No evidence of a left intramuscular hematoma. Focal, minimal, elongated\nfluid with minimal surrounding enhancement in the right gluteus maximus muscle\nis non-specific and could be inflammatory, muscle strain, infection,\ninjection, or related to trauma; correlate with injury. No radioopaque\nforeign body identified. No drainable fluid collection.", "output": "1. Left flank and posterior lateral gluteal soft tissue ecchymosis and a\nsmall 1.9 cm hematoma just superficial to the skin at the level of the left\niliac crest.\n\n2. Focal, minimal, ill-defined fluid in the right gluteus maximus muscle with\nsurrounding mild enhancement is non-specific and could be inflammatory,\nsecondary to trauma, related to injection, muscle strain, or infectious. \nCorrelate with clinical history. No radioopaque foreign body. No drainable\nfluid collection.\n\n3. No evidence of acute fracture or other traumatic injury in the abdomen or\npelvis.\n\n4. Fatty liver.\n\n5. Chronic lower thoracic mild degenerative change and anterior wedging." }, { "input": "LOWER CHEST: There is a 6 mm right lower lobe nodule without priors for\ncomparison (series 3, image 1). There is also a 3 mm right middle lobe lung\nnodule (series 3, image 2). Otherwise, the lungs are clear. No pleural\neffusion. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic and nodular in appearance. Lipiodol\nfrom recent recent chemoembolization is seen throughout the left lobe and\nwithin the a dominant left lobe mass measuring 5.4 x 4.9 cm on today's\nexamination. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Gallstones are seen within a decompressed gallbladder. There is\ndiffuse gallbladder wall thickening, which is likely due to underdistention\nand underlying liver disease.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 14.4 cm. No focal lesions within the\nlimitations of a non enhanced examination. A 1.7 cm splenule is seen at the\nhilum.\n\nADRENALS: A previously characterized left adrenal myelolipoma is unchanged\ncompared to the recent MR ___ 3, image 18). The right adrenal gland is\nnormal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. Mild bilateral perinephric\nstranding.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nunremarkable.\n\nREPRODUCTIVE ORGANS: There is a hyperdense focus within the right\nposterolateral prostate measuring 2.4 x 1.3 x 1.2 cm (series 3, image 85 and\nseries 5, image 47).\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Extensive\natherosclerotic disease is noted.\n\nBONES: The sclerotic lesion within the right femoral head likely represents a\nbone island. Bilateral pars defects are seen at L5-S1 without\nspondylolisthesis. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: Partially imaged soft tissue density is seen within the anterior\nchest wall bilaterally (series 3, image 1), likely gynecomastia. The\nabdominal and pelvic wall is within normal limits.", "output": "1. Cirrhotic liver with lipiodol from the patient's recent chemoembolization\nthroughout the left lobe of the liver, and surrounding a dominant 5.4 cm mass.\n2. Incompletely characterized 3 mm and 6 mm right lung nodules, which should\nbe followed up with a chest CT.\n3. Hyperdense focus within the right posterolateral prostate measuring up to\n2.4 cm, which should be correlated with PSA levels and followed up with a\nprostate ultrasound.\n4. Other chronic findings include a left adrenal myelolipoma, cholelithiasis,\nsplenomegaly, and gynecomastia.\n\nRECOMMENDATION(S):\n1. Chest CT.\n2. Prostate ultrasound." }, { "input": "CHEST: Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation throughout. There is\nno evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are symmetric size. There is no evidence of stones, or\nhydronephrosis. A extrarenal pelvis on the right is again noted. Mild fat\nstranding is stable since ___. Stable 1.2 cm cystic lesions within\nthe upper pole and interpolar regions of the left kidney (3: 79, 77).\n\nGI: Patient status post urinary diversion and ileal conduit creation.\nVisualized esophagus, stomach, small bowel, and colon are within normal limits\nwithout obstruction, fat stranding, or focal mass lesion. The appendix is\nnormal without evidence of acute appendicitis. No ascites or free\nintraperitoneal air. No free fluid around the ileal conduit.\n\nRETROPERITONEUM: There is no evidence of mesenteric lymph node enlargement.\nStable 1.2 x 1.2 cm aortocaval lymph node (3:76). No additional\nretroperitoneal lymph node enlargement.\n\nVASCULAR: The abdominal aorta is normal in caliber without aneurysmal\ndilatation. Moderate calcified atherosclerotic disease is seen throughout the\nabdominal aorta.\n\nPELVIS:\n\nStatus post total cystectomy, radical prostatectomy, and lymph node\ndissection. No pelvic sidewall or inguinal lymph node enlargement. Multiple\nsurgical clips seen along the pelvic sidewall bilaterally consistent with\nknown prior lymph node dissection. There is no free fluid in the pelvis. No\npelvic mass.\n\nBONES AND SOFT TISSUES: No focal lytic or blastic lesions concerning for\nmalignancy.", "output": "1. Stable 1.2 cm aortocaval lymph node.\n2. Stable left renal lesion consistent with simple cyst.\n3. No evidence of local or distant disease recurrence within the abdomen or\npelvis, on this limited study." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are lobulated in contour, with right greater than left\ncortical atrophy, unchanged and likely related to chronic reflux. The\nbilateral kidneys display normal nephrogram. Two cysts in the left kidney\nmeasuring 1.4 cm are similar to prior. Compared with CT ___,\nthere is a new wedge-shaped area of hypoattenuation in the right upper pole\ninvolving cortex, with minimal vague adjacent perinephric stranding (9:34,\n10:23, 5:62). There is no hydronephrosis.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: Patient is status post cystectomy with ileal conduit. The ileal\nconduit is normal in appearance, with no parastomal hernia. There is no free\nfluid in the pelvis. Multiple surgical clips in the bilateral pelvis are\nagain noted.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: A previously seen aortocaval lymph node measures 1.3 cm,\nunchanged (5:73). There are multiple additional tiny periaortic nodes,\nsimilar to prior. There is no new retroperitoneal lymphadenopathy. There is\nno mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small left inguinal hernia containing fat is noted.", "output": "1. Stable 1.3 cm aortocaval node. No new lymphadenopathy in the abdomen or\npelvis.\n2. New wedge-shaped area of hypoattenuation within the right renal superior\npole cortex may reflect a focus of prior infarct or sequela of prior\ninfection, however close attention on follow-up is recommended.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S): Recommend close attention on follow-up to right renal\nupper pole wedge-shaped hypodensity." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN: The liver, pancreas, spleen and adrenal glands are unremarkable.\nAgain seen are bilateral hypodense renal lesions some of which are too small\nto characterize while others are cysts, stable.\n\nGASTROINTESTINAL: No intestinal obstruction or ascites.\n\nPELVIS: Patient is status post prostatectomy, radical cystectomy with creation\nof urinary ileal conduit.\n\nLYMPH NODES: The 1.2 cm aortocaval lymph node is not significantly changed\nfrom 1.3 cm previously. No enlarged pelvic lymph nodes are visualized. A few\nprominent mesenteric lymph nodes are nonspecific, stable.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is again noted.\n\nBONES: No aggressive osseous lesions.", "output": "Stable examination." }, { "input": "LOWER CHEST: There are new bilateral pleural effusions, left side greater than\nright, with probable bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver appears heterogeneous and has an irregular contour,\nsuggestive of cirrhosis. In the left lateral lobe of the liver there are new\nfoci of decreased attenuation which somewhat coalesce, spanning approximately\n3.6 x 3.8 cm axially (series 12, image 45), not definitely seen on the\nreference noncontrast study from ___. No focal drainable fluid\ncollection is seen. In the posterior right lobe of the liver there is a focal\narea of hyperdensity on the arterial phase images measuring approximately 4 x\n3.1 cm. This becomes less visible on more delayed phases of contrast with no\ndefinite washout, likely perfusional shunting. There is no intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is moderate upper abdominal ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring 15 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple subcentimeter hypoattenuating structures in both kidneys,\ntoo small to characterize. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Moderate\nascites.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small ventral abdominal wall hernia containing fat\nand fluid measuring up to 4.3 cm.", "output": "1. Ill-defined hypodense foci spanning approximately 3.8 x 3.6 cm in the left\nlateral lobe of the liver appears new since the reference noncontrast CT\nexamination from ___, and is concerning for early infection. No\ndrainable fluid collection.\n2. Nodular liver contour, suggestive of hepatic cirrhosis, with associated\nmild splenomegaly.\n3. New bilateral pleural effusions with bibasilar atelectasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild central intrahepatic\nbiliary dilatation. The gallbladder is distended without wall thickening. \nThere are gallstones in the region of the neck. There is mild pericholecystic\nfluid along the hepatic surface of the gallbladder. There is mild fat\nstranding along the inferior aspect of the gallbaldder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.3 cm intermediate density, partially exophytic lesion in the lower pole of\nthe right kidney is noted. A subcentimeter hypodensity in the upper pole of\nthe left kidney is too small to characterize. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nHigh-density intraluminal material is seen within a few loops of small bowel\nand may represent previously administered residual contrast. Diverticulosis\nof the sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative changes of the thoracolumbar spine noted. Right total hip\narthroplasty noted. Lumbar levoconvex scoliosis is noted.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are\nnoted.Fat-containing umbilical hernia noted.", "output": "1. The gallbladder is distended with gallstones in the region of the neck and\nmild fat stranding along the inferior aspect. No wall thickening is noted.\nThere is mild pericholecystic fluid along the hepatic surface of the\ngallbladder. Mild central intrahepatic biliary ductal dilation is also noted.\nFindings are concerning for early cholecystitis.\n2. A 1.3 cm intermediate density, partially exophytic lesion in the lower pole\nof the right kidney is noted. Recommend renal ultrasound if not previously\nworked up.\n3. High-density intraluminal material is seen within a few loops of small\nbowel and may represent previously administered residual contrast or ingested\nmaterial.\n\nRECOMMENDATION(S): Renal US for further evaluation of the finding described\nin impression 2." }, { "input": "LOWER CHEST: There is bibasilar atelectasis without focal consolidation. \nThere is no pleural or pericardial effusion. Heart size is borderline\nenlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is shrunken and nodular, consistent with known cirrhosis.\nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is not distended but\ndemonstrates gallbladder wall edema and surrounding pericholecystic fluid,\nlikely due to patient's cirrhosis. There is trace perihepatic ascites (series\n2; image 32). Main portal vein appears patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged without evidence of focal lesion, measuring 15.2 cm\nin size (previously 14.8 cm on recent PET-CT).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are overall normal in size. There is focal cortical thinning\nof the interpolar region of the left kidney (series 2; image 30). There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Distal esophagus is distended. Known esophageal carcinoma\nis not well assessed. Gastric varices are re-demonstrated along the posterior\naspect of the gastric fundus (series 2; image 13). Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nTransverse and distal ascending colon are decompressed state. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: 3.0 x 2.4 cm hypodense soft tissue mass (series 2; image 19) in\nthe region of the gastrohepatic ligament corresponds to previously seen FDG\navid lesion and likely represents a necrotic gastrohepatic lymph node. \nAdditional gastrohepatic lymph node is pathologically enlarged (series 2;\nimage 21), measuring 1.1 cm in short axis. Aortocaval node is not\npathologically enlarged by CT size criteria, measuring 0.8 cm in short axis\n(series 2; image 33). Scattered mesenteric lymph nodes do not meet CT size\ncriteria for enlargement (for example, series 2; image 40). There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Multiple perisplenic and esophageal varices are noted, including a\nsplenorenal shunt. Additional perigastric varices are also seen and appear\nintraluminal, as above.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate degenerative changes of the lumbar spine with Schmorl's\nnodes noted at the inferior endplate of L3 and L4 as well as the superior\nendplate L5 and S1. There is mild anterior wedging of the T12 vertebral body,\nwhich appears chronic in nature.\n\nSOFT TISSUES: There is a small diastasis of the anterior abdominal wall in the\nregion of the umbilicus.", "output": "1. Cirrhosis with sequela of portal hypertension including splenomegaly, trace\nperihepatic ascites, and splenic, esophageal, and gastric varices.\n2. Patent portal vein.\n3. Enlarged gastrohepatic lymph nodes, as seen on recent PET-CT, compatible\nwith known malignancy.\n4. No bowel obstruction. No abscess. No biliary dilatation." }, { "input": "LOWER CHEST: Again seen are bilateral small pleural effusions (left greater\nthan right), improved on the right and unchanged on the left compared to CT of\nthe chest from ___. Again seen are ___ nodules and\nground-glass opacities in the bilateral lung bases, which could represent\ninfection or aspiration. There is bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of hepatic mass within limitations of an unenhanced scan.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits. There is trace perihepatic ascites,\ndecreased compared to prior CT of the abdomen/pelvis from ___.\n\nPANCREAS: There is mild diffuse atrophy of the pancreas. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is contrast filled with a enteric tube in place.\nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nThe colon and rectum are within normal limits. Rectal tube in situ. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder is collapsed with a Foley in place. There is\ntrace free fluid in the pelvis, improved from prior.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nCompression deformity L1 is unchanged. Degenerative changes of the\nthoracolumbar spine are mild.\n\nSOFT TISSUES: There is diffuse anasarca of the body wall.", "output": "1. No acute findings within the abdomen and pelvis. No evidence of source of\ninfection within limits of a noncontrast study.\n2. Trace perihepatic and pelvic ascites, decreased from prior.\n3. Redemonstration of ___ nodules and ground-glass opacities in the\nbilateral lung bases, which could represent infection or aspiration, similar\nto ___.\n4. Small bilateral pleural effusions, improved on the right and unchanged on\nthe left." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nThere is a small amount of ascites.\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a 10 mm ill-defined hypodense lesion in the right lobe of the liver\n(series 2, image 60). There is focal hypodensity within hepatic segment 4\nalong the falciform ligament which may represent focal fatty infiltration.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is diffuse mucosal\nthickening and edema involving the duodenum and jejunum (best appreciated on\nseries 601, image 14). The distal small bowel loops are normal without\nobstruction. Terminal ileum is normal. There are surgical clips adjacent to\nthe cecum which may represent postsurgical changes from appendectomy. There\nis a rectal tube in place. Large bowel otherwise grossly normal.\n\nPELVIS: The bladder is decompressed with Foley catheter. There is a small\nmount of anti dependent air within the bladder which is most likely secondary\nto recent instrumentation. There is mild free-fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: No suspicious osseous lesions are identified. There is an unchanged\nsuperior end plate compression deformity of the L1 vertebral body with\napproximately 25% height loss.\n\nSOFT TISSUES: Diffuse body wall edema compatible with anasarca.", "output": "1. Diffuse wall thickening and edema involving the duodenum and jejunum. \nFindings are nonspecific and can be secondary to infectious or inflammatory\netiologies or potentially due to low protein/albumin states. Consider further\nevaluation with endoscopy.\n2. 10 mm peripheral ill-defined hypodense lesion along the periphery of the\nright hepatic lobe, which is incompletely characterized. MRI liver can be\nconsidered for further evaluation.\n3. Mild ascites and anasarca compatible with third spacing.\n\nRECOMMENDATION(S): 1. Endoscopy can be considered for further evaluation of\nthe duodenal and jejunal wall thickening and edema.\n2. MRI liver can be considered for further evaluation of the ill-defined\nhypodense lesion in the right lobe of the liver." }, { "input": "LOWER CHEST: There is mild atelectasis of the lung bases. There is no\npericardial or pleural effusion. The heart size is normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A 10 mm hypodense\nlesion arising from the posterior aspects of the left kidney, at the upper\npole, represents a cyst, better characterized on the prior MR urogram ___\n2, image 18). Other previously-characterized cysts are not well-visualized on\nthis noncontrast study. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A nasogastric tube terminates within the stomach. Along\nwith contrast extends throughout the stomach and small bowel and into the\nproximal large bowel. Again seen are multiple loops of dilated small bowel,\nwith a transition point in the lower mid pelvis (series 601b, image 34),\nlocated in the distal ileum, approximately 15 cm proximal to the ileocecal\nvalve, similar to the ___ study. There is mild stranding at the\ntransition point and a small amount of free intrapelvic fluid which has\nincreased since the prior study (series 601b, image 36, 42). There is no\npneumatosis or pneumoperitoneum. The colon and rectum are within normal\nlimits. The appendix could not be visualized.\n\nPELVIS: The bladder is moderately distended, and appears normal.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size (series 2, image 76).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Partial small bowel obstruction with a transition point at the lower mid\npelvis, approximately 15 cm proximal to the ileocecal valve, similar in\nconfiguration to the ___ study. Oral contrast administered for\nthis examination has passed the transition point into the colon.\n2. Increased mild intrapelvic free fluid and stranding near the transition\npoint since ___ study. No pneumatosis or free air." }, { "input": "LOWER CHEST: Please refer to dedicated CT chest report on same day for\nintrathoracic findings\n\nABDOMEN:\n\nHEPATOBILIARY: There is new apparent loss of volume in segment 5 with a few\nperipherally dilated bile ducts possibly related to atrophy, however of\nuncertain etiology. There is cholelithiasis without gallbladder wall\nthickening.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Right adrenal gland is absent. Left adrenal is the unremarkable.\n\nURINARY: Post radical right nephrectomy. In the right nephrectomy resection\nbed along the retroperitoneum, there is a new simple appearing fluid\ncollection, possibly representing a lymphocele measuring 6.1 x 6.5 cm (3:86). \nThere is an enhancing nodule posterior to it, measuring 8 mm (3:76). There is\na diminutive fat containing lesion measuring 4 mm in the superior aspect of\nthe left kidney, likely an AML. A few stable hypodense left renal lesions are\nnoted, corresponding to cysts on prior MR.\n\n___: No intestinal obstruction. There is small volume ascites.\n\nPELVIS: Prominent periuterine varices are again noted. There is trace free\nfluid in the pelvis. There is small volume ascites in the pelvis.\n\nLYMPH NODES: There is a left para-aortic lymph node measuring 1.1 cm (3:63),\nnew as compared to CTA abdomen pelvis ___. No enlarged pelvic lymph\nnodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no aggressive osseous lesion.", "output": "Post radical right nephrectomy with findings compatible with recurrent\ndisease." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Left adrenal gland is unremarkable. Status post right\nadrenalectomy.\n\nURINARY: Multiple left-sided parapelvic cysts are stable from previous. \nSubcentimeter left-sided renal cortical cysts are also noted. No solid mass. \nNo hydroureteronephrosis. Status post right nephrectomy. No soft tissue is\nidentified within the surgical bed.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Status post retroperitoneal lymph node dissection. Several\nprominent periaortic lymph nodes are again noted, the largest measuring 8 mm\n(axial series 3, image 69), previously 11 mm. Fluid collection is again noted\nwithin the retroperitoneum which has slightly decreased in size, measuring 5.9\nx 5.9 x 9.6 cm, previously 6.3 x 6.5 x 11.0 cm. Solid nodule previously noted\nposterior to the fluid collection is not identified on the current\nexamination. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted at the origin of the celiac trunk and SMA. Contrast reflux\ninto the left gonadal vein, with multiple prominent pelvic vessels.\n\nBONES: Stable L4 hemangioma. No suspicious osseous lesion.\n\nSOFT TISSUES: Subcutaneous nodules and gas involving the anterior abdominal\nwall, likely the sequelae of subcutaneous medication injection.", "output": "1. Postsurgical changes from right radical nephrectomy and adrenalectomy with\nretroperitoneal lymph node dissection. Several residual prominent para-aortic\nlymph nodes are again noted, which have slightly decreased in size in\ncomparison to the prior examination.\n2. Simple appearing retroperitoneal fluid collection appears similar to\nprevious and may be in keeping with a lymphocele. Solid nodule along the\nposterior aspect of this collection which was previously visualized is not\nclearly identified on the current exam.\n3. No new suspicious soft tissue or osseous lesions are identified." }, { "input": "LOWER THORAX: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation.\nUncomplicated cholelithiasis.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: Status post right adrenalectomy. The left adrenal gland is\nunremarkable.\n\nURINARY: Status post right nephrectomy. No soft tissue recurrence is\nidentified in the right nephrectomy bed. Left-sided extrarenal pelvis. \nSubcentimeter hypodense lesion within the upper pole of the left kidney, too\nsmall to characterize, but likely a small cyst. No hydroureteronephrosis. \nUnremarkable bladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are\nnormal in caliber. Normal appendix.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric adenopathy. Surgical clips from\nprior retroperitoneal lymph node dissection. No pelvic or inguinal\nadenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Slight interval decrease in size of\nretroperitoneal fluid collection measuring 36 x 40 x 68 mm, previously 59 x 59\nx 96 mm, likely a postoperative lymphocele.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic calcification.\n\nBONES: No suspicious osseous lesion. Stable L4 vertebral body hemangioma.\n\nSOFT TISSUES: 9 x 10 mm enhancing nodule deep to the right psoas muscle (axial\nseries 2, image 82), which is new from prior. There is an additional 12 x 14\nmm rounded structure deep to the right common iliac vein (axial series 2,\nimage 86) isodense to the adjacent vein and could represent an additional site\nof recurrent disease versus a prominent venous structure/varix.", "output": "1. 10 mm enhancing soft tissue nodule deep to the right psoas muscle worrisome\nfor recurrent disease, new from previous.\n2. Additional indeterminate intermediate density rounded structure deep to the\nright common iliac vein appears more evident on the current examination but\ngrossly stable, possibly representing an additional site of recurrent disease\nversus prominent vein/varix given the similar enhancement to the additional\nvessels.\n3. Interval decrease in size in retroperitoneal fluid collection, likely\npostoperative lymphocele.\n\nRECOMMENDATION(S): PET CT may be helpful for further evaluation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:41 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: In hepatic segment 6 is 3.3 x 2.0 hypodensity with\nnon-continuous peripheral nodular enhancement (2:27, 601b:25), consistent with\na hemangioma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation.\n\nInferior to the right lobe of the liver is a 4.7 x 2.3 x 1.6 cm rim enhancing\ncollection with areas of low density and areas high-density material within it\n(2:34, 601b:25) A small amount of perihepatic high-density fluid is seen\n(601b:27).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Post right\ncolectomy with right anterior abdominal ostomy with mild bowel wall thickening\nat the entrance to the stoma and in the colon proximal to the stoma. Contrast\npasses through the stoma. The appendix is not visualized.\n\nInfra umbilical rim enhancing lobulated fluid collection with pockets of air\nmeasures 6.6 x 6.0 cm (601:16). A rim enhancing mesenteric fluid collection\nmeasures 3.1 x 2.3 cm (02:53, 601:23).\n\nEnhancing peritoneum suggest peritonitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nA rim enhancing fluid collection right deep pelvis contains locules air\nmeasurements 3.3 x 2.3 cm (601b:36).\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is subcutaneous air overlying the left anterior abdominal\nwall likely due to subcutaneous injections.", "output": "1. Post right colectomy with 4 discrete fluid collections: infrahepatic\nmeasuring 4.7 x 2.3 cm, subumbilical measuring 6.6 x 6.0 cm, intramesenteric\nmeasuring 3.1 x 2.3 cm, and deep pelvic measuring 3.3 x 2.3 cm.\n2. Bowel wall thickening at the stoma and just proximal to it suggests mild\nenteritis. The ostomy remains patent.\n3. Enhancing peritoneum suggest peritonitis.\n4. No evidence of leak or perforation." }, { "input": "LOWER CHEST: Hypodense appearance of the intracardiac blood pool suggests\nanemia. Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. The calcifications likely reflect sequelae of prior granulomatous\ndisease. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas is markedly atrophic. There is extensive pancreatic\nparenchymal calcification likely reflecting the sequelae of chronic\npancreatitis (3:77). No peripancreatic stranding. Previously described main\nductal dilatation is better assessed on the MR dated ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Punctate parenchymal calcifications again likely\nreflect sequelae of prior granulomatous disease. There is a stable 11 mm\naccessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. \nPreviously seen dilation of the bilateral ureters has resolved. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable, not well assessed on CT. There\nis no small bowel obstruction. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. There is moderate fecal\nloading of the colon. the appendix is normal. Previously seen diffuse\nmesenteric fat stranding has resolved. There is no free fluid in the abdomen.\n\nPELVIS: Urinary bladder contains a Foley catheter. High density material\nwithin the bladder is indeterminate measuring approximately 38 Hounsfield\nunits. Bladder wall trabeculations are again noted. Distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Within the limitation of a non-enhanced study there is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted involving the abdominal aorta, iliac arteries and femoral\narteries.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nExtensive degenerative changes in spine most prominent from L2 through L5.\n\nSOFT TISSUES: Bilateral inguinal hernias containing a small amount of fluid.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Sequelae of chronic pancreatitis as described above.\n3. High density material within the bladder is indeterminate, correlation with\nurinalysis is recommended.\n4. Hypodense appearance of the intracardiac blood pool suggesting anemia.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Calcified granuloma in the right lower lobe is stable from ___. \nThere is mild subsegmental atelectasis in the medial right lower lobe. There\nis no pleural or pericardial effusion. Coronary calcifications are partially\nimaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of hepatic mass within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout. There is no main\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 3.4 cm mass in the anterior lower pole of the left kidney\nwhich corresponds to a solid mass seen on outside MRI the on ___, not\nfurther characterized on unenhanced scan. An adjacent multiloculated cystic\nlesion seen on prior MRI measuring approximately 2.6 cm appears grossly\nunchanged in size. No hyperdensity is seen within this lesion on CT, though\nthere was hemorrhage within the dominant locule on prior MRI. There is a 1.2\nexophytic cyst from the upper pole of left kidney. There is nonspecific\nbilateral perinephric stranding, similar to prior MRI. There is no\nnephrolithiasis. There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is sigmoid diverticulosis\nwithout findings of acute diverticulitis. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcification in uterus, likely from a calcified fibroid.\nThe adnexa are symmetrically prominent for age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There are moderate to severe degenerative changes throughout the\nvisualized lower thoracic and lumbar spine. There is grade 1 anterolisthesis\nof L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Patient declined IV contrast. 3.4 cm mass is again seen in the anterior\nlower pole of the left kidney, which corresponds with solid mass seen on\noutside MRI, cannot further characterize in the absence of intravenous\ncontrast, but remains unchanged in size. An adjacent approximately 2.6 cm\nmultiloculated cystic lesion seen on prior MRI is grossly unchanged in size." }, { "input": "LOWER CHEST:\n\nFibrotic changes are seen at the lung bases. Distal tip of a central line is\nvisualized at the right atrium. There is a trace left pleural effusion.\n\nABDOMEN:\nThere is no abdominal free air or ascites.\n\nHEPATOBILIARY: The liver is homogeneous in attenuation throughout without\nfocal lesion. There is no intrahepatic bile duct dilatation. Mild dilatation\nof the common bile duct up to 1.0 cm is similar to the prior thoracic spine\nMRI. The gallbladder is unremarkable without radiopaque gallstones or wall\nthickening.\n\nPANCREAS: The pancreas is mostly fatty replaced without duct dilatation or\nmass lesion.\n\nSPLEEN: The spleen is normal in size.\n\nKIDNEYS AND ADRENALS: The adrenal glands are normal bilaterally. The kidneys\nenhance and excrete contrast symmetrically, without hydronephrosis.\n\nGASTROINTESTINAL: A patulous enteroenteric anastomosis is seen in the right\nlower quadrant, approximately in mid to distal ileum. The small bowel is\notherwise normal in caliber without evidence of obstruction. The colon is\nunremarkable. Scattered oval densities within the bowel are probably ingested\nmedication tablets.\n\nLYMPH NODES: Retroperitoneal and mesenteric lymph nodes are not pathologically\nenlarged. Small calcified lymph nodes are noted at the porta hepatis.\n\nRETROPERITONEUM: Previous fluid collection in the lateral aspect of the left\npsoas muscle is significantly decreased in size, with pigtail catheter now at\nthe periphery of the residual abscess cavity. A 1.4 cm rim enhancing fluid\ncollection at the anteromedial aspect of the left psoas (2:46, 601:28) is not\nsignificantly changed from prior CT, but has decreased from prior lumbar spine\nMRI when it measured 1.9 cm.\n\nVASCULAR: Nonspecific metallic surgical material is seen in the location of\nthe IVC just below the renal veins, below which the IVC is absent. Paraspinous\nvenous collaterals are seen, as well as dilated right and left gonadal veins.\nThe abdominal aorta and common iliac arteries are non aneurysmal with mild\natherosclerotic plaque.\n\nPELVIS:\n\nThe urinary bladder, distal ureters, and prostate gland are unremarkable. No\nfree fluid is present in the pelvis. There is no pelvic or inguinal\nlymphadenopathy.\n\nBONES AND SOFT TISSUES:\n\nA disc spacer is in place at L3-4 bordered by erosive changes in the inferior\nL3 and superior L4 vertebral body endplates. Extensive facet joint\ndegenerative changes are seen at L4-5 and L5-S1. Old fractures are noted in\nthe right and left eighth ribs.\n\nThe left elbow and forearm are partially included in the field of view. The\nleft elbow appears irregular, but is not optimally evaluated on this exam.", "output": "1. Marked decrease in size of fluid collection in the left lateral psoas\nmuscle status post catheter drainage. The pigtail drain was removed by the\ncross-sectional radiology team after review of the images. A second small\nfluid collection in the anteromedial left psoas muscle is stable from prior\nexams.\n2. No new fluid collection or new site of infection in the abdomen or pelvis.\n3. Erosive changes in the L3 and L4 vertebral bodies spanning an L3-4\nintervertebral disc spacer, compatible with reported history\nosteomyelitis/discitis at this level.\n4. Trace left pleural effusion and fibrotic changes in the lower lungs.\n5. Absence of the IVC below the renal veins with venous collateral formation.\n6. Postsurgical changes of the small bowel with patulous enteroenteric\nanastomosis." }, { "input": "CHEST: Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: 3 fiducial seeds are seen along the pancreatic head. The pancreas\ncontinues to be atrophic with ductal dilation, similar to the ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis. A millimetric hypodensity in\nthe left kidney is too small characterize, similar to ___, and\nlikely represents a cyst (5:68).\n\nBOWEL: The stomach is decompressed and not well evaluated. Small bowel\nopacifies with oral contrast without wall thickening or evidence of\nobstruction. The appendix is well visualized and unremarkable. The large bowel\ncontains stool without wall thickening or evidence of obstruction.\nDiverticulosis is noted without evidence of diverticulitis. There is no intra\nabdominal free air or free fluid.\n\nRETROPERITONEUM: Right omental metastases within the right upper quadrant\nappear less prominent compared to prior exam on ___ (5:77). Soft\ntissue stranding/thickening anterior to the aorta measures 2.3 x 1.2 cm\n(12:24)\n\nVASCULAR: The abdominal aorta demonstrates moderate atherosclerosis. An\ninfrarenal IVC filter is noted.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nDegenerative changes are seen in the lumbar spine. Compression deformity of\nthe L5 vertebral body is new compared to ___ (09:37).", "output": "1. Continued improvement of right omental disease compared to ___.\n\n2. Soft tissue nodularity/stranding anterior to the upper abdominal aorta is\nmildly increased in size from 1.9 x 0.9 cm to 2.3 x 1.2 cm.\n\n3. Compression of the L5 vertebral body, new from ___." }, { "input": "LOWER CHEST: Heart size is borderline without significant pericardial\neffusion. There are severe coronary artery calcifications. Calcified pleural\nplaques are seen bilaterally. There is mild dependent atelectasis. There is\na rounded area of subpleural consolidation in the left lung base measuring 20\nx 10 mm with small air pockets, not well characterized on this nondedicated\nexamination.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no intrahepatic biliary\ndilatation. The CBD is distended 12 mm without radiopaque stone visualized. \nThe gallbladder is distended with borderline thickening of the wall, though\nwithout frank surrounding inflammatory fat stranding or radiopaque stone\nvisualized. This was better characterized on the earlier same day abdominal\nultrasound.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There are changes from partial gastrectomy with portions of\nthe postsurgical stomach wall appearing slightly prominent, though not\noptimally evaluated. Small bowel loops are normal caliber without\nobstruction. Ingested oral contrast reaches the level of the transverse colon\nexcluding obstruction. The large bowel and rectum are thin-walled without\npericolonic fat stranding or fluid collections identified.\n\nPELVIS: The bladder is prominently distended though is otherwise unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is unremarkable.", "output": "1. Changes from partial gastrectomy with portions of the postsurgical stomach\nappearing slightly prominent. This may be postoperative, though a localized\ndisease recurrence cannot be excluded and evaluation via CT is suboptimal.\n2. 20 x 10 mm rounded area of subpleural consolidation in the left lung base\nwith tiny air pockets most likely reflect areas of focal scarring, though\nfollow-up with non urgent dedicated chest CT is recommended for further\nevaluation.\n3. Distended gallbladder without radiopaque stone or other secondary evidence\nof cholecystitis, better evaluated on the concurrent same-day ultrasound exam.\n4. Dilation of the CBD to 12 mm which appears to taper distally without\nradiopaque stone. This can be evaluated via MRCP as clinically indicated.\n5. Extensive atherosclerotic disease.\n6. Enlarged prostate.\n7. Otherwise no acute findings.\n\nRECOMMENDATION(S): Nonurgent chest CT follow-up." }, { "input": "LOWER CHEST: Severe emphysema at the lung bases noted. The imaged portion of\nthe heart is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver enhances normally without focal concerning lesion. Main\nportal vein is patent. No biliary ductal dilation is seen. The gallbladder\nappears normal without radiopaque gallstones.\n\nPANCREAS: The pancreas enhances normally without focal abnormality or signs of\ninflammation.\n\nSPLEEN: Spleen is normal in size without focal abnormality.\n\nADRENALS: Adrenal glands are normal bilaterally.\n\nURINARY: The kidneys enhance symmetrically with prompt excretion of contrast\nnoted bilaterally. No worrisome renal lesion, hydronephrosis or signs of\npyelonephritis.\n\nGASTROINTESTINAL: The stomach is decompressed. The duodenum appears normal. \nSmall bowel loops demonstrate no signs of ileus or obstruction. The appendix\nis normal. The colon is notable for diverticulosis and no evidence of\ndiverticulitis. No bowel obstruction or signs of inflammation.\n\nPELVIS: The urinary bladder is mostly decompressed. Distal ureters opacify\nnormally. No pelvic sidewall or inguinal adenopathy. No pelvic free fluid or\nfree air.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild to moderate degenerative disease in the lower lumbar spine L4-5 and L5-S1\nnoted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No findings to account for abdominal pain.\n2. Severe emphysema.\n3. Colonic diverticulosis without diverticulitis.\n4. Normal appendix." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\npancolonic diverticulosis, otherwise the colon and rectum are unremarkable. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There are an increased number of retroperitoneal lymph nodes,\nmeasuring up to 9 mm in short axis diameter. There is also an increased\nnumber of lymph nodes along the iliac chains bilaterally, also measuring up to\n9 mm. These are nonspecific. No definite size significant lymphadenopathy is\nidentified.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the lumbar spine, with bilateral pars\ndefect and grade 1 anterolisthesis noted the L5-S1 level.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.", "output": "1. Prominent, subcentimeter retroperitoneal lymph nodes as detailed above,\nwhich are nonspecific but warrant clinical correlation and close follow-up.\n2. Otherwise, no intra-abdominal abscess or other cause for the patient's\npresentation identified.\n\nRECOMMENDATION(S): Clinical correlation and short-term (6 month) follow up\nfor the subcentimeter retroperitoneal lymph nodes as detailed above.\n\nNOTIFICATION: The recommendation above was entered by Dr. ___ on\n___ at 10:32 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: Small bilateral pleural effusions with overlying compressive\natelectasis.\n\nABDOMEN:\n\nStreak artifact from metallic hardware limits evaluation of the upper abdomen.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL:Moderate to severe distension of the stomach with ingested\nmaterial. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small amount\nof free fluid in the lower pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStreak artifact from metallic hardware limits evaluation.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Streak artifact from patient's metallic hardware severely limits evaluation\nof the upper abdomen.\n2. No evidence of bowel obstruction." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. A pacemaker is partially\nvisualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. Patient has undergone interval common bile duct stent\nexchange, with a small amount of pneumobilia in the left lobe. The\ngallbladder decompressed and contains layering air. There is no ascites.\n\nPANCREAS: A hypoattenuating mass with fiducials in the pancreatic head and\nneck measures approximately 4.4 x 2.8 cm, not significantly changed (2:30). \nThere is upstream diffuse dilation of the main pancreatic duct up to 6 mm,\nunchanged. (2:24). The pancreatic mass abuts the main portal vein at the\nconfluence of the splenic vein and SMV, however the vessels remain patent. A\nhypoattenuating lesion arising off the pancreatic tail is not significantly\nchanged, measuring 2.1 x 1.9 cm. Peripancreatic stranding is improved\ncompared with prior. Previously seen left anterior renal fluid has resolved.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Scattered subcentimeter peripancreatic, porta hepatis and\nperiaortic nodes are not significantly changed. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "1. No acute intra-abdominal process with explain patient's pain.\n2. No significant change in known pancreatic mass compared with prior.\n3. Interval decrease in peripancreatic stranding and fluid compared with\nprior. In the setting of normal lipase, this is unlikely to represent\npancreatitis, and is likely related to underlying mass.\n4. A common bile duct stent appears appropriately positioned, with\npneumobilia." }, { "input": "PANCREAS: Compared with ___, a hypoattenuating pancreatic head\nlesion is decreased in size, measuring 2.6 x 1.6 cm in the axial plane,\ncompared with 3.5 x 2.0 cm previously. There is persistent upstream dilation\nof the main pancreatic duct up to 4-5 mm, similar to prior. There is\npersistent contact with the main portal vein, which is slightly narrowed at\nthe proximal aspect, and the SMV. There is hazy soft tissue surrounding the\ndistal celiac axis and extending to the common hepatic artery and origin of\nthe gastroduodenal artery.\n\nA hypoattenuating cystic lesion arising from the pancreatic tail is decreased\nin size, measuring 1.8 x 1.3 cm, compared with 2.2 x 1.5 cm previously\n(3:100). An additional 8 mm hypodense cystic lesion arising from the tail,\nand a 1.1 x 1.0 cm cystic lesion arising from the pancreatic body, are not\nsignificantly changed (3:111).\n\nPANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 2.6 x 1.6 cm, compared with 3.5 x 2.0 cm\npreviously.\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent, measuring up to 4-5 mm, similar to prior.\nBiliary tree abrupt cutoff with or without upstream dilatation: Common bile\nduct stented, with small amount of pneumobilia.\n\nArterial evaluation\nSMA involvement: absent\nCeliac Axis involvement: Absent\n\nCommon hepatic artery involvement: Present (601b:66)\nIncreased hazy attenuation/stranding contact: <180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to celiac axis: absent\nExtension to bifurcation of right/left hepatic artery: absent\n\nGastroduodenal artery involvement: Present at the origin (3:115)\nIncreased hazy attenuation/stranding contact: >180\u00b0\n\nVariant anatomy: none\n\n\nVenous evaluation\nMPV involvement: present\nDegree of solid soft-tissue contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\npresent, slight narrowing of the proximal main portal vein is decreased from\npriors (601b:80).\n\nSMV involvement: present\nDegree of solid soft-tissue contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop): \nResolved.\nExtension to first draining vein: absent\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: Absent, but there is hazy soft tissue that is\ndiscontinuous from the tumor around the common hepatic artery and the celiac\naxis (601b:73) that is concerning for lymphatic involvement. Subcentimeter\nretroperitoneal and mesenteric lymph nodes are not pathologically enlarged,\nand are not significantly changed from priors.\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nVASCULAR:\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Thickening of the distal esophageal wall appears prominent for\nthe level of distension (3:85). Please refer to the separate report of CT\nchest performed on the same day for description of the remainder of the\nthoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout,\nconsistent with steatosis. There is no evidence of focal lesions. There is no\nevidence of intrahepatic biliary dilatation. The common bile duct is\nstented, with a small amount of pneumobilia. Focal thickening of the\ngallbladder wall at the fundus is consistent with adenomyomatosis (3:124). \nThere are no gallstones.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix contains air, has normal caliber without evidence of fat stranding. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Multiple\nprominent pelvic and inguinal nodes are not significantly changed from priors.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A tiny umbilical hernia and left inguinal hernia containing fat\nare noted.", "output": "1. Interval decrease in size of a 2.6 cm hypoattenuating pancreatic head mass,\nwith persistent contact with the main portal vein and SMV, common hepatic\nartery and origin of the gastroduodenal artery.\n2. Hazy soft tissue around the proximal common hepatic artery and the distal\nceliac axis is concerning for lymphatic involvement though there not discrete\nenlarged lymph nodes. Small mesenteric, retroperitoneal, pelvic and inguinal\nlymph nodes are not seen only changed from priors.\n3. Thickening of the distal esophageal wall appears prominent for the level of\ndistension. Recommend correlation with symptoms and possible endoscopy.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S): Endoscopy if clinically indicated.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:17 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. The gallbladder is surgically absent. There is\ndilatation of the common bile duct measuring up to 9 mm which tapers down\ninferiorly.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding. There is mild dilatation of pancreatic duct measuring up to 4 mm\nwith no definite obstructive lesion, mass or stone noted.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: Streak artifacts from bilateral hip prosthesis limit evaluation of\npelvis. The visualized urinary bladder appear normal. There are small\nbilateral fat containing inguinal hernias with no evidence of strangulation.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status post bilateral hip replacement. There is no evidence\nof worrisome osseous lesions or acute fracture. Degenerative anterior\nosteophytes are seen in the lumbar spine most pronounced L3-L4 with a\nSchmorl's node noted in the inferior endplate of L3.\n\nSOFT TISSUES: Focus of subcutaneous infiltration in the left inferior\nabdominal wall (series 2, image 49), possibly related to a subcutaneous\ninjection.", "output": "1. No evidence of pancreatitis or acute abdominal or pelvic pathology.\n2. Mild dilatation of the common bile duct and distal pancreatic duct is\nnonspecific with no definite mass or obstructing stone visualized. If\nclinically indicated, further evaluation with LFTs and possibly an ERCP is\nrecommended." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is no bowel obstruction.\nThere is extensive sigmoid diverticulosis.In the left lower quadrant, adjacent\nto a proximal sigmoid diverticulum, there is pericolonic fat stranding. The\ncolonic wall is mildly thickened in this region as is the adjacent lateral\nconal fascia. These findings are compatible with diverticulitis. No definite\nextraluminal fluid or air is identified. Apparent crescentic air adjacent to\nthe bowel wall (601:29; 602:73) is not in the region of the most extensive fat\nstranding; it is difficult to distinguish whether this is a contained\nperforation or air within a diverticulum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The fibroid uterus is enlarged. Nabothian cysts are\nseen. The endometrium is not well evaluated on this examination.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes are seen without evidence of acute\nfracture.\n\nSOFT TISSUES: A fat containing umbilical hernia is noted.", "output": "1. Severe sigmoid diverticulitis with equivocal tiny contained perforation. \nNo drainable fluid collection.\n2. Enlarged fibroid uterus is not well evaluated on this examination.\n3. Cholelithiasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple small, subcentimeter hypodensities in the periphery the\nliver parenchyma. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder surgically absent with cholecystectomy\nclips seen in the surgical bed.\n\nPANCREAS: The pancreas is displaced superiorly, however, it demonstrates\nhomogeneous attenuation throughout. There is no evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate sized hiatal hernia. Much of the bowel\nis displaced by the large abdominal/pelvic mass. However, small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: There is a large, well-circumscribed cystic mass with thin septations\nmeasuring 28 x 24 x 28 cm (04:46; 601:28). The mass appears to arise from the\nright adnexa and extends into the upper abdomen, displacing adjacent organs\nand causing mild extrinsic compression of the IVC. The urinary bladder and\ndistal ureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and contains multiple fibroids,\nlargest which measures approximately 7.3 cm.\n\nLYMPH NODES: There are multiple shotty periaortic nodes, the largest of which\nmeasures 1.0 cm in short axis (04:51). There is no mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSubcentimeter foci of sclerosis are seen in the right pubic bone, left\nacetabulum and right sacrum.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Large, well-circumscribed cystic mass with thin septations measuring 28 x\n24 x 28 cm arises from the right adnexa and extends into the upper abdomen\ndisplacing adjacent organs and causing mild compression of the IVC. This is\nconsistent with a cystic ovarian tumor.\n2. Enlarged, fibroid uterus.\n3. Moderate-sized hiatal hernia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is minimally nodular in contour and demonstrates\nhomogenous attenuation throughout. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: There has been marked interval reduction of a peripancreatic\npseudocyst status-post Axios stent placement. There is now one or 2 adjacent\nrim enhancing fluid collections spanning up to 1.9 x 1.4 x 2.8 cm (series 5,\nimage 36 and series 7, image 36). Additional, smaller fluid collections near\nthe pancreatic tail measure 1.7 x 1.3 cm (series 5, image 49) and 1.4 x 0.9 cm\n(series 5, image 52). A somewhat linear area of very dense material superior\nto the pancreatic tail in the location of the prior large pancreatic\npseudocyst is new, almost certainly reflecting oral contrast which traversed\nthe patent stent. Though decreased, significant peripancreatic fat stranding\npersists the pancreatic parenchyma itself enhances normally and homogeneously\nwithout focal lesion or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape. A\npunctate calcification the left adrenal gland is new, likely the sequela of\ninflammation related to pancreatitis.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The visualized stomach is unremarkable, noting the new Axios\nstent. Visualized small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The visualized colon is within normal\nlimits.\n\nLYMPH NODES: Scattered prominent lymph nodes in the upper abdomen are perhaps\nmildly enlarged compared to the prior examination, likely reactive. The\nsplenic, superior mesenteric, and hepatic portal veins are patent.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Upper abdominal varices are again seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAn old posterior left eleventh rib fracture is again seen new.\n\nSOFT TISSUES: There is a moderate, fat containing umbilical hernia.", "output": "1. Marked interval reduction of a peripancreatic pseudocyst status-post Axios\nstent placement. Few, small, remaining fluid collections measure up to 2.8\ncm, not in communication with the new stent, but likely too small for\nintervention. The stent appears patent.\n2. Overall improved peripancreatic inflammation.\n3. Mild liver nodularity and upper abdominal varices suggest cirrhosis." }, { "input": "CHEST: The lung bases are clear. There is no pleural or pericardial effusion.\nABDOMEN: HEPATOBILIARY: In hepatic segment III, there is a well-circumscribed\nmass, which measures 4.6 x 4.8 x 4.4 cm (AP x TRV x CC), and demonstrates poor\nnodular areas of arterial hyperenhancement (03:50), with gradual contrast\nfilling on portal venous and 3 min delayed phase imaging (07:17). A\nhyperenhancing area of surrounding hepatic parenchyma with a feeding artery is\nalso noted (03:43), likely due to arterioportal fistula. Multiple other\narterially enhancing lesions are noted, including a 12 mm x 12 mm area in\nhepatic segment II (03:27), a 15 x 15 mm area in hepatic segment VIII (03:23),\nand a 12 mm x 14 mm area in hepatic segment VI (3:68).\n\nThe portal veins are patent. No intra hepatic biliary ductal dilatation is\nnoted. The gallbladder is filled with remaining contrast material from recent\nERCP, along with several small gallstones. Ascitic fluid is seen in the upper\nabdomen. A prominent portacaval lymph node measures 10 mm in short axis\ndiameter (04:51). A fat containing ventral hernia is noted (03:50).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\nKIDNEYS: The kidneys are symmetric in size with normal excretion of contrast\nmaterial. No stones, focal renal lesions or hydronephrosis are identified.\nRETROPERITONEUM AND MESENTERY: Multiple mesenteric nodular masses and\nenlarged lymph nodes are noted throughout the abdomen, consistent with\nrecurrent disease. For example, omental lesions measure 14 x 13 mm (4:67)\nand 22 x 18 mm in the mid-abdomen (4:78). In the left lower quadrant, a 13 x\n11 mm lymph node (4:89) is present, along with a 10 x 15 mm right lower\nquadrant lymph node (4:89). Additionally, multiple omental masses are noted in\nthe left upper quadrant, at the level of the splenic flexure of the colon,\nmeasuring up to 3.5 x 1.6 cm (4:63). Surrounding fat stranding, and multiple\nother adjacent omental implants and nodes are present.\n\nVASCULAR: The abdominal aorta is normal. There is conventional anatomic\nconfiguration of the hepatic arterial supply. The bilateral main renal\narteries are patent. A tiny accessory right renal artery is also noted,\nsupplying the upper pole (04:59). The IVC is patent.\n\nLARGE AND SMALL BOWEL: A focally dilated loop of small bowel in the lower mid\nabdomen (3:85) is incidentally noted, possibly related to an adjacent small\nbowel anastomosis, with no clear evidence for obstructing lesion. Otherwise,\nthe intra-abdominal loops of large and small bowel are normal in caliber and\ncontour, with no evidence of wall thickening or obstruction. The stomach and\nduodenum are also normal. Multiple clips are noted in the left lower quadrant,\npresumably related to prior partial left colectomy. The appendix is\nair-filled, and normal in appearance (4:99). Enteric contrast is seen to the\nlevel of the rectosigmoid.\nPELVIS: The urinary bladder and distal ureters are unremarkable. A right\ninguinal lymph node measures up to 9 mm in short axis diameter (04:41).\nOtherwise, no deep pelvic or inguinal adenopathy is present. No free fluid is\npresent within the pelvis. The loops of large and small bowel in the low\nabdomen pelvis are unremarkable.\nBONES AND SOFT TISSUES: No concerning lytic or blastic lesions are seen\nthroughout the skeleton. No soft tissue abnormalities are present.", "output": "1. Multiple omental and mesenteric nodules throughout the abdomen as well as\nmesenteric lymphadenopathy, are compatible with recurrence of GIST.\n2. Multiple enhancing hepatic lesions are also concerning for GIST metastases,\nmeasuring up to 4.8 cm in hepatic segment III. Ultrasound can be obtained for\nbiopsy planning if clinically indicated.\n3. Patulous lower mid abdominal small bowel loop may be due to anastomosis\nfrom prior surgery. No evidence of obstruction. Correlation with prior outside\nimaging would be helpful, if available." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post left donor nephrectomy. Surgical clips are\nnoted in the left renal fossa. The right kidney is of normal size. There is\nlimited visualization of the known accessory right renal artery on this\nnoncontrast study. There is no evidence of focal renal lesions within the\nlimitations of an unenhanced scan. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Patient is status post left donor nephrectomy with surgical clips noted in the\nleft renal fossa. The examination is otherwise unremarkable." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. \nCalcification in the superior capsule of the spleen stable from prior exam,\nmay be sequela of prior trauma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. A 1.7 cm\nparapelvic cyst in the right kidney with Hounsfield units suggestive of a\nsimple cyst on prior noncontrast exam. Subcentimeter hypodensities arising\nfrom the lower pole and interpolar region of the left kidney is too small to\ncharacterize but likely represents a simple cyst There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized. Ileal\nconduit is seen in the right lower quadrant.\n\nPELVIS: Status post cystectomy. There is new slightly enhancing soft tissue\nin the right hemipelvis adjacent to the sigmoid colon not seen on prior exam\nmeasuring approximately 2.3 x 3.5 cm in concerning for local recurrence.\n\nREPRODUCTIVE ORGANS: Brachytherapy seeds are noted in the prostate.\n\nLYMPH NODES: Status post pelvic lymph node dissection. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is a new lytic mass centered in the right inferior pubic ramus\nmeasuring 3.7 x 4.5 cm extending into the adjacent soft tissue and not present\non prior exam is concerning for metastatic spread.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Enhancing soft tissue in the right hemipelvis adjacent to the sigmoid colon\nmeasuring up to 3.5 cm concerning for regional recurrence.\n2. Lytic lesion in the right inferior pubic ramus with enhancing soft tissue\nmeasuring 4.5 cm concerning for metastatic spread.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "CT OF THE ABDOMEN AND PELVIS WITH IV CONTRAST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nThe patient is post cholecystectomy. The hepatic parenchyma appears normal in\ndensity. No concerning hepatic mass is detected. There is no intrahepatic bile\nduct dilation.\n\nThe pancreas, spleen, stomach, and intra-abdominal loops of small and large\nbowel are normal. The appendix is normal (series 3, image 91). A tiny fat\ncontaining periumbilical hernia is seen (series 3, image 96).\n\nCoarse calcifications within the right adrenal gland have progressed since the\nearliest available comparison CT from ___. There is persistent mild\nnodularity along the medial limb of the left adrenal gland (series 3, image\n68), also unchanged since the ___ study.\n\nBilateral cortically-based hypodense lesions arising from both kidneys,\nstatistically likely cysts, appear minimally changed since the PET-CT from ___, new or enlarged since the ___ study. There is no\ncollecting system obstruction.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy, and no ascites.\n\nExtensive atherosclerotic calcifications are seen throughout the abdominal\naorta, splenic artery, SMA common iliac arteries. A bilobed infrarenal\nabdominal aortic aneurysm measures 2.9 cm along the proximal segment (series\n3, image 81), and up to 4.2 cm in the inferior/distal segment (series 3, image\n92), with a moderate amount of intramural thrombus, but without flow limiting\nstenosis. Or dissection. The size appears minimally changed since the most\nrecent comparison PET-CT from ___.\n\nThe prostate, bladder, and rectum are normal. There is a moderate sigmoid\ndiverticulosis, with no evidence of diverticulitis. Remaining intrapelvic\nloops of small and large bowel are within normal limits.\n\nThere are no osseous lesions concerning for malignancy or infection. Moderate\ndegenerative changes are seen throughout the thoracolumbar spine, including\nloss of disc height at L5/S1 with endplate sclerosis mild osteophytosis\n(series 602, image 45).", "output": "1. No intra or intra-abdominal or intrapelvic metastasis detected. Please\nrefer to the dedicated chest CT examination performed on the same day\nregarding intrathoracic findings.\n2. Bilobed infrarenal abdominal aortic aneurysm appears stable in size since\nthe ___ examination. No flow limiting stenosis or dissection.\n3. Small fat-containing periumbilical hernia.\n4. Moderate sigmoid diverticulosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 1.7 x 1.2 cm calcified nodule in the right adrenal gland is\nunchanged. The left adrenal gland is thickened and nodular, unchanged from\nmultiple priors.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA heterogeneously enhancing mass in the upper pole of the left kidney measures\n2.1 x 2.2 x 2.2 cm (3:64), previously 2.1 x 2.2 x 2.2 cm when measured with\nsimilar technique, and demonstrates washout on delayed phase imaging. An\nadditional 7 mm heterogeneously enhancing nodule in the lower pole of the left\nkidney is unchanged in size, with no clear washout on delayed phase. Multiple\nbilateral hypodensities are again seen, measuring up to 2.2 cm in the upper\npole of the right kidney, consistent with simple cysts. Additional bilateral\nsubcentimeter hypodensities are too small to characterize by CT. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\nvisualized colon is within normal limits. The partially visualized appendix\nis normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: Again seen is fusiform aneurysmal dilatation of the infrarenal\nabdominal aorta, incompletely imaged, though measuring up to 4.3 x 3.7 cm,\nwith mural thrombus, not significantly changed from prior. Severe\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. No significant change in heterogeneously enhancing 2.2 cm mass in the upper\npole of the left kidney, and 0.7 cm mass in the lower pole of the left kidney,\nconcerning for renal cell carcinoma.\n2. Incompletely imaged fusiform aneurysmal dilatation of the infrarenal\nabdominal aorta with mural thrombus is grossly similar to prior.\n3. Unchanged 1.3 cm calcified nodule in the right adrenal gland, and nodular\nthickening of the left adrenal gland.\n4. Please refer to separate report of CT chest performed same day for\ndescription of thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Numerous punctate calcified granulomas\nare scattered throughout. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is distended, but without\nwall thickening, radiopaque cholelithiasis, or adjacent fat stranding.\n\nPANCREAS: The pancreas is predominantly fatty replaced. Scattered pancreatic\ncalcifications are present. A 1.1 x 0.9 cm cystic lesion in the pancreatic\nbody likely reflects a side branch IPMN.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Innumerable punctate granulomas are scattered\nthroughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA hypoattenuating lesion arising from the medial aspect of the interpolar left\nkidney is too small to completely characterize, but statistically likely a\nsimple cyst. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable, noting an enteric tube. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. A rectal tube is in place. There is mild\npresacral edema. The appendix is not visualized.\n\nPELVIS: The urinary bladder is decompressed with a Foley catheter in place. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Incidental note is made of a replaced common hepatic artery\narising from the superior mesenteric artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLumbar spine and pubic symphysis degenerative changes are noted.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia and there are\nsmall bilateral fat containing umbilical hernias.", "output": "1. No evidence of intra-abdominal infection.\n2. Diverticulosis without diverticulitis.\n3. Possible sequelae of chronic pancreatitis include atrophy and scattered\ncalcifications.\n4. Punctate calcified granulomas scattered throughout the liver and spleen\nlikely reflect prior granulomatous infection such as histoplasmosis.\n5. Incidental low-attenuation lesion in the body of the pancreas measuring 1.1\nx 0.9 cm likely reflect a cystic lesion, most likely side-branch IPMN. \nRecommend further evaluation with nonemergent MRCP.\n This preliminary report was reviewed with Dr. ___\nradiologist." }, { "input": "LOWER CHEST: Moderate bilateral pleural effusions with associated compressive\natelectasis in the lung bases. There are diffuse calcification of the\ncoronary arteries and the heart is mildly enlarged. A dialysis catheter\nterminates in the proximal right atrium.\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of concerning focal lesions. Punctate subcentimeter\nhypodensity within right lobe of the liver (02:22) may reflect a tiny cyst. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. Pancreatic ductal prominence to 3-4 mm is top-normal. There\nis no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. In the lower\npole of the spleen is a 2.4 cm, well-circumscribed hypodense lesion compatible\nwith a cyst.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetrically atrophic consistent with diagnosis of\nend-stage renal disease. Multiple well-circumscribed hypodense lesions of the\nkidneys vary in density ranging from ___ ___ units, better assessed\non MR abdomen dated ___. No evidence of hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Extensive\ndiverticulosis of the colon is noted, without evidence of wall thickening and\nfat stranding. The appendix is not well visualized, however there are no\nsecondary signs of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Diffuse demineralization is present with grade 1 anterolisthesis of L3\non L4. Multiple degenerative changes of the lumbar spine are noted.\n\nSOFT TISSUES: The soft tissues are diffusely edematous consistent with\nanasarca.", "output": "1. No definite acute abnormality to account for the patient's symptoms.\n2. Diverticulosis of colon without evidence of diverticulitis.\n3. Bilateral, moderate pleural effusions with associated compressive\natelectasis.\n4. Diffuse anasarca." }, { "input": "LOWER CHEST: The lung bases are clear. The visualized heart and pericardium\nis within normal limits.\n\nHEPATOBILIARY: The liver is normal in attenuation. There is no biliary ductal\ndilatation. An area of focal calcification within the left lobe of the liver\nmay be related to prior granulomatous disease. (02:12). The gallbladder is\nnot visualized.\n\nSPLEEN: Spleen is normal in size and attenuation.\n\nPANCREAS: The pancreas is within normal limits. There is no peripancreatic\nfat stranding.\n\nADRENALS: The adrenal glands are within normal limits.\n\nURINARY: The left kidney is normal in size and shows no evidence of\nhydronephrosis. There is no evidence of nephrolithiasis in the left kidney. \nThere is mild hydroureteronephrosis on the right, and the right kidney is\nslightly enlarged compared to the left. There are no renal or ureteral stones\nidentified on the right however there is a small 3 mm punctate calcification\nalong the dependent portion of the bladder which likely reflects a recently\npassed stone. There is very subtle stranding around the right kidney likely\nrelated to recent obstruction.\n\nGASTROINTESTINAL: The stomach and small bowel are within normal limits. There\nis very mild diverticulosis of the descending and sigmoid colon without\nevidence of diverticulitis. No free fluid or free air in the abdomen. Normal\nappendix.\n\nLYMPH NODES: There is no abdominal lymphadenopathy.\n\nVASCULAR: The aorta is normal in caliber. There is no calcified\natherosclerosis.\n\nPELVIS: The bladder is within normal limits. The rectum is normal. There is\nno pelvic sidewall or inguinal adenopathy. Prostate appears unremarkable. No\npelvic fluid.\n\nBONES AND SOFT TISSUES: No suspicious osseous lesions are identified. The\nsoft tissues are within normal limits.", "output": "Mild right-sided hydroureteronephrosis with a 3 mm punctate calculus seen\nwithin the bladder which likely reflects a recently passed stone." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Presumed accessory spleen stably measures at 7 mm\n(02:59).\n\nADRENALS: The left adrenal gland is diffusely thickened. The indeterminate\nright adrenal lesion/thickening which measures 1.5 cm is grossly stable in\nsize and shape. Thickening of the right lateral limb measuring approximately\n9 mm is also grossly similar compared to prior exam on ___.\n\nURINARY: Patient is status post right nephrectomy. No soft tissue nodule is\nseen within the nephrectomy bed. Previously identified 6 mm hyper attenuating\nexophytic lesion arising from the upper pole of the left kidney is stable\ndating back to ___ (601:41). There is no evidence of new focal\nrenal lesions in the left kidney within the limitations of an unenhanced scan.\nThere is no left hydronephrosis. There is no left nephrolithiasis. There is\nstable perinephric abnormality.\n\n1.4 x 1.1 cm nodule in the right posterior lateral conal fascia is grossly\nstable since ___ (2:76). Previously described soft tissue nodules\nadjacent to the posteromedial aspect of hepatic segment VII is also persistent\nand stable (2:64). No new soft tissue nodules are identified.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder wall is thick, like due to chronic outlet\nobstruction. And distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and partially calcified, and\nseminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSubcentimeter sclerotic focus in the left iliac bone likely reflects a bone\nisland.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted. 6 mm right\nrectus abdominus lipoma is stable. Injection granuloma in the left buttocks\nis unchanged.", "output": "1. Status post right nephrectomy with no evidence of recurrence within the\nnephrectomy bed.\n2. Stable soft tissue nodules along the posterior right lateral conal fascia\nand adjacent to hepatic segment VII are stable dating back to ___.\nNo new soft tissue nodules.\n3. Stable right adrenal thickening/nodule.\n4. Stable exophytic hyperdense nodule in the upper pole of the left kidney.\n5. Please refer to separate report for same-day CT chest for complete\ndescription of the intrathoracic findings." }, { "input": "The lack of IV contrast limits evaluation of all solid organs vascular\nstructures.\n\n LOWER CHEST: Please refer to the separately dictated CT of the chest for\ndetailed evaluation.\n\nHEPATOBILIARY: Unenhanced liver appears unremarkable. Status post\ncholecystectomy.\n\nPANCREAS: Pancreatic contours are unremarkable.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: There is re-demonstration of bilateral adrenal gland nodularity\nwith the nodule on the right measuring up to 1.9 cm. This is stable since\n___.\n\nURINARY:Status post right nephrectomy. There are no suspicious lesions within\nthe nephrectomy bed. Left kidney demonstrates no hydronephrosis,\nnephrolithiasis or suspicious renal masses. There is a stable subcentimeter\nhyperdense nodule along the superior pole of the left kidney.\n\nGASTROINTESTINAL: Stomach is distended with oral contrast and appears\nunremarkable. Small bowel loops are normal in caliber. Appendix is\nunremarkable. There are scattered colonic diverticulosis without\ndiverticulitis.\n\nPERITONEUM: There is no free air or free fluid. There is no peritoneal\nstranding. There is a stable soft tissue nodule within the right lateral\nconal fascia measuring 1.3 cm.\n\nLYMPH NODES: There are subcentimeter retroperitoneal lymph nodes with no\nsignificant interval change since ___.\n\nVASCULAR: There is moderate atherosclerotic calcifications of the normal\ncaliber abdominal aorta.\n\nPELVIS: Urinary bladder is under distended. Prostate gland is enlarged and\nunchanged.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions. \nThere is a stable sclerotic lesion along the left iliac bone. There is also\nstable sclerosis along the inferior endplates of L2 and L1.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "Non contrast CT is insensitive for detection of metastasis. Consider MRI in\nthe future for imaging the abdomen and pelvis.\nPost right nephrectomy with no local recurrence or distant metastatic disease.\nStable bilateral adrenal gland nodularity." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Re-demonstrated is a 1.0 cm anterior accessory\nspleen (03:58). An 8 mm accessory spleen is also seen in the splenic hilum\n(3:62).\n\nADRENALS: Re-demonstrated is a 1.9 cm right adrenal nodule, unchanged since\n___. Thickening of the left adrenal gland without a single discrete\nnodule is also similar in appearance to ___.\n\nURINARY: The patient is status post right nephrectomy. There is no suspicious\nsoft tissue within the nephrectomy bed. Surgical clips are again seen. The\nleft kidney demonstrates no hydronephrosis, nephrolithiasis or suspicious\nrenal mass within the limits of an unenhanced scan. The subcentimeter\nhyperdense nodule along the superior pole the left kidney is a unchanged in\nsize (3:60).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is again enlarged, measuring up to 6.3 cm in\ntransverse dimension.\n\nLYMPH NODES: Multiple subcentimeter retroperitoneal nodes are unchanged since\n___. There is no mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is a lucent lesion in the right anterior acetabulum measuring 2.9\nx 2.1 x 3.6 cm (06:32, 3:113) with adjacent thinning of the cortex, suspicious\nfor metastatic disease. 5 mm sclerotic lesion in the right iliac bone is\nunchanged (3:96). The sclerotic focus in the left iliac bone is unchanged,\ncurrently measuring 9 mm (3:100), previously 1.0 cm. Sclerosis along the\nanterior inferior endplates of L1 and L2 are also unchanged.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted. A\ncalcified granuloma is seen in the left gluteal region.", "output": "1. Please note that noncontrast CT is less sensitive for detection of\nmetastasis. Consider MRI in the future for imaging of the abdomen and pelvis.\nWithin these limitations, there is a lucent lesion measuring 2.9 x 2.1 x 3.6\ncm in the right anterior acetabulum with adjacent cortical thinning,\nsuspicious for metastatic disease. There is no evidence of local recurrence.\n2. Bilateral adrenal gland nodularity/thickening is stable.\n3. Please refer to dedicated CT chest performed on the same date for\ndescription of intrathoracic findings.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:06 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: There is moderate dependent and subsegmental atelectasis in the\nbilateral lower lobes. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL:\n\nIn the mid abdomen, there is a large ill-defined fluid and intermediate\ndensity mass, grossly unchanged in appearance as compared to outside hospital\nCT ___. There is a left retroperitoneal intermediate density\ncomponenta which measures 5.0 x 9.3 cm (series 2:52), unchanged from ___. There is a rim enhancing collection containing fluid and air which\ncontains oral contrast and abuts multiple small bowel loops which measures 7.0\nx 3.1 cm (series 2:53) which tracks through the left anterior abdominal wall\ninto the skin compatible with an enterocutaneous fistula. There are multiple\nenlarged adjacent mesenteric lymph nodes measuring up to 1.0 cm (series 2:56)\nand 1.1 cm (series 2:50)\n\nThe colon and rectum are grossly unremarkable. The stomach is unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: There are multiple prominent mesenteric lymph nodes, as detailed\nabove. Scattered retroperitoneal lymph nodes are not pathologically enlarged\nby CT size criteria. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Again noted is an enterocutaneous fistula exiting out of the\nleft anterior midline. There is significant ill-defined heterogeneous\nenhancement and stranding of the left rectus sheath musculature and\nsubcutaneous tissues.", "output": "1. In the mid abdomen, there is an ill-defined intermediate density mass which\nis grossly unchanged in size and appearance as compared to outside hospital CT\n___. There is a large left retroperitoneal intermediate density\ncomponent which measures 5.0 x 9.3 cm, also unchanged from ___. In\nthe central portion of this mass, there is a rim enhancing collection\ncontaining fluid and air also containing oral contrast which tracks through\nthe left anterior abdominal wall into the skin compatible with an\nenterocutaneous fistula, also unchanged. There are multiple prominent\nmesenteric lymph nodes.\n2. Heterogeneous enhancement and stranding of the left rectus sheath muscle\nand the soft tissues of the anterior abdominal wall is grossly unchanged from\n___." }, { "input": "LOWER CHEST: There is mild bilateral dependent atelectasis. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is re-demonstration of ill-defined fluid and\nintermediate density mass not significantly changed in appearance when\ncompared to prior study. The left retroperitoneal intermittent density\nmeasures 10 x 5.1 cm and is unchanged in appearance. There is\nre-demonstration of fluid collection interposed between small bowel loops\nwhich is less discrete in measurements and may be due to lack of p.o. contrast\non this study however appears grossly unchanged from prior (02:41). Irregular\nareas of enhancement and collections track into the left rectus sheath,\nunchanged. Multiple mesenteric lymph nodes are visualized measuring up to 1\ncm, unchanged from prior (02:49). The stomach is unremarkable. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple prominent mesenteric lymph nodes, as described above, as\nwell as multiple additional mesenteric and retroperitoneal lymph nodes not\npathologically enlarged by size criteria. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is re-demonstration of an enterocutaneous fistula along\nthe lower anterior abdominal wall with significant adjacent soft tissue\nenhancement and fat stranding not scan the changed from prior study.", "output": "1. No evidence of bowel obstruction.\n2. Grossly unchanged ill-defined abdominal mass, with left retroperitoneal\nintermediate density component, and with associated fluid collection that\ninterdigitates between small bowel loops.\n3. Enterocutaneous fistula of the lower anterior abdominal wall with adjacent\nsoft tissue enhancement and fat stranding through the rectus sheath not\nsignificantly changed when compared with prior study.\n4. Stable mesenteric lymphadenopathy. No new lymphadenopathy identified.\nOverall appearance has not significantly changed compared to ___." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis is noted.\nABDOMEN:\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable.\n\nPANCREAS: A 1.8 cm cystic lesion of the region of the uncinate process (5:37)\nlikely represents fluid in adjacent duodenal diverticulum. The pancreas is\notherwise unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The right and left adrenal glands are unremarkable.\n\nURINARY: The kidneys are unremarkable.\n\nGASTROINTESTINAL: Again seen are extensive desmoid tumors anterior and left\nabdomen, not significantly changed from prior. A 9.8 cm more discrete desmoid\nin the left posterior abdomen (5:46) is stable, previously 9.9 cm. Multiple\nsinus tracts are again seen in the anterior left hemi-abdomen. Known\nulceration of the desmoid with communication into adjacent small bowel loops\nis similar to prior. Enteroenteric fistulas are again seen and are similar to\nprior (7:24). There is no gastrointestinal obstruction.\n\nPELVIS: There is no free fluid in the pelvis.The uterus and bilateral adnexa\nare within normal limits.\n\nLYMPH NODES: Enlarged mesenteric lymph nodes measuring up to 8 mm in the short\naxis (5:51) are unchanged. Enlarged left anterior pelvic lymph nodes\nmeasuring up to 1.5 x 1.4 cm (5:73) are similar to prior. There is no\nretroperitoneal or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mesenteric vessels are again\nnoted to be attenuated and encased by the desmoid tumors.\n\nBONES: No aggressive appearing osseous lesions are identified.\n\nSOFT TISSUES: Re-demonstration of enterocutaneous fistula along the lower\nanterior abdominal wall with significant soft tissue enhancement fat\nstranding, similar to prior. A sebaceous cyst is seen in the subcutaneous\ntissues of the right gluteal region. Similar scarring in the gluteal regions.", "output": "1. Compared to ___, no significant change in desmoid tumors with\nknown ulcerations, enterocutaneous and enteroenteric fistulas and multiple\nsinus tracts in the anterior abdomen.\n2. A 1.8 cm cystic lesion in the region of the uncinate process likely\nrepresents fluid in adjacent small bowel diverticulum and not a lesion in the\npancreas itself. Attention on follow-up imaging recommended.\n3. Mesenteric and anterior pelvic lymphadenopathy is stable." }, { "input": "LOWER CHEST: There is dependent bibasilar atelectasis. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. A 1.5 cm cystic lesion in the\nregion of the uncinate process (02:37) is unchanged and likely represents\nfluid in an adjacent duodenal diverticulum.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Again seen are extensive\ndesmoid tumors involving the anterior and left abdomen, not significantly\nchanged from prior. A 10.7 x 5.8 cm focal mass in the left posterior abdomen\n(2:44) is similar to prior, previously 10.5 x 5.8 cm, as remeasured today. \nMultiple sinus tracts in the anterior left hemi-abdomen and known ulceration\nof the desmoids with communication into adjacent small bowel loops is similar\nto prior. Enteroenteric fistulas are similar to prior (601:32), now\ncontaining air and fluid rather than oral contrast material, with continued\nenhancement and inflammation along the walls of the fistula tracts. No new\nfluid collections are seen, and there is no free air or free fluid. There is\nno evidence of gastrointestinal obstruction. Colonic diverticulosis is noted\nwithout diverticulitis.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Enlarged mesenteric lymph nodes measuring up to 0.9 cm in the\nshort axis (2:52) are essentially unchanged. Enlarged left anterior pelvic\nlymph nodes measuring up to 1.5 x 1.2 cm (2:76) are unchanged. There is no\nretroperitoneal or inguinal lymphadenopathy by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted. Encasement of the mesenteric vessels by desmoid tumors are\nunchanged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An enterocutaneous fistula along the lower anterior abdominal\nwall with marked surrounding fat stranding and skin thickening is similar to\nprior. A probable sebaceous cyst in the subcutaneous fat over the right\nmedial gluteal region (2:73) is unchanged. Scarring/stranding in the\nbilateral gluteal regions appear unchanged (2:66).", "output": "1. Compared to ___, essentially unchanged extensive desmoid tumors\nwith multiple sinus tracts, enteroenteric and enterocutaneous fistulas. No\nnew fluid collections identified or bowel obstruction.\n2. Stable mesenteric and pelvic lymphadenopathy." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low attenuation throughout relative to\nthe spleen suggestive of fatty liver. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.\n\nAgain demonstrated are extensive desmoid tumors involving the anterior and\nleft abdomen similar to prior with a 10.7 x 4.8 cm focal mass in the left\nposterior abdomen appearing grossly unchanged (2; 44). Again demonstrated are\nmultiple enhancing sinus tracts in the anterior left hemiabdomen with known\nulceration of the desmoid tumors into adjacent small bowel loops and\ncommunication with multiple enteroenteric fistula tracts as previously\ndemonstrated. A dominant enteroenteric fistula in the mid abdomen with\nenhancing walls continues to contain fluid and air and measures up to 5.0 x\n2.1 cm, overall decreased in size compared to ___ when it measured\napproximately 7.0 x 3.0 cm (2; 48), with a component of this fistula extending\ninto the left rectus muscle and left ventral abdominal wall. No new fluid\ncollection or definite new fistula is identified.\n\nNo evidence of bowel obstruction. There is new mural edema with hyperemia of\nthe mucosa involving the entire colon and rectum as well as small-bowel loops\nwithin the mid lower abdomen and pelvis concerning for proctocolitis and\nenteritis.\n\nNo free air. There is a small amount of simple free fluid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Enlarged mesenteric lymph nodes measuring up to 1.7 cm in short\naxis (601; 25) are unchanged compared to prior. Prominent retroperitoneal\nlymph nodes measures up to 1.0 cm in short axis (2; 35). Left pelvic lymph\nnodes measuring up to 1.1 cm in short axis is unchanged compared to prior (2;\n72). There is no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Again, there is encasement of the mesenteric vessels and the SMV\nand SMA by the desmoid tumors.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: In the lower mid anterior abdominal wall, there are foci of air\nwithin an enterocutaneous fistula with surrounding soft tissue stranding (2;\n55). Probable sebaceous cyst in the subcutaneous fat over the right medial\ngluteal region is similar to prior (2; 69).", "output": "1. Assessment is somewhat limited without oral contrast.\n2. New mural edema and mucosal hyperenhancement of the entire colon, rectum\nand loops of small bowel within the lower mid abdomen consistent with\nproctocolitis and enteritis, which may be infectious or inflammatory in\netiology.\n3. Re-demonstration of extensive desmoid tumors with multiple sinus tracts,\nenteroenteric and enterocutaneous fistulous, with somewhat decreased fluid\ncomponent in some of the fistulous tracts compared to prior. No evidence of\nbowel obstruction or new fluid collections.\n4. Similar mesenteric, retroperitoneal, and pelvic lymphadenopathy.\n5. Probable hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Re-demonstration of an\nextensive soft tissue mass in the mesentery, encasing numerous small bowel\nloops and mesenteric vessels, compatible with the patient's known desmoid\ntumor. Mild interval decrease in size of the soft tissue mass, with the 2\nlargest components measuring 9.9 x 5.3 cm, previously 10.7 x 5.8 cm in the\nleft hemiabdomen, while the other measurable component anterior to the\nduodenum measures 4.4 x 5.6 cm, previously 5.1 x 7.1 cm. Re-demonstration of\nmultiple sinus tracts in the left hemiabdomen which appear decompressed in\ncomparison to the previous study. Stable appearance of an enterocutaneous\nfistula in the midline abdominal wall. Interval resolution of the diffuse\ncolonic thickening.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple enlarged mesenteric lymph nodes are stable. Borderline\nretroperitoneal lymph nodes are stable, not enlarged by size criteria. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Re-demonstration of an extensive, infiltrative mesenteric mass, in keeping\nwith patient's known desmoid tumor. There has been mild overall decrease in\ntumor bulk compared to previous, with the previously visualized sinus tracts\nappearing decompressed. Stable anterior abdominal wall enteric cutaneous\nfistula.\n2. No intra-abdominal fluid collections.\n3. Interval resolution of the proctocolitis." }, { "input": "LOWER CHEST: At the imaged lung bases, there is subsegmental atelectasis. No\npleural effusion is seen. The imaged portion of the heart is unremarkable.\n\nABDOMEN: The liver enhances normally without focal concerning lesion. No\nbiliary ductal dilation is seen. The main portal vein is centrally patent. \nThe gallbladder is unremarkable. The spleen is normal. Adrenals are normal\nbilaterally. The kidneys enhance symmetrically and excretion of contrast is\nprompt and equal. The abdominal aorta is normal in course and caliber without\nappreciable atherosclerotic calcification. There is no retroperitoneal\nlymphadenopathy. Again seen is a large infiltrative mass along the root the\nsmall bowel mesentery which is consistent with known desmoid tumor. This\ntumor is again seen abutting the uncinate process of the pancreas. Desmoid\ntumor encases the SMA, SMV and there central branches, in a similar overall\npattern as compared with the most recent CT and MRI. Enterocutaneous fistulae\nare seen extending to the mid abdominal wall, in a similar pattern as compared\nwith recent prior exams without new drainable fluid collection. Multiple\nenlarged mesenteric lymph nodes are again seen, for example on series 2, image\n49, not significantly changed. There is no evidence of SMV thrombosis. There\nis however noted to be slight attenuation of the distal aspect of the SMV just\nproximal to the portal confluence, seen on series 2 image 43. Enterocutaneous\nfistulae traverse the left rectus musculature with sites of cutaneous contact,\nsuperior and to the left of the umbilicus. As seen previously, there is\nmarked hyperemia and inflammatory stranding along the enterocutaneous fistula\ntracts. While there is significant soft tissue encasement of small-bowel\nloops representing infiltrative desmoid tumor, there is no evidence of\nsmall-bowel obstruction with contrast extending through the level of the\nascending colon. No free fluid or free intraperitoneal gas.\n\nPELVIS: The appendix is normal. The colon contains a mild fecal load. \nUrinary bladder is mostly decompressed. The uterus and ovaries appear normal.\nLymph nodes in the left anterior pelvis are again seen, enlarged up to 14 mm\nin short axis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Redemonstration of infiltrative desmoid tumor along the small bowel mesentery\nencasing numerous small bowel loops complicated by development of\nenterocutaneous fistulae, contacting the skin superior and to the left of the\numbilicus. No drainable fluid collection. No associated small bowel\nobstruction." }, { "input": "LOWER CHEST: Bibasilar atelectasis, left greater than right. No large pleural\neffusion or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Again seen is a 2.1 x 1.2 cm hypodensity within the pancreatic head\nwhich is not significantly changed in size compared to multiple prior exams. \nThis was characterized as a loculated fluid collection on prior MRCP (02:32). \nNo other pancreatic masses are identified.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Again seen is an extensive\nmesenteric soft tissue mass encasing numerous loops of small bowel and\nmesenteric vessels compatible with patient's known clinical history of desmoid\ntumor. This measures approximately 14.9 x 5.4 cm, previously 14.8 x 5.1 cm\n(02:35). The left-sided component currently measures 10.8 x 4.2 cm,\npreviously 10.4 x 4.6 cm on ___ (02:43). Enteric cutaneous fistulae\nare again seen extending to the mid abdominal wall and are unchanged compared\nto ___. No drainable fluid collection is identified. Multiple\nenlarged mesenteric lymph nodes are not appreciably changed (for example\n02:42, 02:44). There is no evidence of bowel obstruction or perforation. The\ncolon and rectum are within normal limits. Enteric contrast fills the lumen\nof the appendix which is otherwise normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Mesenteric lymphadenopathy as described above. Multiple enlarged\nlymph nodes in the anterior pelvis are unchanged and measure up to 1.2 cm in\nshort axis (2:68, 69, 71, 72).\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted. Soft tissue mass encases the superior mesenteric artery, distal main\nportal vein at the portal splenic confluence, and superior mesenteric vein,\nsimilar to prior exam.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Enterocutaneous fistulas in the mid abdomen as described above. \nOtherwise the tissues of the abdominopelvic walls", "output": "1. Stable appearance of an extensive mesenteric soft tissue mass consistent\nwith patient's known history of desmoid tumor, associated with enteric\ncutaneous fistulae contacting the anterior abdominal wall.\n2. No drainable fluid collection or abscess formation.\n3. No evidence of bowel perforation or obstruction.\n4. Otherwise no substantial change compared to exam dated ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Again seen is an area of septations and\nincreased density of the wall of the fundus of the gallbladder, unchanged\nsince ___. .\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter cortical hypodensity in the left kidney is too small to\ncharacterize, but most likely represents a cyst. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is no CT correlate for abdominal pain and weight loss. No evidence\nof malignancy." }, { "input": "LOWER CHEST: There is an approximately 3-mm right lower lobe pulmonary nodule\n(Series 2, Image 4), stable since at least ___. The remaining incompletely\nvisualized lungs are clear. No pleural effusion. The partially visualized\nheart and pericardium are within normal limits.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver parenchyma is homogeneous in attenuation throughout.\nNo focal hepatic lesion. No intrahepatic or extrahepatic biliary ductal\ndilatation. The gallbladder is not markedly distended. There is a large,\nnon-obstructing calcified gallstone (1.9-cm) within the lumen. No gallbladder\nwall thickening or pericholecystic fluid collection. No ascites.\n\nPANCREAS: The pancreas is normal in attenuation throughout. No focal\npancreatic lesion, pancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout. No focal\nsplenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and symmetric with normal\nnephrograms. Tiny hypodensity in the cortex of the right midpole is too small\nto accurately characterize on CT but statistically most likely a cyst. No\nconcerning focal renal lesion. No hydronephrosis or perinephric abnormality. \nThe urinary bladder is very distended and grossly unremarkable.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The proximal this filled with oral contrast. The\ndescending colon, sigmoid colon, and rectum are filled and distended with\nstool. The colon is otherwise unremarkable. The appendix is not definitely\nseen but no secondary signs of appendicitis are noted. No mesenteric\nlymphadenopathy or stranding. No bowel obstruction, pneumatosis,\npneumoperitoneum, or intra-abdominal fluid collection.\n\nRETROPERITONEUM: No retroperitoneal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm or calcified atherosclerosis.\n\nPELVIS: No pelvic or inguinal lymphadenopathy. No free fluid in the pelvis. \nThe uterus is unremarkable - prominence of the endometrium is within normal\nlimits if the patient is not postmenopausal.\n\nBONES AND SOFT TISSUES: Mild degenerative changes with Schmorl's nodes are\nnoted at T12-L1. The abdominal and pelvic walls are within normal limits.", "output": "1. No specific acute finding to explain the patient's left lower quadrant\npain on CT. Moderate colonic stool burden.\n\n2. Large, approximately 1.9-cm, non-obstructing gallstone. CBD 4 cm." }, { "input": "LOWER CHEST: There is a 5 mm nodule within the right middle lobe, unchanged\nsince ___. Mild dependent atelectasis bilaterally. No new\nconsolidations. No pleural effusion. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is decompressed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 6 mm splenule at the hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple subcentimeter hypodensities within the kidneys\nbilaterally, too small to characterize, but likely represent simple cysts. \nOtherwise, kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. There is a hypodense lesion within the sigmoid colon measuring up\nto 2.0 cm (series 4, image 59 and series 7, image 45), which appears to have\nan intraluminal component, but may be submucosal location. No stricture is\nvisualized. There is no evidence of adjacent fat stranding. The appendix is\nnot visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A 1.4 cm fibroid is visualized within the posterior\nmyometrium (series 4, image 63. The endometrium appears to be irregular and\nthickened measuring up to 1.3 cm, and warrants a pelvic ultrasound (series 7,\nimage 41). No adnexal masses are visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia. Abdominal and\npelvic wall is within normal limits.", "output": "1. No bowel stricture, inflammation, or obstruction.\n2. 2.0 cm hypodense focus within the sigmoid colon, which appears\npredominately intraluminal, in the approximate location of focal narrowing\nseen on recent colonoscopy. This could represent a submucosal lesion or\nresolving edema/fluid from recent infection, though difficult to differentiate\nfrom a small focus of intraluminal fluid or stool. Consider short-term\nfollowup colonoscopy and biopsy.\n3. Diverticulosis.\n4. Thickened endometrium measuring up to 1.3 cm, which should be followed up\nwith a pelvic ultrasound.\n5. 5 mm right middle lobe nodule, unchanged since ___.\n\nRECOMMENDATION(S):\n1. Short-term followup sigmoidoscopy or CT to reassess previously-seen area of\nnarrowing and a possible hypodense focus in this area on today's examination.\n2. Pelvic ultrasound is for the evaluation of the endometrium.\n3. In the case of nodule size >4 - 6 mm: For low risk patients, follow-up at\n12 months and if no change, no further imaging needed. For high risk patients,\ninitial follow-up CT at ___ months and then at ___ months if no change.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:00 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates geographic areas of hyperattenuation\nwith more central area of hypoattenuation. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits. Extensive filling\ndefect is visualized in the main portal vein and its intrahepatic branches\nextending into the SMV and branches with hazy appearance of the adjacent\nmesenteric fat.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral subcentimeter renal hypodensities are visualized too small\nto characterize though likely compatible with renal cysts. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colonic lumen\nis fluid-filled which may be second to a diarrheal process. No bowel wall\nthickening or stranding is seen about the colon the rectum. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diastasis recti is visualized most prominently in the\nperiumbilical region otherwise the abdominal and pelvic wall is within normal\nlimits.", "output": "1. Acute portal vein and SMV thrombus with associated areas of hepatic\nperfusion alteration and no specific signs of bowel ischemia.\n2. Fluid within the colonic lumen compatible with diarrheal illness. No\nevidence for colitis.\n3. Normal appendix." }, { "input": "LOWER CHEST: There is mild right basilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is fatty in attenuation. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is no hiatal hernia. There is no bowel obstruction. \nSmall and large bowel are fluid filled. There is no wall thickening or\nsurrounding fat stranding. Appendix is normal. There is no intra-abdominal\nfree fluid or free air.\n\nPELVIS: The bladder is distended. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Incidental note is made of a common origin of the celiac trunk and\nSMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a mild retrolisthesis of L3 on L4 subtle retrolisthesis of L4 on L5.\n\nSOFT TISSUES: There is a small fat containing inguinal hernias.", "output": "Fluid filled large and small bowel, which can be seen in the setting of\ngastroenteritis. Otherwise, unremarkable examination." }, { "input": "LOWER CHEST: There is left greater than right-sided dependent atelectasis. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse hypoattenuation of the liver suggestive of\nsteatosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The bladder wall appears thickened secondary to underdistention. No\ninfection was indicated on urinalysis. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is chronic appearing loss of height of the posterior midline aspect of\nthe T11 vertebral body.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\ncouple tiny hypodensities are noted in the left liver lobe, too small to\ncharacterize but likely hepatic cysts or biliary hamartomas. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a 2.2 x\n1.6 cm structure medial to the cecum/ascending colon, containing fecal\nmaterial and air, with adjacent fat stranding (601b:25) and thickening of the\ncecum and terminal ileum, possibly reactive. However, given the extensive\nthickening of the cecum, an underlying mass cannot be excluded. The rounded\nstructure may represent a prominent diverticulum, although larger than\ntypically seen in isolation along the cecum. There is a small locule of air,\nadjacent to the possible diverticulum, which is concerning for\nmicroperforation. No evidence of abscess formation. Diverticulosis is also\nseen in the sigmoid colon. The rectum is within normal limits. The appendix\nis normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Marked thickening of the cecum with a 2.2 x 1.6 cm round air-and-fecal\ncontaining structure medial to the cecum with adjacent fat stranding, which is\nconcerning for cecal diverticulitis. Small focus of extraluminal gas is\nconsistent with microperforation.\n2. Cecal thickening could be reactive, but underlying mass not excluded and\nshould be evaluated for after acute episode subsides. Thickening of the distal\nterminal ileum is likely reactive.\n3. Normal appendix.\n\nRECOMMENDATION(S): Colonoscopy after acute episodes subsides.\n\nNOTIFICATION: Findings discussed with Dr. ___ by Dr. ___\n___ at 10:15AM on ___ via telephone." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered subcentimeter hypodensities are noted in the the liver segments \nlikely hepatic cyst or biliary hematoma. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is diffusely distended with food products. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Sigmoid diverticulosis is noted without evidence of acute\ndiverticulitis. Otherwise, the remaining colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nCalcified injection granulomas are noted in the left buttock.", "output": "1. No acute CT intra-abdominal or intrapelvic findings to correlate with\npatient's symptoms" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodensity is seen in the right hepatic lobe, too small to\nfully characterize but likely representing hepatic cyst or biliary hamartoma. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not definitely visualized on this exam. \nThere is no adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nsclerotic lesion is seen in the right ilium, likely representing bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute CT findings to correlate with patient's chronic hematuria,\nspecifically no evidence of nephrolithiasis, hydronephrosis, or perinephric\ncollection." }, { "input": "LOWER CHEST: Interval development of moderate left and small right pleural\neffusions with adjacent atelectasis. Trace pericardial fluid is likely\nphysiologic.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is heterogeneous in attenuation and contains\nnumerous hepatic metastases predominantly within the left hepatic lobe, which\nmeasure up to 1.6 x 1.5 cm (05:25), previously 1.3 x 1.2 cm. The main portal\nvein is attenuated by soft tissue density material seen within the porta\nhepatis (05:25), similar to the prior examination. This mass also compresses\nthe extrahepatic common biliary duct, which is cannulated by a percutaneous\ntranshepatic biliary drain that subsequently terminates in the duodenum. \nExpected pneumobilia is noted. Mild intrahepatic biliary ductal dilation is\nsimilar to prior examination. The gallbladder is nondistended and contains\nrefluxed contrast and air (05:32).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The patient is status post splenectomy.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post partial large bowel resection\nwith end ileostomy and ___ pouch. A nasogastric tube terminates within\nthe stomach. The stomach itself is distended with gastric contents and oral\ncontrast material. A ball of fecalized material within the lumen of the small\nbowel just adjacent to the jejunojejunal anastomosis is unchanged in size from\nthe prior study of ___ and not associated with upstream small\nbowel dilation. The subsequent loops of small and large bowel are normal in\ncaliber without evidence of focal wall thickening.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. The patient is status posthysterectomy. A 1.5 x\n1.2 cm left vaginal cuff nodule (5:68) is similar as compared to the prior\nexamination, allowing for differences in technique.\n\nMESENTERY AND LYMPH NODES: An enlarged epicardial lymph node measures 1.2 cm. \nA small, left peritoneal nodule (05:44) measures 1.0 cm, previously 7 mm. \nThere is no pathologically enlarged pelvic or inguinal lymph nodes identified.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.", "output": "1. Stable appearance status post partial colectomy and end ileostomy, except\nto note new moderate gastric distention with nasogastric tube in appropriate\nposition. No evidence of smalll bowel obstruction.\n2. Interval development of bilateral pleural effusions with adjacent\natelectasis.\n3. Interval placement of a percutaneous transhepatic biliary drain which\nappears appropriate position. Mild residual intrahepatic biliary ductal\ndilation is largely stable.\n4. Minimal interval progression in size and conspicuity of numerous hepatic\nmetastases and a left peritoneal nodule.\n5. Stable, known recurrent disease at the left vaginal cuff." }, { "input": "LOWER CHEST: A calcified granuloma is seen within the left lower lobe. \nOtherwise, visualized lung fields are within normal limits. There is no\nevidence of pleural effusion. There is minimal pericardial fluid within\nphysiologic limits.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is seen within the endometrial cavity. There is\nno adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "1. No acute intra-abdominal process on noncontrast enhanced CT.\n2. IUD seen centrally within the uterus." }, { "input": "LUNG BASES: Mild atelectasis is noted in the lower lungs.\n\nABDOMEN: The liver similar to prior with several small hypodensities again\nnoted for instance in the left lobe on series 601, image 25 measuring 1.2 x\n1.8 cm, likely a cyst. The gallbladder contains several gallstones though\nthere is no CT evidence for acute cholecystitis. A calcification is again\nnoted within or adjacent to the distal common bile duct measuring 5 mm best\nseen on series 2, image 28, unchanged from ___. No evidence of acute\npancreatitis. The spleen is normal in size. Adrenals are normal bilaterally.\nAn atrophic appearance of the left kidney with an exophytic midpole cyst\ncontaining mural calcification is again noted. The right kidney appears\nunremarkable. The right ureter appears somewhat distended unchanged from\nprior without distal stone. The abdominal aorta is mildly calcified, tortuous\nwithout aneurysm. There is no retroperitoneal lymphadenopathy. The stomach\nis normal. Diverticulosis of the duodenum noted.\n\nPELVIS: Extensive small bowel diverticulosis is noted. Small-bowel\ndiverticulitis is noted along the left anterior mid abdomen best seen on\nseries 602 images 57 - 60. Similar to prior and there is no evidence of macro\nperforation. There is a second site of small-bowel diverticulitis seen just\nbelow the umbilicus to the left of midline anteriorly, best on series 602\nimage 45 and series 2 image 46. A small rounded hypodense structure abuts the\nposterior wall of the small bowel, possibly a distended diverticulum versus\ntiny abscess. This structure measures approximately 2.1 x 2.0 cm. There is\nno associated bowel obstruction. No portal venous gas. The appendix is not\nvisualized. The colon also contains numerous diverticula. Prostate is\nenlarged measuring 4.6 x 4.8 cm. The urinary bladder is partially distended\nand appears normal. There is no pelvic sidewall or inguinal adenopathy. No\nfree air or free fluid.\n\nBones: No worrisome lytic or blastic osseous lesion. Grade 1 anterolisthesis\nof L4 on L5 without pars defects.", "output": "1. Extensive small bowel diverticulosis with new site of small-bowel\ndiverticulitis along the anterior left pelvic wall just below the umbilicus. \nPossible tiny associated abscess.\n2. Second site of small-bowel diverticulitis in the left anterior mid abdomen\nat the same site of diverticulitis and to recent priors.\n3. Cholelithiasis with possible distal CBD stone unchanged from 2 prior CTs\ndating back to ___.\n4. Atrophic left kidney." }, { "input": "LOWER THORAX: Linear atelectasis at the lung bases. No pleural or pericardial\neffusion.\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation. Status\npost cholecystectomy.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly. 12 mm accessory splenic tissue\nadjacent to the inferior pole of the spleen. There are multiple surgical\nclips anterior to the spleen.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: 31 mm cyst arising from the upper pole of the left kidney with hair\nthin septation without measurable enhancement (Bosniak 2). No hydronephrosis.\nUnremarkable bladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are\nnormal in caliber. Scattered colonic diverticula.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy. No adnexal mass.\n\nLYMPH NODES: No retroperitoneal or mesenteric adenopathy. No pelvic or\ninguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Unremarkable.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic calcification.\n\nBONES: No suspicious osseous lesion.\n\nSOFT TISSUES: 19 x 26 mm soft tissue density at the level of the right\ninternal inguinal ring is present and unchanged since ___, in keeping with a\nsurgical plug from right inguinal hernia repair in ___. There are several\nsurgical clips noted along the course of the right inguinal canal. Spinal\nstimulator device within the posterior soft tissues.", "output": "Soft tissue mass described on outside CT within the right lower quadrant is\nstable since ___, in keeping with surgical plug from right inguinal hernia\nrepair in ___." }, { "input": "LOWER CHEST: Trace right pleural effusion with minimal bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Trace perisplenic free fluid.\n\nADRENALS: Coarse calcifications of the bilateral adrenal glands are again\nseen, unchanged from prior, which may reflect prior hemorrhage or\ngranulomatous disease.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is decompressed. No bowel obstruction. There is\npossible mild thickening of some loops of proximal small bowel in the left\nabdomen. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Possible mild thickening of loops of proximal small-bowel, which can be\nseen with mild enteritis.\n2. Trace right pleural effusion" }, { "input": "Heart size is normal without significant pericardial fluid. There is a small\nright-sided pleural effusion. There is mild bibasilar atelectasis.\n\nCT abdomen with contrast: The liver is morphologically cirrhotic with nodular\ncontour without focal lesion or biliary dilatation. Portal vein is patent. \nGallbladder is distended without stones. There is mild prominence of the\nwall, likely secondary to background cirrhosis.\n\nSpleen is massively enlarged measuring up to 23.3 cm in longest axis. There\nis no focal splenic lesion.\n\nPancreas and adrenal glands are unremarkable. Scattered sub cm renal\nhypodensities are too small to fully characterize but likely represent cysts. \nKidneys otherwise present symmetric nephrograms without focal solid lesion or\nhydronephrosis.\n\nStomach is unremarkable. Duodenum and a few other small bowel loops\ndemonstrate wall thickening, unchanged from prior examination, likely related\nto portal enteropathy. Large bowel is thin-walled and unremarkable without\npericolonic fat stranding or fluid collection. Normal appendix is visualized\nin the right lower quadrant (2:77).\n\nAbdominal aorta is normal caliber. There are scattered, mildly prominent\nporta hepatis and retroperitoneal lymph nodes measuring up to 10 mm in short\naxis, likely secondary to background cirrhosis. There is trace ascites. \nThere is no pneumoperitoneum or ventral abdominal hernia. There are prominent\nsplenorenal varices as well as prominent re- cannulization of the umbilical\nvein. There is no organizing fluid collection.\n\nCT pelvis with contrast: Bladder, seminal vesicles, prostate and rectum are\ngrossly unremarkable. There is no free pelvic air. There is no inguinal or\npelvic sidewall lymphadenopathy by CT size criteria.\n\nBones and soft tissues: There is no suspicious focal bone lesion.", "output": "1. Cirrhotic liver with sequela of portal hypertension including massive\nsplenomegaly, trace ascites and variceal formation.\n2. Unchanged areas of small bowel thickening most prominent in the duodenum,\nlikely secondary to portal enteropathy.\n3. Small right pleural effusion.\n4. Otherwise no acute findings in the abdomen or pelvis. No organizing fluid\ncollection.\n5. Spine is better evaluated on the concurrent same-day total spine MR\nexamination." }, { "input": "LOWER CHEST: There is a small, dependent, right pleural effusion. Visualized\nlung fields are within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is very nodular in appearance, with homogeneous\nattenuation throughout. The main hepatic portal vein is dilated and widely\npatent with a severely enlarged communicating paraumbilical vein anteriorly. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits. There is a very small amount of\npericholecystic fluid without gallstones or gallbladder wall thickening.\n\nPANCREAS: The pancreas is incompletely visualized, but has normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: There is stable, massive splenomegaly. Spleen is otherwise\nhomogeneous in attenuation without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are incompletely visualized, but appear of normal and\nsymmetric size with normal nephrogram. There is no evidence of focal renal\nlesions or hydronephrosis. There are 2 small, nonobstructive stones within\nthe left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is increased enhancement of the proximal stomach wall.\nVisualized small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. Visualized transverse and ascending colon are within\nnormal limits.\n\nLYMPH NODES: There are multiple mildly enlarged lymph nodes near the cardia of\nthe stomach. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Liver is markedly cirrhotic without any evidence of focal lesions. A\nwidely patent and markedly dilated paraumbilical vein communicates freely with\nthe intrahepatic portal vein.\n2. Increased enhancement proximal gastric wall likely indicative of portal\ngastropathy.\n3. Mild fat stranding throughout the mesentery indicative of edema related to\nportal hypertension.\n4. Stable, massive splenomegaly.\n5. Nonobstructive nephrolithiasis the left kidney." }, { "input": "LOWER CHEST: Visualized lung fields are notable for bilateral lower lobe\natelectasis. Slightly more confluent opacity in the right lung base is\nworrisome for pneumonia. Interval increase in a moderate right non\nhemorrhagic pleural effusion. The heart is unremarkable. No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation with nodular contour\nconsistent with known history of cirrhosis. The main portal vein is dilated\nand widely patent with a severely enlarged communicating periumbilical vein\nanteriorly. The SMV is patent. There is no evidence of focal lesions. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder the gallbladder is mildly distended with mild pericholecystic free\nfluid. No gallbladder wall thickening. No calcified gallstones. Multiple\nprominent periportal and porta hepatis lymph nodes have increased since prior\nexamination for example 2.3 x 0.9 cm (02:32) perisplenic lymph node has\nenlarged (previously 1.9 x 1 cm).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Massive splenomegaly is again noted measuring 25.2 cm (previously 24\ncm). No focal splenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nFew subcentimeter renal hypodensities are too small to characterize. There is\nno evidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is diffuse\ncircumferential small bowel wall edema primarily involving the ileum and\ndistal jejunum measuring up to 6 mm. Small bowel loops demonstrate normal\ncaliber and enhancement throughout. Diffuse colonic wall edema is noted. No\ncolonic distention. No pneumatosis. No free intraperitoneal air. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Multiple prominent mesenteric lymph nodes are again seen, largest\nmeasuring 1.2 x 0.7 cm (2:61) within the right lower quadrant (previously 1 x\n0.6 cm). There is no retroperitoneal or mesenteric lymphadenopathy. There is\nno pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mildly distended gallbladder with pericholecystic free fluid and adjacent\nfat stranding may be secondary to underlying liver dysfunction. Clinical\ncorrelation is recommended to assess for acute cholecystitis.\n2. Liver cirrhosis with sequelae of portal hypertension including massive\nsplenomegaly, and paraumbilical re- cannulization.\n3. Interval increase in moderate right non hemorrhagic pleural effusion with\nright lower lobe opacity worrisome for pneumonia or aspiration pneumonia.\n4. Increase in periportal and porta hepatis lymph nodes likely related to\nunderlying liver dysfunction. Close attention on followup is recommended.\n5. Diffuse small bowel and colonic wall edema is nonspecific and can be seen\nin the setting of portal colapathy\n6. No evidence of acute pancreatitis or intra-abdominal abscess." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate bilateral passive subsegmental\natelectasis involving the lower lobes. Moderate-sized bilateral pleural\neffusions. There is a small amount of pericardial effusion. Multiple\nradiopaque staples are seen along the right anterior mediastinum and median\nsternotomy wires likely related to the recent CABG. There is evidence of a\nmitral valve prosthesis.\n\nThere is a partially imaged focal area of intermediate attenuation (25 ___\n(series 3, image 1) in the right anterior cardiophrenic angle measuring\napproximately 4.0 x 2.7 cm, this is of indeterminate etiology due to lack of\nintravenous contrast, likely postoperative fluid collection. Another\nheterogenous soft tissue attenuation area seen inseparable from the\npericardium showing areas of hyperdensity measuring approximately 6.2 x 2.1 cm\n(series 3, image 19), given recent surgery hematoma is a possibility. A\npartially imaged feeding tube is seen extending up to the proximal stomach.\n\nABDOMEN:\n\nHEPATOBILIARY: Unenhanced appearance of the liver is within normal limits. \nThere is a small amount of perihepatic fluid. No evidence of intra or\nextrahepatic biliary dilatation. Few small calculi are seen in the\ngallbladder.. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits. There is a small amount\nof ascites.\n\nPANCREAS: The pancreas is atrophied with the pancreatic body and tail not\nvisualized..\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Unenhanced appearance of both kidneys is within normal limits. A 6\nmm nonobstructive calculus is seen in the lower pole of the left kidney. \nThere is no hydronephrosis. Are of normal and symmetric size. There is no\nevidence of focal renal lesions within the limitations of an unenhanced scan. \nThere is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Unenhanced appearance of the stomach is unremarkable.. \nThere is evidence of prior surgery to the large bowel with a colorectal\nanastomosis seen which remains patent. The small and large bowel loops are\nnormal in caliber with normal wall thickness. The large bowel is fluid\nfilled. There is no evidence of bowel obstruction. Rectal tube seen in situ.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is evidence of partial ankylosis involving bilateral sacroiliac joints.\n\nSOFT TISSUES: Mild anasarca of the abdominal and pelvic soft tissues.", "output": "1. Fluid filled large bowel, no evidence of bowel obstruction. Trace ascites.\n2. Nonobstructive calculus in the left kidney.\n3. Partially imaged fluid collection in the anterior superior mediastinum is\nlikely related to the recent surgery. Heterogenous density area inferiorly in\nthe mediastinum on the right likely represents postoperative hematoma related\nto the recent CABG.\n4. Bilateral pleural effusions and subsegmental atelectasis. Small\npericardial effusion." }, { "input": "LOWER CHEST: Limited evaluation of lung bases demonstrates persistent\nground-glass opacities in the lingula (2b:93, 94), largely unchanged from\nearly ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are several small, subcentimeter hypodensities in the right hepatic lobe\nwhich are too small to characterize. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSeveral bilateral renal cortical hypodensities are too small to characterize\nbut likely cysts. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.t definitively\nvisualized.\n\nPELVIS: The urinary bladder demonstrates mucosal hyperemia and mild thickening\ncircumferentially. There is no free fluid in the pelvis.\n\nLYMPH NODES: Retroperitoneal lymphadenopathy measuring up to 1.0 cm in short\naxis at the para-aortic station (2A: 28) is unchanged from at least ___.\nThere is no mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. An inferior vena caval stent\nis noted immediately inferior to the renal veins. Moderate to severe\natherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. A sclerotic focus within the right iliac bone is unchanged\nfrom ___ and likely a bone island. Severe levoscoliosis is noted centered in\nthe lower thoracic and upper lumbar spine. The abdominal and pelvic wall is\nwithin normal limits.", "output": "1. Urinary bladder wall hyperemia and mild thickening is concerning for\ncystitis. Recommend correlation with urinalysis.\n2. Ground-glass opacities within the lingula are stable from least ___. Findings may represent a chronic or recurrent infectious or\ninflammatory process.\n3. Borderline retroperitoneal lymphadenopathy is stable from at least ___." }, { "input": "LOWER CHEST:\n\nMild bibasilar atelectasis is present. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: As seen previously, multiple foci of pneumobilia and massive\nintrahepatic biliary ductal dilatation are again seen, consistent with known\n___ disease, and similar in overall extent compared to prior CT and MRCP\nfrom ___. The gallbladder is surgically absent. The left portal vein is\nnot visualized, as described previously, likely chronically thrombosed. The\nright portal vein is patent.\nPANCREAS: Foci of air are noted within the main pancreatic duct (02:21,\n601b:13). The pancreatic parenchyma itself is unremarkable, with no\nperipancreatic fluid collection or abscess identified.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The left kidney is mildly atrophic, but otherwise the kidneys present\nsymmetric nephrograms excretion of contrast, with no focal lesion or\nhydronephrosis.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. The appendix is well visualized in the right lower quadrant and is\nnormal.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is mild calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder is decompressed by a Foley catheter.. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis. \nNo pelvic masses are seen.\n\nBONES AND SOFT TISSUES:\n\nNo focal osseous lesion suspicious for malignancy is identified. Compression\nfractures of the L1 and L5 vertebral bodies are again seen, unchanged compared\nto the prior CT.", "output": "1. Segment marked areas of intrahepatic biliary ductal dilatation with\npneumobilia, similar in extent compared to recent prior studies, including\nlarge filling defects, compatible with known Caroli disease. Acute\nexacerbation of known recurrent pyogenic cholangitis cannot be excluded.\n2. Fractures of the L1 and L5 vertebral bodies are unchanged.\n3. No evidence of bowel obstruction or intra-abdominal fluid collection or\nabscess. Normal appendix." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion. The heart is mildly enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is severe intrahepatic biliary duct dilatation with\nmultiple stones and multiple foci of pneumobilia, similar to priors and\nconsistent with recurrent pyogenic cholangitis. The gallbladder is surgically\nabsent. Patient is status post choledochoduodenostomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized, however\nthere are no secondary signs of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. The left portal vein is again not visualized, consistent with\nchronic thrombosis. Again seen are paraesophageal, perigastric and splenic\nvarices.\n\nBONES: Again seen is vertebra plana of the L1 vertebral body. A compression\ndeformity of the L5 vertebral body with anterolisthesis of L4 on L5 is similar\nto prior. No acute fracture.\n\nSOFT TISSUES: There is mild diffuse anasarca.", "output": "1. No diverticulitis or other acute intra-abdominal or pelvic process.\n2. Severe intrahepatic biliary duct dilatation with multiple stones and\npneumobilia is similar to priors and compatible with known recurrent pyogenic\ncholangitis.\n3. Compression deformities of the L1 and L5 vertebral bodies are unchanged." }, { "input": "LOWER CHEST: There is a small left pleural effusion with overlying compressive\natelectasis, worsened. There is trace right pleural effusion and minimal\nright atelectasis, worsened. Heart is enlarged. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is persistent pneumobilia,, severe intrahepatic biliary\nductal dilatation, consistent with known recurrent pyogenic cholangitis. \nDegree of pneumobilia in the left hepatic lobe has increased, and there is new\nbiliary stent in place. Left portal vein is not seen, consistent with chronic\nthrombosis, stable. Patent main, right portal vein. Stable varices,\nincluding paraesophageal, pelvic varices. Mild abdominal, pelvic ascites is\nnew.\n\nPANCREAS: No pancreatic abnormality. There is diffuse edema in ascites, no\ndisproportionate fluid collection or edema about pancreas to suggest\npancreatitis, correlate with laboratory evaluation. Stable mild prominence of\npancreatic duct.\n\nSPLEEN: Normal spleen. New perisplenic ascites. .\n\nADRENALS: Normal\n\nURINARY: No focal renal lesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Moderate wall\nthickening of the ascending colon, hepatic flexure, may be reactive, consider\ninflammatory, infectious colitis ; ischemia is less likely. No evidence of\nperforation. No evidence of bowel obstruction. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small amount\nof free fluid in the lower pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are severe compression deformities of the L5 and L1 vertebral\nbodies with near complete collapse, stable since ___. There is\ngrade 1 L4 on L5 anterolisthesis, stable. There is probably moderate central\ncanal narrowing at L1, and moderate to severe at L5, stable. . There is a\nscoliotic curvature of the thoracolumbar spine, convex to the right.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Post biliary stent placement, with more prominent pneumobilia, extensive\nbile duct dilatation, in this patient with known recurrent pyogenic\ncholangitis. New mild ascites.\n2. Wall thickening right ___ be reactive, consider infectious,\ninflammatory colitis, less likely ischemic process.\n3. Persistent severe compression deformities at the L5 and L1 vertebral\nbodies with significant central canal narrowing.\n4. Diffuse edema secondary to ascites, no disproportionate fluid or edema\nabout pancreas to suggest pancreatitis on CT." }, { "input": "LOWER CHEST: Small amount of consolidation is noted in the left lower lobe,\nlikely due to atelectasis.. There is no definite evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is persistent pneumobilia, predominantly involving the\nleft hepatic lobe, with severe intrahepatic biliary ductal dilatation. Please\nnote the pneumobilia can be seen with prior history of sphincterotomy,\nhowever, if there is no history of surgery, these findings can be compatible\nwith recurrent pyogenic cholangitis. There is been interval removal of a\nbiliary stent from ___. The left portal vein is not well seen,\nconsistent with chronic thrombosis, unchanged. The gallbladder is surgically\nresected. Again seen are paraesophageal and pelvic varices. There is no\nevidence of perihepatic ascites.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No bowel obstruction or bowel wall thickening is seen. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: Compression deformities are again seen in the L1 and L5 vertebrae with\nnear complete collapse, unchanged since ___. There is grade 1\nanterolisthesis of L4-L5, also unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval removal of the biliary stent from ___. There is\npersistent pneumobilia predominantly involving the left hepatic lobe with\nsevere intrahepatic biliary ductal dilatation. Please note that pneumobilia\ncan be seen with history of sphincterotomy, however, if there is no history of\nsurgery, these findings can be compatible with recurrent pyogenic cholangitis.\nAn MRCP could be obtained for further evaluation.\n2. Stable compression deformities again seen in the L1 and L5 vertebrae.\n\nRECOMMENDATION(S): An MRCP could be obtained for further evaluation." }, { "input": "LOWER CHEST: Trace amount of bilateral pleural effusions and minimal bibasilar\natelectasis is noted. There is no pericardial effusion. The heart is mildly\nenlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular contour and shrunken, consistent with\ncirrhosis. There is peripheral parenchymal atrophy. There is no evidence of\nfocal lesions. As previously, there is central and intrahepatic biliary\nductal dilation with stable amount of pneumobilia in the left lobe of the\nliver and trace amount in the right. Previously noted stones on MRI from ___ are not as well demonstrated on today's exam, though likely\nrepresented by heterogeneous hyperdensity within the dilated bile duct in the\nleft lobe, caudate, and right lobe. Previously noted mild peribiliary\nenhancement of the intrahepatic ducts in segment 8 and segment 2 and 3 are\npersistent, with more intense enhancement in segment 2, compared to ___.\n\nThere are likely small esophageal varices.\n\nThe gallbladder is surgically absent.\n\nPANCREAS: Pancreas is mildly atrophic with minimal prominence of the main\npancreatic duct. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Again seen are paraesophageal, perigastric, and pelvic varices. As\npreviously, the left portal vein is not well visualized, consistent with\nchronic thrombosis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPre-existing compression deformities of L1 and L5 are unchanged. \nAnterolisthesis of L4 on L5 by 7 mm is also similar.\n\nSOFT TISSUES: Anterior abdominal wall dehiscence is unchanged. Otherwise, the\nabdominal and pelvic wall is unremarkable.", "output": "1. ___ biliary enhancement in segment II and III with less intense\nenhancement in segment VIII and intraductal filling defects, consistent with\nhistory of chronic recurrent pyogenic cholangitis with persistently dilated\ncentral and intrahepatic biliary ducts. No fluid collection.\n2. Other stable and chronic findings as described above." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate areas of subsegmental\natelectasis. There is no evidence of pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: within the limitations of an unenhanced scan, the pancreas is\nunremarkable.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Within limitations of an unenhanced study the kidneys are unchanged\nin size. Again seen is the cortical hypodensity in the medial interpolar\ncortex of the left kidney measuring 1.5 cm. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatus hernia, the stomach is otherwise unremarkable. \nSmall bowel loops are normal in caliber. Appendix is unremarkable. Mild\nsubmucosal fatty infiltration seen involving the descending colon and the\nsigmoid with mild wall thickening. Small amount of retained contrast is seen\nin the distal large bowel, likely injected during the recent GI procedure. \nThere is evidence of discontinuity in wall of the sigmoid at the level of the\nanastomotic stricture with extraluminal contrast seen extending out through\nthe defect into the mesocolon (series 2, image 68) with multiple small\nextraluminal foci of gas (series 2, image 66) with surrounding and fluid in\nthe surrounding mesocolon. Free intraperitoneal air is seen extending into\nthe upper abdomen. Moderate amount of free intraperitoneal fluid is seen\nextending cranially around the perihepatic space, paracolic gutters as well as\ninto the pelvis.\n\nPELVIS: The urinary bladder is partially filled.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative disc disease involving the lumbar spine.\n\nSOFT TISSUES: Small fat containing umbilical hernia. Bilateral fat containing\ninguinal hernias.", "output": "Findings consistent with sigmoid perforation at the level of the anastomotic\nstricture with moderate free intraperitoneal air and free fluid.\n\nNOTIFICATION: Findings were notified to the clinical team Dr. ___ Dr.\n___ by Dr. ___ MD within 2 minutes of discovery of the findings at\n18:10 hours." }, { "input": "LOWER CHEST: Bibasilar atelectasis. There are small bilateral non hemorrhagic\npleural effusions, and a trace pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is decompressed but\notherwise within normal limits. A hypodensity within hepatic segment 4A \nlikely represents a perfusional change.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A 2 cm fluid density simple renal cortical cyst within the superior\npole of the left kidney is unchanged. The kidneys are of normal and symmetric\nsize with normal nephrogram. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a\ndiverting ostomy. The appendix is not visualized. Postsurgical changes are\nseen at the level of the anastomosis, with no obvious extraluminal contrast. \nContrast is seen within the rectum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Midline\nlaparotomy wound with overlying surgical staples. A 3.0 x 2.2 x 3.0 cm fluid\ndensity underneath the inferior aspect of the laparotomy wound lies partially\nwithin the abdominal musculature and has a likely wall surrounding the\ncollection.", "output": "1. No visible contrast leak. The surgical anastomosis is intact with contrast\npassing into the rectum.\n2. There is a 3.0 x 2.2 x 3.0 cm fluid density collection within the\nmusculature beneath the inferior aspect of the laparotomy site, with a likely\nwall present.\n3. Bilateral small nonhemorrhagic pleural effusions, with overlying bibasilar\natelectasis." }, { "input": "LOWER CHEST: Visualized lung fields are notable for bibasilar and lingular\natelectasis. Trace right pleural effusion noted. Heart is normal in size. \nNo pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a moderate amount of mixed density fluid including\nhemorrhagic products along the perihepatic space (04:29). The liver otherwise\ndemonstrates homogeneous attenuation throughout. There is no evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Moderate amount of intermediate density fluid is\nnoted surrounding the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Medial to the distal esophagus there is a 1.4 x 1.5 cm\nintermediate density collection most consistent with intra peritoneal fluid\ntracking superiorly. Distal esophagus is otherwise unremarkable. The stomach\nis unremarkable. Patient is status post reversal of a right lower quadrant\nileostomy with intact anastomosis in the right lower quadrant and locules of\ngas within the subcutaneous tissues, expected post surgically. Small bowel\nloops otherwise demonstrate normal caliber and wall thickness throughout. \nContrast is noted within the colon, likely from prior studies. Status post\npartial sigmoidectomy with intact anastomosis. The residual colon and rectum\nare within normal limits. The appendix is normal and filled with contrast.\n\nPERITONEUM: Few locules of free intraperitoneal air are expected given recent\npostoperative state. (6:47). Additionally there is moderate volume of mixed\ndensity intraperitoneal fluid with hyperdense components consistent with blood\nproducts. Largest component of blood measures approximately 15.1 x 3.7 x 12\ncm along the right lateral mid abdomen pushing the cecum medially. (04:56). \nNo retroperitoneal hematoma.\n\nPELVIS: The urinary bladder is decompressed with a Foley catheter and expected\nlocules of gas.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Anterior postsurgical midline changes noted. Soft tissues are\notherwise unremarkable. No intramuscular hematoma.", "output": "1. Moderate hemoperitoneum predominately located along the right lateral mid\nabdomen mildly displacing the cecum medially. No retroperitoneal or\nintramuscular hematoma.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:50 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST:\n\nPulmonary nodules and other thoracic findings are discussed in a separate\nreport for the concurrently performed chest CT.\n\nABDOMEN:\n\nAgain demonstrated are postsurgical changes of Whipple procedure. There\ncontinues to be infiltrative soft tissue within the operative bed surrounding\nthe portal vein, celiac axis, and SMA, essentially unchanged from the previous\nexam. Left and right portal veins and hepatic veins remain patent. A segment\nof narrowing along the SMA may be postsurgical. Multiple borderline enlarged\nmesenteric lymph nodes delete up to 9 mm in short axis have not changed\nsignificantly (series 5, images 79 and 81).\n\nNo focal concerning lesion is seen within the liver. There is expected\npneumobilia as well as mild intrahepatic biliary duct dilatation. The remnant\npancreas enhances homogeneously. The gallbladder is absent. The spleen,\nadrenal glands, and kidneys are normal appearing. The left gonadal vein is\ndilated in the abdomen and pelvis but severely narrowed where it joins with\nthe left renal vein.\n\nPatent gastrojejunostomy is noted. The small bowel is nondilated throughout,\nwith oral contrast progressing through the rectum. The colon is grossly\nunremarkable. There is a trace amount of free fluid in the pelvis.\n\nPELVIS:\n\nThe urinary bladder is unremarkable. Multiple engorged veins are noted around\nthe uterus. The ovaries are not clearly distinguished from adjacent bowel\nloops.\n\nBONES:\n\nNo aggressive osseous lesion is identified.", "output": "1. Persistent infiltrative soft tissue surrounding the portal venous, colon,\nceliac axis, and SMA, with borderline enlarged mesenteric lymph nodes, not\nsignificantly changed from ___. As before this appearance may be\nattributable to radiation treatment, but close attention on followup is\nrecommended.\n2. Narrowing at the junction of the left gonadal vein with the left renal vein\nwith evidence of venous congestion in the pelvis.\n3. Please refer to separate CT chest report for discussion of pulmonary\nnodules and other thoracic findings." }, { "input": "PLEASE SEE CHEST CT DICTATION FOR FORMAL CHEST FINDINGS. BIBASILAR PULMONARY\nNODULES ARE AGAIN APPRECIATED AND UNCHANGED.\n\nTHERE HAS BEEN NO CHANGE IN THE INFILTRATIVE SOFT TISSUE WITHIN THE SURGICAL\nBED, SURROUNDING THE PORTAL VEIN, CELIAC AXIS AND SMA. THERE IS OBLITERATION\nOF THE SMV. PORTAL VEINS REMAIN PATENT AS DO THE HEPATIC VEINS. EXPECTED\nBILIARY AIR STATUS POST WHIPPLE PROCEDURE. THERE IS SOME ENHANCEMENT\nSURROUNDING THE BILIARY DUCTS WITHIN THE POSTERIOR SEGMENT OF THE RIGHT LOBE,\nOF UNKNOWN SIGNIFICANCE. IN THE RIGHT CLINICAL SETTING, CHOLANGITIS WOULD HAVE\nA SIMILAR APPEARANCE. THERE IS OVERALL HETEROGENEITY AND ENHANCEMENT OF THE\nLIVER, THIS IS LIKELY VASCULAR IN ORIGIN AND NO DEFINITE MASSES ARE SEEN.\n\nTHE SPLEEN, ADRENAL GLANDS, KIDNEYS AND RESIDUAL PANCREAS APPEAR UNREMARKABLE\nAND UNCHANGED. PATIENT APPARENTLY HAS A GASTROJEJUNOSTOMY WHICH APPEARS\nPATENT, VISUALIZED LOOPS OF LARGE AND SMALL BOWEL DEMONSTRATE NO DEFINITE\nABNORMALITIES.\n\nCT OF THE PELVIS VISUALIZED LOOPS OF LARGE AND SMALL BOWEL SHOW NO DEFINITE\nABNORMALITIES, AND NO FREE FLUID, NO ADENOPATHY.\n\nBONE WINDOWS DEMONSTRATE AN ELEMENT OF OSTEOPENIA, NO SUSPICIOUS AREAS.", "output": "1. UNCHANGED APPEARANCE OF INFILTRATIVE SOFT TISSUE MASS WITHIN THE THE PORTAL\nAREA WITH ASSOCIATED ADENOPATHY AND OBLITERATION OF THE SUPERIOR MESENTERIC\nVEIN.\n2. EXPECTED BILIARY AIR AND MILD BILIARY DILATATION. SOME ___\nENHANCEMENT INVOLVING THE POSTERIOR SEGMENT OF THE RIGHT LOBE, OF UNKNOWN\nSIGNIFICANCE. IN THE RIGHT CLINICAL SETTING, CHOLANGITIS SHOULD BE CONSIDERED.\n3. REMAINDER OF THE EXAM ALSO APPEARS UNCHANGED INCLUDING BY A BASILAR\nPULMONARY NODULES. PLEASE REFER TO CHEST CT FOR FORMAL CHEST FINDINGS." }, { "input": "CT OF THE ABDOMEN: PLEASE SEE CHEST CT REPORT FOR FORMAL CHEST FINDINGS. \nSINCE THE PRIOR EXAM, THERE HAS BEEN PERCUTANEOUS DRAINAGE OF THE RIGHT LOBE\nOF THE LIVER WITH CATHETER IN APPROPRIATE POSITION. THERE ARE NO DEFINITE\nHEPATIC LESIONS TO SUGGEST METASTATIC DISEASE. SINCE THE PRIOR EXAM, THERE\nAPPEARS TO BE THROMBOSIS OF THE RIGHT ANTERIOR AND POSTERIOR PORTAL VEIN\nBRANCHES. THE LEFT PORTAL VEIN AND MAIN PORTAL VEIN REMAIN PATENT. THERE IS\nATTENUATION OF THE MAIN PORTAL VEIN JUST DISTAL TO THE CONFLUENCE OF THE SMV\nAND SPLENIC VEIN. THE SMV AND SPLENIC VEIN REMAIN PATENT. THERE IS MILD\nBILIARY DUCTAL DILATATION AND EXPECTED BILIARY AIR, UNCHANGED.\n\nTHERE REMAINS HETEROGENEOUS HYPO ENHANCING SOFT TISSUE CENTERED AROUND THE\nPANCREATIC RESECTION BED AND ROOT OF THE MESENTERY. THIS INVOLVES THE SMA AND\nSMV THOUGH BOTH REMAIN PATENT. THE ATTENUATION OF THE PORTAL VEIN DISCUSSED\nABOVE IS DUE TO THIS SOFT TISSUE. .\n\nTHE KIDNEYS, ADRENAL GLANDS, SPLEEN AND VISUALIZED LOOPS OF LARGE SMALL BOWEL\nAPPEAR UNREMARKABLE AND UNCHANGED. THERE IS A PERSISTENT GASTROHEPATIC NODE\n(SERIES 6, IMAGE 57. SLIGHTLY SMALLER THAN ON THE PRIOR EXAM. CURRENTLY THIS\nMEASURES 13.4 MM COMPARED TO 18 MM ON THE PRIOR STUDY.\n\nCT OF THE PELVIS: THE SMALL AMOUNT OF FLUID ADJACENT TO THE RIGHT LOBE OF THE\nLIVER IN THE RIGHT COLLOID GUTTER. VISUALIZED LOOPS OF LARGE AND SMALL BOWEL\nAPPEAR GROSSLY NORMAL. PROMINENCE OF THE LEFT GONADAL VEIN, LIKELY DUE TO\nBEING USED AS A COLLATERAL VESSEL.\n\nBONE WINDOWS DEMONSTRATE OSTEOPENIA AND MILD DEGENERATIVE CHANGES ONLY. NO\nSUSPICIOUS AREAS.", "output": "1. INTERVAL PLACEMENT OF A RIGHT PERCUTANEOUS BILIARY DRAIN WITH APPROPRIATE\nPOSITIONING.\n2. INTERVAL DEVELOPMENT OF THROMBUS INVOLVING THE RIGHT ANTERIOR AND POSTERIOR\nPORTAL VEIN BRANCHES, THE MAIN PORTAL VEIN REMAINS PATENT WITH AN AREA OF\nATTENUATION AS DESCRIBED ABOVE.\n3. ILL-DEFINED SOFT TISSUE AT THE BASE OF THE MESENTERY AND EXTENDING ABOUT\nTHE SMA, SMV AND CELIAC AXIS IS GROSSLY UNCHANGED.\n4. SLIGHTLY SMALLER GASTROHEPATIC ADENOPATHY .\n5. INTERVAL DEVELOPMENT OF A SMALL AMOUNT OF ASCITES WITHIN THE RIGHT COLLOID\nGUTTER" }, { "input": "LOWER CHEST: The included lung bases are clear. The heart is not enlarged and\nthere is no pericardial effusion.\n\nCT ABDOMEN WITH CONTRAST:\n\nHEPATOBILIARY: The liver enhances normally without focal lesions. There is no\nintra or extrahepatic biliary duct dilation. The gallbladder is normal without\nstones or wall thickening. The portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation without focal lesions, duct\ndilation or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation without focal lesions.\n\nADRENALS: Bilateral adrenal glands are normal in size and shape.\n\nURINARY: Both kidneys enhance and excrete contrast promptly and\nsymmetrically. There is mild fullness of the right renal pelvis. There is mild\nhydroureter on the right with an obstructing stone in the mid to distal ureter\nmeasuring 3 mm (2:62) and hyper-enhancement of the right ureter. No\nconvincing signs of pyelonephritis.\n\nGASTROINTESTINAL: The stomach, small and large bowel are normal in caliber\nwithout wall thickening or obstruction.\n\nRETROPERITONEUM: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVASCULAR: The abdominal aorta and iliac arteries are normal in caliber.\n\nThere is no free air or free fluid.\n\nCT PELVIS WITH CONTRAST: The urinary bladder and rectum are normal. There is\nno pelvic wall or inguinal lymphadenopathy and no free fluid.\n\nBONES AND SOFT TISSUES: There are no worrisome blastic or lytic lesions. The\nabdominal and pelvic wall is within normal limits.", "output": "3 mm obstructing stone in the right mid to distal ureter causing mild\nhydroureteronephrosis. Right urothelial enhancement in the setting of elevated\nwhite count is worrisome for superimposed infection. No discrete evidence of\npyelonephritis.\n\nClose clinical followup is recommended with consideration for percutaneous\nnephrostomy if ureteral obstruction is not relieved.\n\nNOTIFICATION: The updated findings were telephoned to Dr. ___ By Dr. ___\n___ at 11:20 pm, ___, 5 minutes after discovery." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN: Bilateral peripelvic cysts are again noted. In the interpolar region\nof the right kidney there is a 1.3 cm renal cyst. Otherwise, the kidneys are\nunremarkable.\nThe liver, spleen, pancreas, and adrenal glands are unremarkable.\n\nGASTROINTESTINAL: There is no intestinal obstruction or ascites.\n\nLYMPH NODES: There is redemonstration of soft tissue density in the\nretrocrural area at the level of the celiac trunk, largely unchanged and\nstable when compared to most recent study from ___.\nNo enlarged abdominal or pelvic lymph nodes are demonstrated.\n\nPELVIS: There is a trace amount of pelvic free fluid.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen.", "output": "Stable examination. No new adenopathy in the abdomen or pelvis." }, { "input": "LOWER THORAX: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation.\nUnremarkable gallbladder.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: Bilateral renal cortical cysts. No hydronephrosis. Unremarkable\nbladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are\nnormal in caliber. Normal appendix. Uncomplicated sigmoid diverticulosis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Mild retrocrural soft tissue density appears similar to prior. \nNo retroperitoneal or mesenteric adenopathy. No pelvic or inguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: No ascites.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic\ncalcification.\n\nBONES: Degenerative changes of the lumbar spine, worst at L5-S1 and L1-L2. No\nsuspicious osseous lesions.\n\nSOFT TISSUES: Unremarkable.", "output": "1. No abdominopelvic lymphadenopathy.\n2. Stable nonspecific retrocrural soft tissue density, possibly post\ntreatment." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Peripheral wedge-shaped hypodensity\nalong the falciform ligament is likely perfusional in nature. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\n\nRETROPERITONEUM: Multiple prominent mesenteric and retroperitoneal lymph nodes\nare noted, none of which are pathologically enlarged by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.\nAbdominal and pelvic wall is within normal limits.", "output": "No evidence for acute intra-abdominal process. Specifically, no inguinal\nhernia. Normal appendix." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Within the partially visualized\nbase of the heart, there are either coronary calcifications or stent within\nthe right coronary artery.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 2 mm obstructing left UVJ stone (series 2, image 80). \nThere is resultant mild left hydroureteronephrosis, in addition to a small\namount of left perinephric stranding, but no fluid collections. There are no\nother visualized renal stones bilaterally. Otherwise, the kidneys are\nslightly atrophic in appearance bilaterally. There is no evidence of focal\nrenal lesions within the limitations of an unenhanced scan.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Otherwise, the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Calcification along the anterior longitudinal ligament is seen within\nthe lower thoracic spine. Mild degenerative changes are seen within the lower\nlumbar spine. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "A 2 mm obstructing left UVJ stone with resultant mild left\nhydroureteronephrosis and a small amount of perinephric stranding." }, { "input": "LOWER CHEST: There is subsegmental dependent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: There is mild left hydroureteronephrosis, with periureteral\nstranding. A 3 mm stone is seen at the left ureterovesicular junction. No\ncalculi are identified within the kidneys bilaterally. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia and increased fat deposition\nat the esophageal hiatus. No free air, ascites or bowel obstruction.\n\nPELVIS: There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "3 mm bladder stone at the left ureterovesical junction with mild left\nhydroureteronephrosis." }, { "input": "LOWER CHEST: A 6 mm left lower lobe nodule is not significantly changed\ncompared with CT chest ___ (2:4). There is mild bibasilar\natelectasis. There is no evidence of pleural or pericardial effusion. \nPacemaker leads are partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout,\nsuggestive of hepatic steatosis. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a periampullary\nduodenal diverticula. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains coarse calcification. The seminal\nvesicles are normal. A penile implant is in place.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes in the lumbar spine are not significantly changed\nfrom prior. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. Diverticulosis, with no evidence of acute diverticulitis.\n3. A 6 mm left lower lobe nodule is not significantly changed compared with CT\nchest ___." }, { "input": "LOWER CHEST: There is a 6 mm left upper lobe pulmonary nodule, not\nsignificantly changed in size or appearance from previous study. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent with\nsurgical clips in the gallbladder fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Of note, kidneys do\nnot demonstrate excretion of contrast though a split bolus technique was\nemployed. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is re-demonstration of\na. Pillar duodenal diverticula. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. There is diffuse large\nbowel wall thickening and hyperemia most pronounced in the left colon,\ncompatible with colitis, infectious versus inflammatory. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine without evidence of\nworrisome osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Pancolitis.\n2. Lack of excretion of contrast from the kidneys warrants clinical attention\nand correlation with serum creatinine.\n3. Stable 6 mm left upper lobe pulmonary nodule.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:11 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a Lipiodol in hepatic segment VII and VI, post\ntransarterial chemoembolization for hepatocellular carcinoma, with focal\nuptake within the segment VII HCC. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is mildly enlarged, measuring 13.4 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. Duodenal diverticulum. The\nvisualized colon is unremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is focal ectasia of the infrarenal abdominal aorta, measuring\nup to 2.4 cm (3:36). There is heavy atherosclerotic calcification at the\norigins of the bilateral renal arteries. Note is made of a prominent\numbilical vein, with evidence of recanalization on the prior contrast-enhanced\nMRI.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Post-TACE Lipiodol deposition in hepatic segment VII and VI surrounding the\nHCC. No extrahepatic Lipiodol noted.\n2. Sequela of portal hypertension including splenomegaly and a recannulized\numbilical vein." }, { "input": "LOWER CHEST: Atelectatic changes are seen in the lung bases. Extensive\natherosclerotic calcifications are seen in the mitral annulus and aortic\nvalve. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Post TACE changes are seen in the hepatic segments 6 and 7 with\nsurrounding edema noted in the post procedural bed. The liver contour is\nnodular in keeping with known cirrhosis. The main portal vein appears patent.\nThere is moderate perihepatic ascites, which is new since the prior study in\n___, extends into the abdomen and pelvis. There is no definite\nrim enhancement to suggest abscess formation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions, measuring up to 14.3 cm in the AP dimension.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is collapsed. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Incidentally\nnoted is a duodenal diverticulum. The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nmoderate amount of free-fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Infrarenal abdominal aorta is ectatic measuring up to 2.4 cm in\ndiameter. Moderate atherosclerotic disease is noted. Multiple varices are\nnoted, including splenic, inferior epigastric, perigastric, paraesophageal,\nand patent umbilical vein. Nonocclusive filling defect noted within the right\nexternal iliac vein (2:70) and right common iliac vein (2:60).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are bilateral L5 pars defects with associated grade 1 spondylolisthesis\nof L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Post-TACE changes are seen in the liver segment 6 and 7 with surrounding\nedema and new moderate perihepatic ascites, extending into the abdomen and\npelvis. No definite rim enhancement to suggest abscess formation.\n2. Cirrhotic liver with stigmata of portal hypertension including varices.\n3. Nonocclusive filling defects suggesting thrombi within the right external\niliac and common iliac veins, age indeterminate.\n\nNOTIFICATION: The updated finding of impressions three was discussed with\n___, M.D. by ___, M.D. on the telephone on ___ at\n10:50 pm, 1 minutes after discussion of findings with attending radiologist." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural effusion. There is a small amount of loculated\npericardial fluid anteriorly, similar to prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post liver transplant. A CBD stent is\npresent and in stable position. There is pneumobilia in the left and right\nlobes, in keeping with stent patency. The liver is otherwise unremarkable\nwithin the limits of the unenhanced study aside from a small cyst in segment\n6. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are unremarkable within the limits of study technique. \nThere is no hydronephrosis and there are no intrarenal stones demonstrated.\n\nGASTROINTESTINAL: The bowel is grossly unremarkable aside from mild sigmoid\ndiverticulosis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable aside\nfrom prostate calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is mild ectasia of the infrarenal aorta measuring up to 2.2 cm\nin AP dimension. Moderate atherosclerotic disease is noted.\n\nBONES: There is a new mild anterior wedge compression fracture of L1 vertebral\nbody and superior endplate. No aggressive bone lesions are demonstrated.\n\nSOFT TISSUES: There is a small fat containing periumbilical hernia. There is\na stable appearance of greater omental postsurgical changes and/or infarct. A\n2.4 x 1.2 cm ovoid soft tissue density in the lateral right lower rectus\nsheath is noted at the site of a previous small fluid collection. This\nappears to be a small indirect inguinal hernia.", "output": "1. No evidence of CBD stent obstruction.\n2. No abdominal or pelvic lymphadenopathy.\n3. New mild L1 compression fracture with less than 25% height loss." }, { "input": "LOWER CHEST: Numerous masses are seen throughout both lung bases, including a\nconglomerate mass measuring 5.0 x 4.6 cm left lower lobe (9:1). Please refer\nto separate report of CT chest performed on the same day for description of\nthe thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: There are multiple homogeneous, hypoenhancing lesions\ndemonstrated throughout both hepatic lobes, not visualized on prior CT torso\nfrom ___ or PET-CT from ___. Dominant lesions include a 2.7 cm\nhypodensity in hepatic segment II (series 5: image 92), a 2.4 cm hypodensity\nin segment III (5:120) and a 2.8 cm hypodensity in segment V (65:2). There is\nthin hypervascularity around the periphery of the lesions, which follow a\nsimilar pattern of enhancement to the right lower lobe lesion, suspicious for\nmetastases from with the known carcinoma primary. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral millimetric cortical hypodensities which are too small to\ncharacterize by CT. A 1.8 cm isoenhancing cyst within the cortex of the left\nkidney is unchanged from ___. There is no evidence of suspicious focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Sigmoid\ndiverticula without inflammation are noted, otherwise the colon and rectum are\nwithin normal limits. The appendix is normal. There are hemorrhoids present.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. A calcification within the uterus is likely from a calcified fibroid.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Incidental note is made of a circa-aortic left renal vein.\n\nBONES: A sclerotic focus along the right iliac bone is stable since at least\n___. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Likely\ninjection granulomas are present in the right buttock.", "output": "1. Multiple hypovascular lesions within both hepatic lobes which are new from\nprior studies and demonstrate a similar enhancement pattern to the known\ntumors in the lung. Findings are consistent with new hepatic metastatic\ndisease.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 14:08 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "Chest is reported separately.\n\nMultiple hepatic metastases are again visible. The largest lesion is again\nlocated in in the fifth segment and appears unchanged, measuring up to 53 x 34\nmm in axial ___ (12:17, as remeasured today and directly compared using\nboth studies in the delayed phase, in which there of most comparable). Second\nlargest lesion, centered in the left lateral segments, measures up to 41 x 34\nmm in axial ___ (as measured on 05:43, again measured on delayed phase\nimaging), not significantly changed. Due to ill-defined margins, a number of\nthe other liver lesions are difficult to assess for very small changes but no\ndefinite changes found. Peripelvic cysts again noted in the central right\nKidney.\n\nThere is no biliary dilatation. The gall bladder has been resected. Pancreas\nappears normal. Spleen is normal in size and appearance. Adrenals appear\nnormal. Small posterior left renal cortical defect is likely due to remote\nprior infection.\n\nThere is a very small paraesophageal hiatal hernia. Small bowel is\nunremarkable. There is mild sigmoid diverticulosis.\n\nSmall dystrophic calcifications unchanged in the uterus. Adnexa appear\nnormal. Bladder is unremarkable. Major vascular structures appear widely\npatent. Atherosclerotic changes are mild. No lymphadenopathy or free fluid.\n\nSclerotic foci in the pelvis unchanged.", "output": "No definite short-term change in hepatic metastatic disease." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is no calcium burden in the\nabdominal aorta and great abdominal arteries. The celiac axis, common hepatic\nartery, and proximal splenic artery are patent. There is thrombosis of the\ndistal splenic artery the hilum (02:40; 602:104). There is a small amount of\ncalcification along the distal splenic artery wall without focal aneurysm. The\nSMA and ___ are patent. There are single renal arteries bilaterally. The\nportal vein, splenic vein, and SMV are patent. Incidental note is made of a\nretroaortic left renal vein.\n\nLOWER CHEST: Minimal atelectasis is noted at the left lung base. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout,\nwhich may suggest hepatic steatosis. There is no evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is contains stones, without evidence of gallbladder wall\nthickening or pericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is borderline enlarged up to 13 cm, stable. Again seen is\nan area of splenic hypo/non enhancement consistent with infarct.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. There\nis no evidence of mesenteric lymphadenopathy. The appendix is not seen.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits for patient's age. \nThere is a corpus luteal cyst in the right ovary. No suspicious adnexal\nlesions.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A tiny umbilical hernia containing fat is noted.", "output": "1. Thrombosis of the distal splenic artery at the hilum, with redemonstration\nof splenic infarct. There is a small amount of calcification along the distal\nsplenic artery wall without focal aneurysm.\n2. Cholelithiasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter cortical hypodensity in the right kidney is too small to\ncharacterize, however likely represents a simple cyst. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\nextensive diverticula in the descending and sigmoid colon. There is a segment\nof sigmoid colon spanning approximately 5 cm which demonstrates wall\nthickening with surrounding fat stranding (2:61, 601b:38). There is no\nextraluminal air or fluid collection. The appendix is normal (601b:35).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus contains a small fibroid, and bilateral\nadnexae are within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Posterior spinal fusion hardware is partially visualized. \nPostoperative changes in the left iliac bone are seen. There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute uncomplicated sigmoid diverticulitis. Colonoscopy is recommended after\ntreatment if not already performed to exclude an underlying colonic mass.\n\nRECOMMENDATION(S): Recommend colonoscopy after treatment of diverticulitis if\nnot already performed." }, { "input": "CHEST:\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury based on an unenhanced scan. The heart, pericardium,\nand great vessels are within normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is\npresent. No mediastinal mass or hematoma.\n\nPLEURAL SPACES: Small right pleural effusion. No pneumothorax.\n\nLUNGS/AIRWAYS: There is atelectasis of the bilateral lung bases with punctate\ncalcifications, right greater than left, similar to prior exam and likely\nreflecting the sequelae of chronic aspiration. Patient is intubated. The\nairways are otherwise patent to the segmental level.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration within the limitation of an\nunenhanced scan.There is no perihepatic free fluid. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is atrophic. No focal pancreatic lesions are\nidentified. No pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration within the limitation of an unenhanced\nscan.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Previously seen\nright-sided staghorn calculus is no longer visualized. Residual punctate\nnonobstructing right renal pelvic stones measure up to 7 mm. There is mild\nprominence and wall thickening of the right renal pelvis and proximal ureter\nwhich is felt to be chronic in nature. There is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube is seen terminating within the stomach. \nSmall bowel loops demonstrate normal caliber. Diverticulosis of the ascending\ncolon is noted without evidence of diverticulitis. A rectal catheter is\npartially visualized.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder is under distended with Foley catheter in place. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized uterus is unremarkable. No adnexal\nabnormalities are identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: Redemonstration of bilateral hip dysplasia, similar to prior exam. \nPosterior spinal fusion hardware is seen spanning the thoracolumbar spine. No\nevidence of hardware related complications.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Punctate nonobstructing right renal pelvic stones measure up to 7 mm and is\nassociated with chronic wall thickening of the right renal pelvis and proximal\nureter.\n2. Small right pleural effusion.\n3. Diverticulosis of the ascending colon without evidence of diverticulitis." }, { "input": "LOWER CHEST: There is emphysema at the lung bases. No pleural or pericardial\neffusion seen.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 6 mm hypodensity in the right lobe (02:23) which\nmay represent a cyst or hamartoma. Otherwise liver enhances normally. There\nis mild intrahepatic and extrahepatic biliary dilatation, within expected\nlimits status post cholecystectomy. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of suspicious renal lesions or hydronephrosis. 1.2 cm\nhypodensity in the left kidney is similar to prior. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass. Oral\ncontrast is seen in the excluded stomach, suggestive of gastro-gastric\nfistula. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is soft tissue stranding in the subcutaneous tissues at\nthe surgical incision, within expected limits.", "output": "1. No evidence of bowel obstruction or internal hernia. No fluid collection.\n2. Oral contrast is seen in the excluded stomach, suggestive of gastro-gastric\nfistula.\n\nNOTIFICATION: The findings were discussed with the surgery team by Dr. ___\nin person on ___ at approximately 23:10, at the time of discovery." }, { "input": "LOWER CHEST: Please see separate report for intrathoracic findings from\nsame-day CT chest.\n\nABDOMEN:\n\nHEPATOBILIARY: Compared to ___, there is a new 4.7 x 3.8 x 4.8 cm\nhypodense lesion with peripheral enhancement and both superior and inferior\nsatellite lesions (___). There is a 2.7 x 1.5 x 2.2 cm lesion in segment 8\n(___). All are concerning for metastasis. There is a subcentimeter\nhypodensity in segment 6 (___), too small to characterize. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is a 0.7 cm hypodense lesion in the posterior aspect,\nconcerning for metastasis. Otherwise, spleen shows normal size and attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are few bilateral subcentimeter hypodensities, too small to\ncharacterize. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient is\nstatus post proctosigmoidectomy. No evidence of local recurrence. The\nappendix is not visualized, however, there are no secondary signs to suggest\nappendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Compared to ___, there are multiple new hypodense lesions with\nperipheral enhancement in segment 8 and segment 7 of the liver. These are\nconcerning for metastases.\n2. There is a 0.7 cm hypodense lesion in the posterior spleen, concerning for\nmetastasis.\n3. No evidence of local recurrence. No lymphadenopathy.\n4. Please see separate report for intrathoracic findings from same-day CT\nchest." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHypodense lesion within the peripheral segment 4A/4B of the liver measures 4.0\nx 3.2 cm, previously 4.7 x 3.8 cm (05:58). Additional hypoenhancing lesion in\nsegment 8 also appears smaller compared to prior exam measuring 0.9 x 1.8 cm,\npreviously 1.5 x 2.7 cm (05:58). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. And a 8 mm\nhypodensity in the posterior peripheral aspect of the spleen appears stable\ncompared to prior exam.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Status post\nproctosigmoidectomy. The anastomosis site appears widely patent. There is no\nevidence of local recurrence. The ascending and transverse colon walls appear\nthickened and hypervascular, concerning for colitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in size of multiple hepatic lesions likely representing\nmetastases.\n2. Stable appearance of 8 mm hypodensity in the spleen also concerning for\nmetastasis.\n3. Thickening and hypervascularity of the ascending and transverse colon\nconcerning for colitis.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is fatty with regions of sparing noted. Hepatic\nmetastatic lesions are stable to minimally improved. For example, the\nlargest, left hepatic lesion, previously measuring 3.8 cm now measures 3.5 cm\n(4:61). Another left lesion measures 1.5 cm, is stable. (4:55). The right\nhepatic lesion measures 1.5 cm (4:60), also stable. There is mild dilatation\nof the common bile duct, likely related to post cholecystectomy.\n\nPANCREAS: The pancreas is unremarkable. There is no peripancreatic stranding.\n\nSPLEEN: Again seen is a 8 mm hypoattenuating lesion in the posterior spleen\n(4:61), stable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are unremarkable. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post proctosigmoidectomy with stable\nappearance of postsurgical changes, including presacral thickening and a\nstable 5 mm presacral nodule (4:116). There is improved hyperenhancement of\nthe colonic wall, now predominantly seen in the ascending colon, suggestive of\npersistent colitis. The appendix is normal.\n\nPELVIS: The uterus and bilateral adnexae are unremarkable.\n\nLYMPH NODES: There is no abdominal, pelvic, or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable disease except for minimal decrease of one hepatic metastasis.\n2. Improved but persistent, now mild ascending colitis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: There is low-attenuation of the liver, compatible with hepatic\nsteatosis. There are multiple hypoattenuating enhancing lesions in the liver\ncompatible with known metastatic disease. A dominant lesion in the hepatic\nsegment 4 measures approximately 3.8 x 2.7 cm, which is similar to the prior\nexam in ___, previously measuring up to 3.7 cm. A second hypodense\nlesion is seen in segment 8 of the liver measuring 1.5 x 0.8 cm, previously\nmeasuring up to 1.6 cm, also unchanged. There is stable appearance of a 0.5\ncm segment 7 lesion compared to the prior study. No new hepatic lesions are\nidentified. There is patulous appearance of the common bile duct, measuring up\nto 1.2 cm. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Again seen is a 0.8 cm hypoattenuating lesion in the posterior spleen,\nunchanged. The spleen is enlarged, measuring 14 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost proctectomy with coloanal anastomoses seen in the deep pelvis. There is\npersistence presacral thickening with stable appearance of a presacral lymph\nnode measuring up to 5 mm (series 2: Image 116). The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. The uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Expected appearance post proctectomy with coloanal anastomosis without\nevidence of local recurrence.\n2. Stable appearance of hepatic metastases compared to ___. No new\nmetastatic lesions identified." }, { "input": "ABDOMEN:\n\nHEPATOBILIARY: The largest hepatic metastasis has increased in size, now\nmeasuring 4.5 x 3.4 x 5.2 cm, previously measuring 3.7 x 2.8 x 3.4 cm (series\n2, image 54). An additional hepatic metastasis within the right lobe of the\nliver has also slightly increased in size (series 2, image 51). No new\nhepatic lesions are visualized. There is no evidence of intrahepatic biliary\ndilatation. Patient is status post cholecystectomy. Prominence of the common\nbile duct is likely due to post cholecystectomy state.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: An 8 mm splenic hypodensity is stable. No new focal splenic lesions. \nThe spleen is nonenlarged. A tiny accessory spleen is seen at the hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient is\nstatus post proctectomy with ___ anastomosis, which is unchanged in\nappearance. The proximal colon is within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is normal in appearance. No adnexal masses. \nThere is a moderate amount of air within the vagina, similar compared to\nprior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is a focal narrowing at the origin of the celiac artery with\npoststenotic dilatation (series 602, image 47), findings which can be seen\nwith median arcuate ligament syndrome.\n\nBONES: A sclerotic lesion within the left sacrum is unchanged compared to\nprior, likely representing a bone island. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. increased size of the previously visualized hepatic metastases, currently\nmeasuring up to 5.2 cm, previously measuring up to 3.7 cm.\n2. No new foci of metastatic disease within the abdomen or pelvis.\n3. Focal narrowing at the origin of the celiac artery with poststenotic\ndilatation, findings which can be seen with median arcuate ligament syndrome.\n4. Please refer to the concurrent chest CT for evaluation of the intrathoracic\nstructures." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Known hepatic metastases are overall similar in size. The\nlargest metastasis in segment 4A now measures 4.6 x 3.5 x 4.9 cm, previously\n4.5 x 3.4 x 5.2 cm (series 5, image 60; series 8, image 9); a separate or\nconfluent lesion just superior and anterior to this dominant lesion is also\nunchanged measuring 2.7 x 2.4 x 2 cm (series 5, image 54; series 8, image\n11).. A 2.3 x 1.2 x 2.1 cm metastasis in segment 8 previously measured 2.2 x\n1 x 2 cm (series 5, image 60; series 8, image 11).\n\nNo evidence of intrahepaticic biliary dilatation. The gallbladder is\nsurgically absent. Mild ectasia of the extrahepatic common bile duct is\nlikely secondary to postcholecystectomy status.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size. A 9-mm hypodensity in the posterior\naspect of the spleen is minimally changed, previously 8 mm (Series 5, image\n61).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient has\nhad prior proctectomy with a ___ anastomosis, similar in appearance.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits. No adnexal masses.\n\nLYMPH NODES: A 9-mm lymph node near the diaphragmatic hiatus appears grossly\nsimilar compared to the prior exam (series 5, image 63). No retroperitoneal,\npelvic sidewall, or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm however focal short segment narrowing\nof the proximal celiac artery is unchanged. Calcified atherosclerotic disease\nis minimal.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. 7 mm\nsclerotic lesion left sacrum is unchanged (series 8, image 35).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No substantial interval change in overall disease burden in abdomen or pelvis" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThere is once again diffuse decreased attenuation of the liver parenchyma in\nkeeping with hepatic steatosis. Multiple liver metastases are again noted:\nLargest metastatic lesion in segment 4 (series 2, image 59) measures 3.1 x 5 x\n4.8 cm, previously 3.6 x 4.6 x 5.6 cm\nMetastatic lesion in periphery of segment ___ (series 2, image 59) measures 2\ncm, previously 2.3 cm.\nNo new liver lesion seen.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size. 9 mm metastatic lesion in the upper\npole of spleen is unchanged. There is no new splenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost proctectomy and ___ anastomosis. The anastomosis appears intact. \nBowel anastomosis in the right lower quadrant is unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. 7\nmm sclerotic lesion in the left sacrum is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Slight interval decrease in size of hepatic metastases.\n2. Known splenic lesion is unchanged.\n3. No evidence of local disease recurrence or new metastatic disease in the\nabdomen pelvis." }, { "input": "LOWER CHEST: Multiple nodules measuring up to 0.8 cm are seen in the bilateral\nlung bases. Please refer to separate report of CT chest performed on the same\nday for a detailed description of the thoracic findings.\n\nABDOMEN:\n\nLIVER: The liver demonstrates homogenous attenuation. Three heterogeneously\nhypoattenuating masses in the liver are bigger, as follows:.\n\n1. 5.3 x 3.9 cm mass in segment IV (04:56), previously 5.0 x 2.8 cm\n2. 2.7 x 1.7 cm mass in segment VIII (04:56), previously 1.9 x 1.1 cm\n3. 0.9 cm mass in segment VIII, near the liver dome (04:53), previously 0.5\ncm.\nNo new focal masses are identified. The portal and hepatic veins are patent. \nNo ascites.\n\nBILIARY: There is no evidence of intrahepatic biliary dilatation. Prominence\nof the CBD up to 8 mm in diameter likely reflects sequela of prior\ncholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is borderline in size at 13.7 cm. A 1.1 cm hypoattenuating\nlesion in the posteromedial aspect (04:57) is unchanged from ___, but\nis new from earlier priors, and most likely represents a site of metastatic\ndisease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA duplex left kidney is again demonstrated, with convergence of the two\nureters noted in the left pelvis (12:107). There is no evidence of focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.\n\nPatient is post proctosigmoidectomy and reversal of loop ileostomy. \nAnastomosis sutures are seen in the low pelvis (04:121). There is no evidence\nof local recurrence. The remaining colon and rectum are within normal limits.\nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: An 8 mm gastrohepatic node (4:60) is similar, previously 8 mm. \nMultiple prominent mesenteric lymph nodes are mildly bigger. For example, a\nnode measuring 6 mm in the short axis in the left mid abdomen (07:18)\npreviously measured 4 mm. There is no evidence of retroperitoneal, pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Small sclerotic foci in the bilateral iliac bones (4:108) and left\nsacrum (4:94) are unchanged going back to ___. No new worrisome osseous\nlesions are seen. There is no acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Enlarging hepatic metastases and mesenteric lymph nodes. No new liver\nlesion identified. Stable size of splenic lesion.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. 2.5\ncm hypodensity in segment VIII is consistent with a hepatic cyst and remains\nstable. No other focal liver lesions identified within the limitations of\nthis unenhanced study. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is slightly atrophic. Previously seen renal cysts\nare suboptimally assessed on this unenhanced study. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS:\nThe uterus is within normal limits for patient's age.\nThere is an oblong hypodense lesion in the region of the right adnexa\nmeasuring 3 x 5.8 cm (series 3, image 96) which demonstrates fluid\nattenuation.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of lymphadenopathy in the abdomen and pelvis.\n2. Oblong lesion in the region of the right adnexa measuring up to 5.8 cm\ndemonstrating fluid attenuation may represent an adnexal cyst or right\nhydrosalpinx. Correlation with pelvic ultrasound is recommended." }, { "input": "LOWER CHEST: Other than very minimal bibasilar atelectasis, the partially\nvisualized lower lungs are clear. No pleural or pericardial effusion. The\nheart size appears normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver parenchyma is homogeneous in attenuation throughout.\nNo focal hepatic lesion. No intrahepatic or extrahepatic biliary dilatation. \nThe gallbladder is not abnormally distended and appears within normal limits.\nNo radiopaque gallstones, gallbladder wall thickening, or pericholecystic\nfluid collection. No ascites. The main portal vein appears patent.\n\nPANCREAS: The pancreas is normal attenuation throughout. No focal pancreatic\nlesion, pancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout. No focal\nsplenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and symmetric with normal\nnephrograms. There is slight prominence of the right renal pelvis with a\npossible minimally full appearance of the right collecting system, however the\nureter is normal in caliber, and no obstructing lesion or stone is identified.\nThe left renal pelvis and collecting system are unremarkable. No concerning\nfocal renal lesion. No perinephric abnormality. The urinary bladder is\nmoderately distended and unremarkable. Urinary jets are demonstrated\nbilaterally.\n\nGASTROINTESTINAL: The stomach is non-distended. Small bowel loops are normal\nin caliber, wall thickness, and enhancement throughout. The colon and rectum\nare within normal limits. The appendix is not visualized, but no secondary\nsigns of appendicitis are noted. There is a small amount of non-specific\nlow-intermediate density free fluid bilaterally (e.g., Series 604b, Image 18).\nNo bowel obstruction or intra-abdominal free air.\n\nRETROPERITONEUM: No retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm or atherosclerosis.\n\nPELVIS: No pelvic or inguinal lymphadenopathy. Follicular activity is noted\nin the right ovary. The left ovary is unremarkable. The uterus is also\nunremarkable.\n\nBONES AND SOFT TISSUES: There is no suspicious lytic or sclerotic bony lesion.\nAlignment of the visualized spine is normal. No significant degenerative\nchanges are noted in the lumbosacral spine. The abdominal and pelvic walls are\nwithin normal limits.", "output": "1. No nephrolithiasis or ureteral stone. Slight prominence of the right renal\npelvis with possible minimal fullness of the collecting system is\nnon-specific. Normal caliber ureter and no evidence of a distal obstructing\nprocess.\n\n2. The appendix is not seen, but no secondary signs of appendicitis are\npresent.\n\n3. Right ovarian follicular activity and a small amount of bilateral\nlow-intermediate density free fluid is non-specific but may suggest a recently\nruptured ovarian cyst." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is re- demonstration of a hypo attenuating lesion in\nsegment 8 of the liver (image 2:51). It measures 2.6 x 2.3 cm and is\nunchanged compared to previous. The remainder of the hepatic parenchyma is\nunremarkable without evidence of new focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is mild splenomegaly, measuring 13.7 cm, stable in size compared\nto previous.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Bilateral fat containing inguinal hernias are again\nseen.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged, unchanged compared to previous.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Fact containing umbilical hernia is again seen.", "output": "1. Stable 2.6 cm hypo attenuating lesion in the right lobe of the liver. The\nremainder of the abdomen and pelvis is unchanged.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the intrathoracic findings." }, { "input": "LOWER CHEST: Please refer to the separately dictated CT of the chest for\ndetailed evaluation of the chest findings.\n\nHEPATOBILIARY: There is re-demonstrated right hepatic lobe 2.2 cm\nhypoenhancing well-circumscribed lesion with a thin rim of calcifications\nalong its posterior wall, consistent with a minimally complicated hepatic\ncyst. Remainder of the liver appears unremarkable with no new suspicious\nmasses. Portal vein and hepatic veins are patent. There is no biliary ductal\ndilatation. Status post cholecystectomy.\n\nPANCREAS: Diffuse fatty infiltration of the pancreas with no suspicious\nmasses.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY:No hydronephrosis, nephrolithiasis or suspicious masses.\n\nGASTROINTESTINAL: Somewhat bulbous distal esophagus appears unchanged. \nStomach is unremarkable. There is no small bowel obstruction. Scattered\ncolonic diverticulosis without diverticulitis.\n\nPERITONEUM: There is no free air or free fluid. There is no peritoneal\nstranding.\n\nLYMPH NODES: There is no abdominopelvic adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber. There is moderate\natherosclerotic calcifications.\n\nPELVIS: Urinary bladder is under distended. Prostate is enlarged measuring\n5.5 cm. Rectum is unremarkable.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions.\n\nSOFT TISSUES: There are bilateral fat containing indirect inguinal hernia and\nmultiple fat containing anterior abdominal wall hernias.", "output": "1. Stable right hepatic lobe minimally complicated cyst.\n2. Evaluation is otherwise unremarkable with incidental findings as detailed\nabove.\n3. No abdominopelvic adenopathy." }, { "input": "LOWER CHEST: A rounded density in the left lung base corresponds to the\nfinding on the concurrently obtained chest radiograph. There is hazy\nground-glass attenuation surrounding the consolidation. There is no pleural\nor pericardial effusion. Coronary arterial calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. Other than mild perinephric\nedema, there is no significant perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the colon is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnot visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes are present throughout the lumbar\nspine. No focal lesion worrisome for malignancy or infection is identified.\n\nSOFT TISSUES: Right lower anterior abdominal wall hernia repair is again\nnoted.", "output": "1. Rounded left lung base consolidation is compatible with atypical or fungal\npneumonia. Agree with previous recommendation for imaging follow-up to ensure\nresolution.\n2. Coronary atherosclerosis.\n3. Cholelithiasis.\n4. No evidence of hydronephrosis or nephroureterolithiasis.\n5. Diverticulosis." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: There is diffuse hepatic steatosis. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The splenic vein is chronically occluded with a prominent mesenteric\ncollateral extending from the splenic hilum to the superior mesenteric vein,\nunchanged. There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits with the\nexception of a small fat containing umbilical hernia..", "output": "1. No acute findings to explain the patient's abdominal pain.\n2. Hepatic steatosis.\n3. Chronically occluded splenic vein with a collateral arising from the\nsplenic hilum and emptying into the superior mesenteric vein." }, { "input": "Lung bases are clear.\nNo pericardial or pleural effusion.\n\nRedemonstrated are numerous large hypodense hepatic lesions, within the\nlimitations of a study with no IV contrast infusion there is no gross change. \nThe larger lesion is in the left lobe, approximately 8 cm.\nThere is no evidence of intra or extra hepatic biliary dilatation.\nGallbladder is not distended and there are no other signs of cholecystitis.\n\nPancreas, spleen and adrenals are unremarkable.\nThere is no hydronephrosis and no evidence of nephrolithiasis.\nUreters are not dilated.\nBladder is partially collapsed, unremarkable.\n\nThere is no evidence of pneumoperitoneum\nThe stomach is unremarkable, no evidence of bowel dilatation or obstruction.\nThe appendix is not visualized, however no secondary signs of appendicitis are\nseen and there is no evidence of free fluid in the abdomen or pelvis.\nNo evidence of abdominal, pelvic or inguinal lymphadenopathy.\nThere are no concerning focal lytic or sclerotic osseous lesions.\nA left parasacral soft tissue mass is unchanged, measuring approximately 4 x\n3.5 cm (03:57).", "output": "No evidence of pneumoperitoneum or other acute finding.\nExtensive metastatic involvement of the liver is unchanged with no new ascites\nor clear biliary dilatation." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: Again seen are innumerable hypodense lesions with central areas\nof necrosis, which are enlarged since the prior study in ___ and\nmore confluent on today's study, compatible with worsening metastasis. For\nexample, there is a dominant left hepatic lobe lesion measuring 8.9 x 7.2 cm,\npreviously 7.6 x 6.3 cm in ___. The gallbladder is within normal\nlimits. There is mild intrahepatic biliary dilatation without evidence of\nextrahepatic biliary dilatation, similar to prior study. A few enlarged\nportal hepatis lymph nodes are again seen, measuring up to 1.8 cm (02:27) and\ncausing some attenuation of the portal-splenic confluence. The main portal\nvein is patent. There is severe attenuation of the right, middle, and left\nhepatic veins.\n\nPANCREAS: The pancreas body and tail appears atrophic, unchanged. There is no\npancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: 2 cm mass with central hypoenhancement and peripheral hyperenhancement\nis seen along the left anterior aspect of the anorectal junction, not\nsignificantly changed. The urinary bladder and distal ureters are\nunremarkable. There is no free fluid in the pelvis. The fibroid uterus is\nredemonstrated. No definite adnexal abnormality.\n\nLYMPH NODES: Porta hepatis lymph nodes are similar to the prior study, as\ndescribed above. There is mild interval enlargement of previously seen\npara-aortic and retrocaval lymph nodes, measuring 0.9 cm and 0.9 cm\nrespectively. There is no mesenteric lymphadenopathy. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. There is a nutcracker phenomenon with narrowed appearance of the\nleft renal vein (02:26) and gonadal vein prominence bilaterally, leading to\ndilated bilateral hemipelvic varices, right greater than left.\n\nBONES: There is enlargement of a known presacral soft tissue mass, now\nmeasuring up to 4.4 cm, previously 4.1 cm in ___ (2:61) with\nextension to into the left S1 and S2 neural foramina and involvement of the\nsacrum; the latter is not well seen on this study.\n\nSOFT TISSUES: Multiple rounded soft tissue lesions seen along the anterior\nabdominal wall, R likely injection foci. Additionally, there is a small rim\nenhancing fluid collection along the left lower abdominal wall measuring 2.0 x\n1.3 cm, possibly a small abscess but also all possibly inflammation around\nhemorrhage related to an injection site.\n\nPostsurgical changes are seen along the anterior abdominal wall, with mesh\nfrom a hernia repair. Small rim enhancing 2.7 cm fluid collection (602:41) is\nseen deep to the anterior left lower abdominal wall mesh, which is new since\nthe prior exam in ___, and concerning for an abscess.", "output": "1. Worsening hepatic metastasis with innumerable hypoattenuating lesions with\ncentral necrosis which appear enlarged more confluent compared to the prior\nstudy in ___. 2 cm mass at the left anorectal junction is\nunchanged.\n2. Similarly, there is enlargement of a known 4.4 cm presacral soft tissue\nmass, previously 4.1 cm in ___\n3. 2.7 cm fluid collection is seen deep to the mesh along the left anterior\nabdominal wall, also new since ___ and concerning for small abscess.\n4. 2.0 cm fluid collection in the subcutaneous fat of the left lower anterior\nabdominal wall, could represent a small abscess or inflammatory reaction\naround a hematoma from prior injection.\n5. Stable mild central intrahepatic biliary dilatation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:11 pm, 20 minutes after\ndiscussion with attending radiologist." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are innumerable hypoattenuating masses replacing the\nmajority of the liver, compatible with metastatic disease. Overall, the size\nand distribution of these masses is similar compared to the CT dated ___. However, these masses demonstrate increasing central\nhypodensity, compatible with necrosis. There is mild central intrahepatic\nbiliary dilatation. There is no extrahepatic biliary dilatation. The\ngallbladder is not visualized.\n\nPANCREAS: The pancreatic body and tail are severely atrophic. The pancreatic\nhead and neck are unremarkable in appearance. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Known rectal mass is difficult to accurately measure, but\nappears unchanged compared to prior measuring approximately 2.3 x 1.9 cm\n(series 2, image 76). The stomach is unremarkable. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon is within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 2.1 x 1.8 cm hyperenhancing mass within the\nfundus of the uterus, likely a fibroid (series 601, image 30). No adnexal\nmasses are visualized.\n\nLYMPH NODES: There is extensive porta hepatis all lymphadenopathy. The\nlargest lymph node measures approximately 2.9 x 2.5 cm (series 2, image 25),\nunchanged compared to prior. There is mass effect on the adjacent main portal\nvein, but no evidence of occlusion. There also small retroperitoneal lymph\nnodes which are unchanged compared to the prior examination. For example, a\nretroperitoneal lymph node adjacent to superior pole of the right kidney\nmeasures 11 mm in short axis (series 2, image 27), unchanged. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The patient is status post abdominal hernia repair with mesh. \nAgain, there is a rim enhancing fluid collection deep to the left lateral\nborder of the mesh, which measures 2.3 x 1.4 cm, mildly decreased in size\ncompared to the prior examination (series 2, image 38). An additional focal\nfluid collection within the anterior abdominal wall on the left has also\ndecreased in size, now measuring up to 15 mm (series 2, image 48). Remaining\nstranding and nodularity within the anterior abdominal wall is likely due to\ninjections.", "output": "1. Known rectal mass is unchanged in size measuring up to 2.3 cm. Innumerable\nmetastatic lesions replacing the majority of the liver, some of which appear\nnecrotic, overall unchanged compared to prior. Porta hepatis and\nretroperitoneal lymphadenopathy is also stable.\n2. Status post abdominal hernia repair with mesh with a rim enhancing fluid\ncollection deep to the lateral border of the mesh, decreased in size compared\nto prior, now measuring up to 2.3 cm. Additional focal fluid collection\nwithin the left anterior abdominal wall has also decreased in size. No new\nfocal fluid collections.\n3. 2.1 cm hyperenhancing focus within the fundus of the uterus, likely a\nfibroid." }, { "input": "LOWER CHEST: Central venous catheter is seen terminating in the low SVC. \nSolid nodule within the right middle lobe is unchanged (series 2, image 1). \nNo focal consolidations. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Innumerable hepatic metastases are visualized, some of which\nappear centrally necrotic, grossly unchanged compared to the prior\nexamination. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreatic body and tail are severely atrophic. The pancreatic\nhead is unremarkable in appearance without focal lesions or ductal dilatation.\nNo peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Known rectal mass appears unchanged in size measuring 2.7 x\n2.4 cm in maximum axial ___ (series 2, image 85). The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Extensive fecal loading within the right colon. \nOtherwise, the colon is within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus is re-demonstrated. No adnexal masses.\n\nLYMPH NODES: There is extensive lymphadenopathy within the porta hepatis,\noverall unchanged in size and bulk compared to prior. Small pelvic and\ninguinal lymph nodes are unchanged, for example series 2, image 65.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stranding and nodularity within the anterior abdominal wall is\nlikely due to injections. The abdominal and pelvic wall is within normal\nlimits.", "output": "1. No acute abnormalities within the abdomen or pelvis.\n2. Unchanged known rectal mass with extensive metastatic disease.\n3. Large stool burden, slightly worse compared to prior." }, { "input": "LOWER CHEST: Bibasilar atelectasis is mild. Linear scarring and/or\natelectasis in the left lower lung is demonstrated. No evidence of a pleural\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There are small accessory spleens at the hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: Ingested enteric contrast reaches the distal small bowel. \nThe stomach is distended with ingested contrast. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\nascending and transverse colon are within normal limits. The descending and\nsigmoid colon are relatively decompressed. However, the wall appears\nedematous with mucosal hyperemia and mild fat stranding and prominence of the\nVasa recta suggesting colitis. Similarly, the rectum walled demonstrates mild\nthickening and mucosal hyperemia compatible with proctitis. Multiple\nprominent lymph nodes in the mesocolon and the mesorectum in pelvis and\nbilateral lower abdomen could be reactive. No free air or intra-abdominal\norganized fluid collections.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: As above, scattered retroperitoneal and mesenteric lymph nodes\nare prominent. In the pelvis, lymph nodes in the left measure up to 14 mm in\nshort axis (series 2, image 69). No inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No significant calcified\natherosclerotic disease is noted.\n\nBONES: No osseous lesions concerning for malignancy or infection. \nDegenerative changes in the lower thoracic spine are minimal. Degenerative\nchanges in the bilateral sacroiliac joints are mild. Hypodense sub-centimeter\nlesion in L3 vertebral body may be a small intraosseous hemangioma.\n\nSOFT TISSUES: A fat containing periumbilical hernia is tiny.", "output": "1. Proctocolitis involving the descending colon, sigmoid, and rectum. No\norganized or drainable fluid collections.\n2. Multiple pelvic, retroperitoneal, and mesenteric lymph nodes measuring up\nto 14 mm, nonspecific but could be reactive.\n3. No small bowel obstruction. Limited assessment for fistula, but none seen." }, { "input": "LOWER CHEST: Mild atelectasis at the left base. There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. However, there is new nonocclusive\nthrombus seen in the distal main portal vein and extending into the right\nanterior and left portal vein branches. The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is moderate small-bowel dilatation up to the level of\nthe right lower quadrant ileostomy. There is no parastomal hernia. Interval\nsubtotal colectomy was performed. There is hyperemia and fluid within the\nremaining portion of the ___ pouch.\n\nPELVIS: There is small volume free fluid in the pelvis. The uterus and adnexa\nare unremarkable on CT for age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Right lower quadrant ileostomy as above.", "output": "1. Small-bowel obstruction with transition point at the right lower quadrant\nileostomy. No free air. Small amount of ascites.\n2. New nonocclusive thrombus in the distal main portal vein extending into the\nright anterior and left portal vein branches.\n3. Hyperemia and fluid within the remaining portion of the rectum reflecting\nulcerative colitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The patient is status post\ntotal colectomy and ileostomy, with completion proctectomy, ileoanal pouch,\nand diverting ileostomy performed ___. An ileoanal anastomosis is\nseen. Multiple, fluid-filled small bowel loops are dilated up to 3.4 cm. A\nfocal narrowing of bowel is at the level of the right lower quadrant ileostomy\n(02:54), with fecalization within the bowel proximal to this narrowing. The\nsmall bowel is relatively less dilated distal to this narrowing. There are a\nfew areas of trace mesenteric fluid, for example in the left lower quadrant\n(02:49). Presacral edema/thickening is new from the prior CT and most likely\npostoperative.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Air within the right anterior mons pubis/labia (2:84), without\nsurrounding stranding, is new from the prior study. Otherwise, the abdominal\nand pelvic wall is within normal limits.", "output": "1. Multiple, mildly dilated small bowel loops, with a transition point just\nproximal to the right lower quadrant ileostomy, with trace mesenteric fluid,\nconcerning for a partial/early small bowel obstruction.\n2. Foci of gas within the subcutaneous tissue of the right anterior mons\npubis/labia. Recommend clinical correlation for any signs of infection, or\nprior injection or procedure of this area." }, { "input": "LOWER CHEST: There is a small left pleural effusion with basilar atelectasis\nbilaterally. No focal consolidations within the partially visualized lung\nbases. No evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is an expected amount of postoperative pneumobilia. The\ncommon bile duct appears mildly prominent, which is also postoperative in\nnature. The liver demonstrates homogenous attenuation throughout. There is\nno evidence of focal lesions. The gallbladder is surgically absent. There is\na small amount of free fluid surrounding the porta hepatis. There are 2 JP\ndrains, which terminate in the surgical bed.\n\nPANCREAS: The pancreatic duct appears prominent, which is unchanged comparison\nto the prior examination. Otherwise, the remaining pancreas has normal\nattenuation throughout, without evidence of focal lesions. There is a small\namount of free fluid surrounding the pancreatic tail.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are 2 renal hypodensities within the interpolar region on the\nright. The first is too small to characterize, but likely represents a cyst. \nThe other measures 1.1 x 1.3 cm with intermediate density, which is unchanged\nin comparison to the MR dated ___ and likely represents a\nproteinaceous cyst. Otherwise, the kidneys are of normal and symmetric size\nwith normal nephrogram. There is no evidence of focal renal lesions. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post hepaticojejunostomy,\npancreaticojejunostomy, and duodenojejunostomy. There is a small amount of\npneumoperitoneum anteriorly, which is expected. Contrast is seen in the\nstomach and filling the mildly dilated afferent limb, measuring up to 3.5 cm. \nNo contrast seen within the decompressed efferent limb. The colon and rectum\nare within normal limits. The appendix is normal.\n\nPELVIS: There is a small amount of air within the bladder, which is likely due\nto catheterization. The urinary bladder and distal ureters are otherwise\nunremarkable. There is a small amount of free fluid within the dependent\nportion of the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are punctate sclerotic foci within the left femoral head, which likely\nrepresent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mildly dilated contrast-filled afferent limb without any oral contrast\npassing into the efferent limb, representing potential obstruction, which may\nbe due to postoperative edema.\n2. Expected amounts of postoperative free fluid, pneumobilia, and\npneumoperitoneum.\n3. New left pleural effusion.\n4. Stable renal hypodensity representing a proteinaceous cyst.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 3:00 ___, 10 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pericardial effusion. Complete, interval resolution of left\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a stable, 2 mm, hypoattenuating lesion in segment 2 (5, 15) that was\nconsistent with a simple cyst on prior abdominal MRI from ___. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The residual pancreatic body and tail demonstrate normal attenuation\nthroughout without evidence of focal lesions. The pancreaticojejunostomy is\nintact. There has been interval, complete resolution of the fluid collection\nin the pancreatic surgical bed with minimal residual fat stranding. The\nleft-sided pigtail catheter is in appropriate position. There is a small\nresidual pocket of fluid inferior to the pancreatic tail. There is mild\ndilation of the main pancreatic duct, not unexpected in the setting of recent\n___ procedure.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There are bilateral, subcentimeter,\nrenal cortical hypodensities that are too small to characterize. Interval\ndecrease in size of a 7 mm lesion of intermediate density in the interpolar\nright kidney may represent proteinaceous debris within an involuting cyst. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Interval decrease in gastric wall thickening is consistent\nwith resolving postsurgical inflammation. The duodenojejunostomy and\nhepaticojejunostomy are patent. Remaining small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles appear unremarkable\nwithin the limitations of CT technique.\n\nLYMPH NODES: Small, homogeneously enhancing lymph nodes in the porta hepatis,\nperipancreatic region, and aortocaval region are likely reactive. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Portal and splenic veins are\npatent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous fat stranding along the midline incision site is\nconsistent with postsurgical inflammatory changes.", "output": "1. Complete interval resolution of the fluid collection in the pancreatic\nsurgical bed.\n2. Hepaticojejunostomy, pancreaticojejunostomy, and duodenojejunostomy are\npatent." }, { "input": "LOWER CHEST: Subsegmental atelectasis seen in the right middle lobe. There is\nno pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 1.1 x 0.6 cm ill-defined hypoenhancing lesion in segment 8 of the\nliver, not seen in the portal or delayed phases, which likely could represent\nan hemangioma (6:54). Another hypodense 3 mm lesion in segment 7, too small\nto characterize. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is an accessory spleen in the hilum.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. No evidence of esophageal wall\nthickening. The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. Small 2cm fluid\ndensity nodule in the mesenterium, at the level of the ileocolic vein (6:75)\nof uncertain etiology but benign characteristics, likely represents a\nduplication cyst.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is one lymph node adjacent to the portal vein (6:60) of\nborderline ___ (1.2 cm) but benign appearance. There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes seen in the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Small hiatal hernia. No esophageal wall thickening seen.\n2. Hepatic lesion in segment 8, which might represent a hemangioma but given\nthe patient's history, an MRI would be recommended for better\ncharacterization. Also, possible duplication cyst can be assessed at the same\ntime.\n\nRECOMMENDATION(S): MRI of the liver." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are heterogeneous areas of low-attenuation within segment\n4 of the liver which correspond to the previously seen heterogeneous\nenhancement on MRI and may represent transient hepatic attenuation\ndifferences. Note is again made of hypodensities in segment 8 measuring up to\n11 mm previously characterized as hepatic hemangiomas. There is no new\ndiscrete liver mass. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Small wedge-shaped hypodensity is noted in the medial upper spleen\nwhich may be postsurgical or sequela of prior infarct. This lesion does not\nhave features concerning for metastasis. The spleen is otherwise\nunremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post esophagectomy and gastric pull up. \nVisualized small and large bowel loops demonstrate normal caliber, wall\nthickness and enhancement.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Postoperative changes from esophagectomy and gastric pull-up.\n2. No evidence of metastatic disease in the abdomen." }, { "input": "LOWER CHEST: There is minimal atelectasis/scarring in the imaged lung bases. \nNo pleural or pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The imaged liver is unremarkable. The gallbladder is\nunremarkable.\n\nPANCREAS: The pancreas is atrophied, without focal mass lesions or main duct\ndilatation.\n\nSPLEEN: The spleen is unremarkable. A 1.8 cm soft tissue nodule in the left\nabdomen is unchanged and demonstrates enhancement characteristics similar to\nthe spleen (02:17), likely representing an accessory spleen.\n\nADRENALS: The right adrenal gland is unremarkable. Thickening of the left\nadrenal gland is unchanged.\n\nURINARY: A 3.9 cm simple cyst in the right kidney is not significantly\nchanged. Additional bilateral subcentimeter cortical hypodensities are too\nsmall to characterize. The kidneys are otherwise unremarkable. No\nhydronephrosis.\n\nGASTROINTESTINAL: There is a moderate hiatus hernia, which is unchanged from\n___. Small and large bowel loops normal in caliber, without abnormal\nwall thickening. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Several calcified fibroids are noted in the uterus. No\nadnexal abnormality is seen.\n\nLYMPH NODES: There are no pathologically enlarged abdominal or pelvic lymph\nnodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine. A 1.2 cm sclerotic\nfocus in the right acetabulum (2:65) is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute findings in the abdomen or pelvis." }, { "input": "LOWER THORAX: The lung bases are clear. No pleural or pericardial effusion.\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation.\nUnremarkable gallbladder.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: Subcentimeter renal cortical hypodensities are too small to\ncharacterize but likely represent small cysts. No hydronephrosis. \nUnremarkable bladder.\n\nGASTROINTESTINAL: The patient's primary esophageal carcinoma is not clearly\nidentified on the current examination. The stomach appears unremarkable. The\nsmall and large bowel are normal in caliber. There is a percutaneous\njejunostomy tube in situ. Mild apparent colonic wall thickening involving the\ndescending and sigmoid colon are likely related to incomplete oral contrast\nopacification and admixture of fecal contents.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly.\n\nLYMPH NODES: Borderline prominent retroperitoneal lymph node at the level of\nthe SMA measuring 8 mm (axial series 5, image 28; coronal series 7, image 20).\nNo pelvic or inguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Unremarkable.\n\nVASCULAR: No abdominal aortic aneurysm. Mild to moderate atherosclerotic\ncalcification.\n\nBONES: Posttraumatic deformity of the left lower ribs posteriorly. No\nsuspicious osseous lesion.\n\nSOFT TISSUES: Unremarkable.", "output": "1. No cause for the patient's symptoms is identified.\n2. Percutaneous jejunostomy tube in situ.\n3. The patient's primary esophageal carcinoma is not confidently identified on\nthe current examination. Single prominent retroperitoneal lymph node.\n4. No other evidence of metastatic disease within the abdomen or pelvis is\nidentified." }, { "input": "Heart size is normal without significant pericardial fluid. The imaged lung\nbases are clear.\n\nCT abdomen with contrast: Liver enhances homogeneously without focal lesion\nor biliary dilatation. Portal vein is patent. Gallbladder demonstrates\nstones without wall thickening or pericholecystic fluid.\n\nSuggestion of a hypodense lesion in the low pancreatic head is simulated by\nvolume-averaging secondary to invagination of mesenteric fat. Spleen,\npancreas and adrenal glands are unremarkable.\n\nKidneys present symmetric nephrograms without focal lesion or hydronephrosis.\n\nStomach is unremarkable. Duodenum and small bowel loops are normal caliber\nwithout evidence of obstruction. Sigmoid diverticulosis is present without\nevidence of diverticulitis. Large bowel is otherwise thin-walled and\nunremarkable without pericolonic fat stranding or fluid collection.\n\nAbdominal aorta is normal caliber. Scattered mesenteric and retroperitoneal\nlymph nodes are not enlarged by CT size criteria. There is no ascites, or\npneumoperitoneum. There is a moderate fat containing umbilical hernia.\n\nCT pelvis with contrast: Patient is status post prostatectomy with multiple\nsurgical clips in place. Bladder and rectum are unremarkable. There is no\nfree pelvic fluid or air. There is no inguinal or pelvic sidewall\nlymphadenopathy by CT size criteria. Dual-chamber penile prosthesis is\npartially imaged.\n\nBones and soft tissues: 8 mm sclerotic lesion in the left iliac bone has\nintervally increased in size compared to ___ where it measured 3 mm\n(5:62). There is no associated increased radiotracer uptake on the subsequent\nbone scan. A healing fracture is noted in the right anterior sixth rib (5:2)\ncorresponding to focally increased radiotracer uptake on subsequent bone scan.\nThere is focal severe degenerative change at the L3-L4 level, unchanged. \nThere are severe right greater than left degenerative changes of the hip\njoints.", "output": "1. Interval increase in size of 8 mm sclerotic lesion in the left iliac bone,\npreviously measuring 3 mm. This lesion is of unclear significance, given lack\nof radiotracer uptake on subsequent bone scan.\n2. Healing right anterior sixth rib fracture, corresponding to increased\nradiotracer uptake on subsequent bone scan.\n3. No other evidence of metastatic disease in the abdomen or pelvis.\n4. Cholelithiasis.\n\nRECOMMENDATION(S): Indeterminate enlarging sclerotic lesion in the left iliac\nbone can be further evaluated by gadolinium-enhanced musculoskeletal mass\ninfection protocol pelvic MR with specific request for additional in and out\nof phase sequences, if desired, given lack of correlate on radionuclide bone\nscan." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Surgical clips are noted from prior prostatectomy. \nDual-chamber penile prosthesis is visualized.\n\nLYMPH NODES: There is a single infrahilar periaortic lymph node which has\nslightly increased in size since prior imaging, measuring 12.2 x 8.8 mm, from\n0.9 x 6.7 mm. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: An 8 mm sclerotic lesion the left iliac bone is unchanged from prior\nimaging in ___. Healed fracture of the right anterior sixth rib is\nseen. Degenerative changes at the level of L3-L4, as well as in the bilateral\nhip joints, right greater than left, are unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is a 12.2 x 8.8 mm infrahilar periaortic lymph node, which has\nincreased slightly in size from prior imaging.\n2. 8 mm sclerotic lesion the left iliac bone is stable from prior.\n3. Healed right anterior sixth rib fracture\n4. No other evidence of metastatic disease in the abdomen pelvis.\n5. Cholelithiasis." }, { "input": "LOWER CHEST: Minimal dependent atelectasis.\n\nHEPATOBILIARY: Homogeneous hepatic enhancement. No suspicious masses. Portal\nvein and hepatic veins are patent. Gallstones.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Mild left adrenal gland hyperplasia.\n\nURINARY:No hydronephrosis. Normal course and caliber of both ureters.\n\nGASTROINTESTINAL: Under distended stomach. Small bowel loops are of normal\ncaliber. Colonic diverticulosis without diverticulitis.\n\nPERITONEUM: No free air. No free fluid. No peritoneal stranding.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Normal caliber mildly atherosclerotic abdominal aorta.\n\nPELVIS: Post prostatectomy with pelvic sidewall lymph node dissection. No\nevidence of local recurrent disease within the pelvis. Penile implants are\nre-demonstrated. Bladder is under distended. Rectum is unremarkable. No\ninguinal adenopathy.\n\nBONES:Interval increase in size and number of numerous sclerotic lesions\nthroughout the bones. The average measures 5 mm. The largest is a previously\nidentified sclerotic lesion along the left iliac bone has increased in size,\ncurrently measuring 1.4 cm compared to 0.8 cm.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Postsurgical changes within the pelvis related to prostatectomy and pelvic\nlymph node dissection. No evidence of recurrent soft tissue masses. No\nsuspicious adenopathy.\n2. Increase of diffuse osseous sclerotic lesions as detailed above." }, { "input": "CT abdomen with contrast: Liver enhances homogeneously without focal lesion\nor biliary dilatation. Gallbladder is unremarkable. Portal vein is patent.\n\nSpleen, pancreas and adrenal glands are unremarkable. A small accessory\nspleen is noted within the splenic hilum. Scattered millimetric renal\nhypodensities are too small to fully characterize but likely represent cysts\nand are unchanged from prior examination. Kidneys otherwise present symmetric\nnephrograms and excretion of contrast without focal solid lesion or\nhydronephrosis.\n\nThere is a small hiatal hernia. Stomach is otherwise unremarkable. Duodenum\nand small bowel loops are normal caliber without evidence of obstruction. \nLarge bowel is thin-walled and unremarkable without pericolonic fat stranding\nor fluid collection.\n\nAbdominal aorta is normal caliber. There are adjacent surgical clips. There\nis no mesenteric or retroperitoneal lymphadenopathy by CT size criteria. \nThere is no ascites, pneumoperitoneum or ventral abdominal hernia.\n\nCT pelvis with contrast: Patient is status posthysterectomy and bilateral\nsalpingo oophorectomy. Areas of stranding in the pelvis appear unchanged and\nare likely postsurgical in nature. No abnormal soft tissues noted within the\nsurgical bed. Bladder and rectum are unremarkable. There is no free pelvic\nfluid or air. There is no inguinal or pelvic sidewall lymphadenopathy by CT\nsize criteria.\n\nBones and soft tissues: There is no suspicious focal bone lesion. There is\ngrade 1 anterolisthesis of L5 on S1 with a left pars defect.", "output": "No evidence of disease recurrence in the abdomen or pelvis." }, { "input": "The lung bases are clear. Minimal amount of pleural effusion is seen\nbilaterally, slightly increased in size.\nThe the visualized portion of the heart and pericardium are normal. There is\nradiological evidence of anemia.\n\nThere is stable moderate intra and extrahepatic biliary dilatation with\npneumobilia. There is severe is stable lesion of the pancreatic duct measuring\nup to 1.3 cm. Hyperdense contents are seen within the proximal portion of the\npancreatic duct and the CBD (image 36), which may represent stones. The\npancreatic parenchyma is atrophic.\n\nMild dilatation of bilateral collecting systems is seen.\nThe spleen and adrenals are grossly unremarkable.\nUnchanged dilatation of the stomach and the proximal duodenum is seen,\npresumably secondary to fibrosis due to prior episodes of pancreatitis.\nThickened anterior para renal fascia is unchanged.\nAs previously, fistulous tract connecting the descending colon and the\nretroperitoneal collection is seen. The left retroperitoneal collection which\ncontains fluid anterior measures approximately 5.5 x 4.5 x 8 cm and is\nunchanged.\n\nInterval increase in the amount of ascites and subcutaneous edema is noted.\n\nRight femoral central line is seen, without evidence of retroperitoneal\nbleeding.\n\nNo osseous lesions are seen.", "output": "No evidence of retroperitoneal hematoma. Volume overload suspected and the\nincrease in ascites, mild pleural effusions and subcutaneous edema.\n\nUnchanged dilatation of the intra and extrahepatic biliary ducts and of the\npancreatic duct with atrophy of the pancreatic parenchyma.\n\nUnchanged fistula in the descending colon and the left retroperitoneal\ncollection." }, { "input": "LIVER TRANSPLANT - PREOPERATIVE EVALUATION\n\nARTERIAL VASCULATURE:\nCeliac trunk normal\nCommon hepatic artery normal, conventional anatomy\n\nPORTAL VENOUS SYSTEM:\nMain portal vein patent\nSuperior mesenteric vein patent: Yes\nInferior mesenteric vein patent: Yes\nSplenic vein patent: Yes\n\nAccessory hepatic veins (>=4mm): Yes\n\nLiver masses concerning for ___: No\n\nLiver volume: awaiting 3D reformats. Please see addendum for liver volume.\n\n\nLOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is atrophic and nodular compatible patient's known\ncirrhosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent with surgical clips noted in the gallbladder fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged with normal attenuation throughout, and without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a right\ninterpolar 2.1 x 2.4 cm nonenhancing well-circumscribed hypodensity that\nlikely represents a simple cyst. The left kidney is without any focal\nlesions. There is no hydronephrosis, nephrolithiasis or perinephric\nabnormality bilaterally.\n\nGASTROINTESTINAL: There is significant diffuse abdominal ascites. There are\nesophageal varices visualized with evidence of perigastric vascular\ncongestion. The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nsignificant for diverticulosis without evidence of surrounding fat stranding\nor bowel wall thickening.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Mild atherosclerotic\ndisease is noted.\n\nBONES: There is a superior compression deformity of L2 that appears chronic. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cirrhosis of the liver without evidence of focal lesions.\n2. Patent hepatic arteries and portal veins with evidence of perigastric\nvascular congestion.\n3. Diffuse abdominal ascites.\n4. 3D reformats would liver volume pending will send separate addendum with\ndata." }, { "input": "LOWER CHEST: Multiple areas of scattered ground-glass opacity as well as\nairspace opacification are seen involving both lungs with some areas showing\ncentral cavitation (series 4, image 2). Bibasilar subsegmental atelectasis\nwith small bilateral pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is atrophic with nodular contours in keeping with the\nknown cirrhosis. There is no evidence of focal lesions within the limitations\nof an unenhanced scan. A TIPS prosthesis is seen arising from the supra\nhepatic IVC terminating at the level of the main portal vein, difficult to\nassess the stent patency on this noncontrast study. There is no evidence of\nintrahepatic biliary dilatation. The gallbladder is surgically absent. CBD\nis mildly prominent measuring 9 mm, likely related to post cholecystectomy\nstatus.\n\nThere is a large amount of ascites.\n\nPANCREAS: Grossly unremarkable. There is no pancreatic ductal dilatation.\n\nSPLEEN: The spleen is enlarged measuring 15.7 cm.\n\nADRENALS: Mildly thickened left adrenal, the right adrenal is normal in size..\n\nURINARY: The kidneys showed retained contrast from a prior contrast study\nlikely portal venogram from ___. There is no hydronephrosis. Again\nseen are multiple cortical cysts, largest in the interpolar region on the\nright measuring 2.2 x 2.1 cm.\n\nGASTROINTESTINAL: Anastomotic suture line seen involving the lesser curvature\nof the stomach. Given limits of noncontrast CT, the bowel loops are normal in\ncaliber. There is a large amount of fecal matter in the rectum. No\npneumatosis. No evidence of bowel obstruction.\n\nPELVIS: The urinary bladder is non filled and shows a Foley bulb in situ. \nFree fluid seen extending into the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Limited assessment on this noncontrast study, no grossly enlarged\nretroperitoneal nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate calcific\natherosclerotic disease involving the abdominal aorta. Infrarenal IVC filter\nin situ.\n\nBONES: Stable appearance of the L1 compression fracture with loss of at least\n25% of vertebral body height. There has been interval development of new\ncompression fractures involving T11 and L3 vertebrae with loss of at least 25%\nof vertebral body height.\n\nSOFT TISSUES: There is diffuse generalized anasarca.", "output": "1. Limited assessment for TIPS patency on this noncontrast study. Stable\nbackground of cirrhosis and splenomegaly with large amount of ascites.\n2. Multiple scattered bilateral ground-glass opacities and patchy airspace\nopacification with some showing central cavitation, these are new since the\nprior CT from ___. Findings concerning for infectious etiology,\ndifferential concerns include aspiration. Clinical correlation recommended.\n3. Multiple superior endplate compression fractures involving T11, L1 and L3,\nthose involving T11 and L3 are new since CT from ___.\n4. Retained contrast in the kidneys is indicative of renal dysfunction." }, { "input": "LOWER CHEST: There has been marked improvement in the multifocal bilateral\npulmonary opacities in the visualized portions of the lungs when compared to\nprior chest and abdominal/pelvic CT compatible with improving infection. A\nfew focal nodular opacities remain. A small emphysematous bleb is noted in\nthe lingula, unchanged. Trace right pleural effusion with associated\natelectasis. Coronary artery calcifications and/or stents noted. Ascending\naorta measures 4.0 cm. Heart is enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: Hepatic cirrhosis. No focal lesion is identified on this\nnonenhanced study. A TIPS is again seen. No intrahepatic or extrahepatic\nbiliary ductal dilatation. The patient is status post cholecystectomy. Large\nvolume of simple ascites, increased from the prior CT.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly with the spleen measuring 14.5 cm without focal lesion.\n\nADRENALS: Mildly thickened left adrenal gland, unchanged. The right adrenal\ngland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size. 2.3 cm simple cyst,\nunchanged. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post gastric bypass. An enteric tube\nis seen with tip extending past the gastrojejunostomy terminating in the\njejunum. Additionally, contrast is seen within the excluded portion of the\nstomach extending into the proximal duodenum. There are mildly dilated spur\nproximal small bowel loops measuring up to 3.2 cm with gradual transition to\nnondilated small bowel loops. Contrast is seen extending into the transverse\ncolon. Mild wall thickening of the cecum is likely reactive. No\nintraperitoneal free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Surgical clips are noted in bilateral adnexae. The\nvisualized reproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. An IVC filter is noted.\n\nBONES: Compression fracture deformities are noted of T10, T11, L1, and L3\nvertebral bodies, all unchanged since ___. Chronic fracture\ndeformities of multiple bilateral ribs, similar. Chronic AVN right femoral\nhead. Stable mild-to-moderate central canal narrowing at L1 level secondary\nto compression fracture.\n\nSOFT TISSUES: There is diffuse anasarca.", "output": "1. Cirrhosis. Interval increase in large volume ascites. No intraperitoneal\nfree air.\n2. Status post gastric bypass. Contrast is seen within the excluded portion\nof the stomach extending into the proximal duodenum, contrast density sized in\nthe excluded portion the stomach, suggesting staple line dehiscence.\n3. Findings suggestive of adynamic ileus.\n4. Interval improvement in bilateral multifocal pulmonary opacities\ncompatible with improving pneumonia." }, { "input": "LOWER CHEST: 4 mm lung nodule the right base. Otherwise visualized lung\nfields are within normal limits.\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a small hypodense lesion in the right hepatic lobe,\nincompletely characterized but most likely a cyst. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Accessory spleen measuring 1.9 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions or hydronephrosis. There are left greater than right\nparapelvic cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Diffuse diverticulosis in the\ntransverse and descending colon and sigmoid, without signs of diverticulitis. \nLarge quantity of stool in a distended rectum. The appendix is within normal\nlimits.\n\nPELVIS: The urinary bladder is decompressed around a Foley catheter.\nThere is no free fluid in the pelvis.\n\nThere is a right adnexal cystic lesion measuring 6.5 x 5.3 with no clear solid\ncomponent or septations. No fat stranding or free fluid surrounding it. The\nleft adnexa is unremarkable. Heterogeneous myometrium with a more discrete\nhypodense round lesion in the fundus measuring 2.9 cm, likely a fibroid. A\nsmall amount of hypodense fluid is noted within the endometrial cavity.\n\nLYMPH NODES: There is a 1.0 x 2.1 cm lymph node along the right common iliac\nchain (5:82). Prominent but smaller lymph nodes are low noted along the right\nexternal iliac chain. There is no deep pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Atherosclerotic calcifications in the abdominal aorta. Filling\ndefects in the right superficial femoral vein and common femoral. No evidence\nof deep venous thrombosis in the included portions of the left femoral veins. \nThe iliac veins are patent.\n\nBONES: No evidence of an osseous destructive lesion. Degenerative changes in\nthe spine.\n\nSOFT TISSUES: In the midline soft tissues of the lower back, there is a\nsuperficial mass measuring 6.1 x 2.5 cm. Small fat containing umbilical\nhernia.", "output": "-No clear evidence for an intra-abdominal malignancy.\n-Right adnexal 6 cm cystic lesion with no clear solid component as well as a\nsmall amount of hyperdense fluid within the endometrial canal. These can be\nfurther evaluated with ultrasound. No ascites.\n-Superficial mass measuring 6.1 x 2.5 cm in the subcutaneous tissues of the\nlower back for which clinical correlation is recommended.\n-Known right superficial femoral and common femoral DVT.\n-Large stool burden throughout the left colon.\n\nRECOMMENDATION(S): Nonemergent pelvic ultrasound to further evaluate a right\nadnexal cystic lesion as well as the endometrial canal." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN AND PELVIS:\n\nThere is severe intrahepatic bile duct dilation extending throughout all\nsegments (series 3, image 51). The gallbladder is distended common\ndemonstrates an edematous wall (series 3, image 64). Evaluation of the porta\nhepatis and extrahepatic bile ducts are limited by massive ascites and lack of\nintravenous contrast.\n\nEvaluation of the pancreatic head is limited, with the tail and body appearing\nnormal. The spleen size is normal. The adrenal glands, kidneys, stomach, and\nintra-abdominal loops of small large bowel are within normal limits.\n\nAn ill-defined band-like hyperdensity along the anterior abdomen is\nnonspecific, and may reflect collapsed loops of small bowel, but appears\nseparate and may possibly reflecting omental implants(series 3, image 86).\n\nRounded densities along the iliac vessels are concerning for lymphadenopathy,\nwith lesions measuring up to of 2.6 x 2.3 cm axially (series 3, image 98,\n113). An enlarged perirectal node anteriorly is also equivocally seen (series\n3, image 119), measuring 2.7 x 1.8 cm axially.\n\nThe bladder is collapsed, and contains a Foley catheter. There is a mild\namount of stool within the rectal vault.", "output": "1. Severe intrahepatic bile duct dilation and gallbladder distention,\nconcerning for downstream obstructing mass given prior reported history of\nintra-abdominal malignancy. Further evaluation limited by lack of intravenous\ncontrast and massive intra-abdominal ascites. Consider ERCP for further\nevaluation.\n2. Likely bi-iliac lymphadenopathy and a abnormally enlarged perirectal node,\nwith further assessment limited by ascites.\n3. Ill-defined band like hyperdensity along the anterior abdomen is\nnonspecific, difficult to evaluate in the setting of massive ascites, but may\nreflect omental implants.\n\nNOTIFICATION: Dr. ___ the findings of this study to Dr. ___ at\n15:55 on ___ via telephone, 5 min after initial interpretation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 5\nmm hypodensity in the left lobe of the liver (series 2, image 14) is too small\nto characterize but likely represents a simple hepatic cyst or biliary\nhamartoma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal abnormalities.\n\n\n2. Diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size. There is a 1.0 cm splenic hypodensity,\nnonspecific, may represent a hemangioma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nextensive diverticulosis of the sigmoid, descending and ascending colon. \nThere is fat stranding is surrounding a region of diverticula in the ascending\ncolon, consistent with acute diverticulitis (2:41). There is no extraluminal\nair or fluid collection. The appendix is normal (602:27).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. There is peritoneal thickening in the pelvis,\nlikely sequela prior episodes of diverticulitis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There are mild multilevel degenerative changes in the thoracolumbar\nspine. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute uncomplicated ascending colon diverticulitis. No extraluminal air or\nfluid collection.\n2. Cholelithiasis, with no evidence of acute cholecystitis." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. Heart is enlarged. There is no\npericardial effusion. Partially imaged transvenous pacing wires.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. There is a\nsubcentimeter hypodensity in the posterior aspect of the spleen, too small to\ncharacterize (series 2, image 24).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size. There are multiple simple cysts\nin the right kidney with the largest measuring 2.2 x 1.9 cm. There is\nbilateral perinephric stranding, more pronounced on the right. There are\nvascular calcifications in the left kidney. There is no definite stone. \nThere is mild dilation of the left ureter. There is no frank hydronephrosis.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nSmall and large bowel are normal in caliber without focal wall thickening. \nThere is a 17 mm linear hyperdense structure in the fourth portion of the\nduodenal, new from ___ (series 601b, image 35). The ducts the appendix is\nnot visualized. There is no intra-abdominal free fluid or free air.\n\nPELVIS: There is a foci of air in the bladder, which may be from prior\ninstrumentation. There is thickening of the anterior bladder wall, new from\n___.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a chronic appearing fracture of the right inferior pubic ramus, new\nfrom ___. There are moderate degenerative changes of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild bilateral perinephric stranding and mild left hydroureter. No\nobstructing stone seen.\n2. Urinary bladder wall thickening, concerning for cystitis, correlate with\nurinalysis. Air within the bladder is likely from recent instrumentation.\n3. Linear foreign body in the fourth portion of the duodenal consistent with\nforeign body, possibly a bone. No evidence of bowel perforation.\n\nRECOMMENDATION(S): Urinalysis and follow-up abdominal radiograph.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:01 am, 5\n minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality. Mild asymmetry of the ureters are likely due to peristalsis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. Bilateral adnexal hypodensities measuring up to 3.7 cm and over 10 cc\nin volume.\n\nLYMPH NODES: There are multiple enlarged mesenteric lymph nodes, measuring up\nto 2.0 x 0.9 cm in the right upper in right lower quadrant. There are other\nmildly enlarged lymph nodes in the left upper and lower quadrant, though not\nis extensive in number and size compared to the right. There is no\nretroperitoneal lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Enlarged mesenteric lymph nodes in the right upper and right lower\nquadrant. Otherwise no acute intra pelvic or intra abdominal abnormalities. \nThis may represent mesenteric adenitis. Please correlate clinically..\n2. Bilateral ovarian enlargement, concerning for polycystic ovarian syndrome. \nCorrelation with exam and laboratory findings. Pelvic ultrasound may also be\nhelpful in further evaluation, if clinically indicated.\n\nRECOMMENDATION(S): Bilateral ovarian enlargement, concerning for polycystic\novarian syndrome. Correlation with exam and laboratory findings. Pelvic\nultrasound may also be helpful in further evaluation, if clinically indicated.\n\nNOTIFICATION: The updated findings were emailed to the ED QA nurses by Dr.\n___ on ___ at 08:51." }, { "input": "LOWER CHEST: There is a trace left pleural effusion, new since prior. \nOtherwise the visualized lung bases are clear. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The CBD measures 7 mm in diameter, not\nsignificantly changed since prior and tapers gradually toward the ampulla. \nThere is no intrahepatic biliary ductal dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The visualized small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe visualized colon is within normal limits. The appendix is normal.\n\nThe previously seen VP shunt catheter has been removed with interval\nresolution of the fluid in the right paracolic gutter.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute upper abdominal infection. Interval resolution of the fluid in\nthe right paracolic gutter.\n2. Trace left pleural effusion." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. Prominence of the common bile duct measuring up to 1.1 cm\nis similar to prior and likely secondary to prior cholecystectomy. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nextensive sigmoid diverticulosis. Hyperemia of a diverticulum the sigmoid\ncolon with significant adjacent stranding and small subcentimeter pericolonic\nfluid collection containing a foci of air concerning for microperforation\noverall concerning for acute diverticulitis (2; 64). No drainable fluid\ncollections or definite abscesses. The appendix is not visualized but there\nare no significant adjacent secondary signs of inflammation.\n\nPELVIS: The urinary bladder is unremarkable. There is prominence of the left\ndistal ureter, likely secondary to the adjacent inflammation. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are noted at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute sigmoid diverticulitis with microperforation with adjacent stranding\nand fluid. No drainable abscess.\n2. Appendix is not visualized but there are no significant secondary signs of\ninflammation." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple, ill-defined, hepatic lesions, demonstrating heterogeneous\nenhancement (06:50), measure up to 6.6 cm. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 13.8 cm. No focal lesions are\nidentified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter left renal hypodensity is too small to characterize. A\nperinephric collection of the upper pole, more hypodense than adjacent renal\nparenchyma, measures approximately 5 mm in greatest axial ___ (6:65,\n9:37).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The bladder is decompressed. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Focal calcification within the right gluteus medius muscle\n(6:104). The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple, ill-defined, heterogeneously enhancing hepatic lesions, measure\nup to 6.6 cm and are concerning for metastatic disease.\n2. Small, left renal subcapsular collection. Differential diagnosis includes\nthe aforementioned probable malignant process, or less likely a\nhematoma/trauma.\n3. Splenomegaly." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nMultiple hypodense hepatic lesions are better assessed on prior contrast\nenhanced CT abdomen pelvis dated ___. The largest measures up to\n6.4 cm within segment 5 (03:30). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent. There\nis trace perihepatic simple free fluid, new compared to prior exam, and likely\nreflective of lidocaine in the setting of recent biopsy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality. The previously demonstrated subcapsular left renal collection is\nnot well evaluated on this noncontrast enhanced exam.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: Scattered porta hepatic, periaortic, and mesenteric lymph nodes\nmeasure up to 1.4 cm in short axis. This is does not appear substantially\nchanged compared to ___ (3:21, 22; 05:26).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: 8 mm sclerotic focus along the right anterior iliac bone likely\nrepresents a bone island (3:64). There is mild symmetric sclerosis of the\nbilateral anterior sacrum, likely degenerative in nature (3:69). There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is re-demonstration of a coarse calcifications seen within\nthe right gluteus medius muscle measuring up to 1.4 cm (3:69). Punctate soft\ntissue in calcific densities along the posterior abdomen may reflect injection\ngranulomas (for example 3:82).", "output": "1. No evidence of intraperitoneal hematoma, or other signs to suggest active\nbleeding within the limits of this noncontrast enhanced exam.\n2. Multiple hypodense hepatic lesions are better assessed on prior CT abdomen\npelvis dated ___.\n3. Trace perihepatic simple fluid free fluid.\n4. Scattered porta hepatic, periaortic, and mesenteric lymph nodes are\nenlarged up to 1.4 cm in short axis. This is stable compared to most recent\nprior exam." }, { "input": "Lungs: Please see the report of the CT chest performed on the same day for\nmore details..\n\nLiver: The liver is homogeneous with a smooth contour.\n\nMultiple hypodense lesions are seen in the liver, as before, the largest in\nsegment 5, measuring 5.6 cm x 6.1 cm, previously 5.8 cm x 6.8 cm, seen on\nseries 4, image 59. There is increased central hypodensity, which could\nrepresent necrosis.\n\nAnother lesion is seen in segment 6, measuring 4.6 cm x 3.7 cm, previously 4.4\ncm x 3.8 cm, seen on series 4, image 263.\n\nAnother lesion is seen in segment ___, measuring 4.9 cm x 3.5 cm, previously\n4.6 cm x 3.2 cm, seen on series 4, image 53.\n\nSmaller lesions are seen in segment 2 and 4A, and are also stable.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder has been surgically removed.\n\nSpleen: The spleen measures 13.9 cm, as before, and is enlarged.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Stable rind of soft tissue at the anteromedial aspect of the upper\npole of the left kidney measuring up to 6 mm in thickness, enhancing on\nprevious examinations, consistent with lymphoma. There is no hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nGastrointestinal: The bowel is within normal limits. There is no evidence of\nbowel dilatation or obstruction.\n\nVascular: There are moderate atherosclerotic calcifications of the abdominal\naorta.\n\nThe portal vein and hepatic veins are patent.\n\nLymph nodes: There is no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion. A calcification is\nseen in the right gluteus medius. There is symmetric sclerosis involving only\nthe sacrum, which could be degenerative in nature.", "output": "1. No significant interval change in size in the hepatic lesions,\nbiopsy-proven diffuse large B-cell lymphoma. There is mild increased central\nhypodensity in the largest lesion, which could represent mild increased\nnecrosis.\n\n2. Stable rind of soft tissue at the anteromedial aspect of the upper pole of\nthe left kidney measuring up to 6 mm in thickness, enhancing on previous\nexaminations, consistent with lymphoma.\n\n3. Stable splenomegaly." }, { "input": "Very small subpleural nodule in the posterior basilar left lower lobe appears\nunchanged. Otherwise, visualized lung bases appear clear.\n\nLiver lesions have decreased substantially; for example, the largest, located\nin segment V previously measured 61 x 56 mm in axial ___ and now only\nmeasures 39 x 33 mm. There is no biliary dilatation. Patient is status post\ncholecystectomy. Spleen is normal in size and appearance. Adrenals appear\nnormal. There is no evidence for hydronephrosis or solid masses involving\neither kidney.\n\nStomach appears normal. Loops of jejunum show moderate wall thickening with a\ntarget appearance. Ilium appears normal. Colon also appears normal. \nAppendix is identified and appears normal.\n\nBladder is nearly empty and difficult to assess. No uterus is identified or\nadnexal masses. Major vascular structures appear widely patent. Vascular\ncalcification is mild. No lymphadenopathy, free air, or free fluid.\n\nThere are no suspicious bone lesions. Soft tissue calcification in the\ngluteus medius may be posttraumatic.", "output": "1. Findings consistent with jejunal enteritis, likely inflammatory or\ninfectious.\n\n2. Marked decrease in liver lesions." }, { "input": "LOWER CHEST: Other than bibasilar atelectasis, the incompletely visualized\nlungs are clear. ___ pleural effusion. The heart size is normal. ___\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation throughout. ___\nconcerning focal hepatic lesion. ___ intrahepatic or extrahepatic biliary\nductal dilatation. The gallbladder may contain tiny non-obstructing calcified\nstones, but is otherwise unremarkable without wall thickening, abnormal\ndistension, or pericholecystic fluid collection. The main portal vein appears\npatent. ___ ascites.\n\nPANCREAS: A 15-mm bilobed cystic lesion in the pancreatic head appears overall\nstable, previously characterized on MRCP to be statistically likely a\nside-branch IPMN (Series 2, Image 31; Series 601b, Image 23). The remaining\npancreas is normal attenuation throughout. ___ evidence of main pancreatic\nduct dilatation or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout. ___ focal\nsplenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and symmetric with normal\nnephrograms. Multiple bilateral cortical hypodensities are too small to\naccurately characterize on CT, but probably represent cysts and are similar to\nthe prior exam and MR. ___ concerning focal renal lesion, hydronephrosis, or\nperinephric abnormality. The urinary bladder is well distended and\nunremarkable.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber, thickness, and\nenhancement. Numerous sigmoid diverticula with extensive uniform wall\nthickening, hyperemia, and surrounding fat stranding is compatible with\nacute-on-chronic diverticulitis. A soft tissue component along the mesenteric\nborder contains gas and could represent a sinus tract (e.g., Series 601b,\nImage 35).\nThere is suggestion of the fluid collection that may be in the wall of the\nsigmoid colon versus folded bowel wall. The remaining colon and rectum are\nunremarkable. The appendix is within normal limits. ___ large intraperitoneal\nfree air, bowel obstruction, or evidence of septic thrombophlebitis. The fat\nplane with the bladder appears preserved.\n\nRETROPERITONEUM: ___ retroperitoneal lymphadenopathy by CT size criteria. \nScattered mesenteric nodes are seen and likely reactive. ___ mesenteric\nlymphadenopathy by CT size criteria.\n\nVASCULAR: ___ abdominal aortic aneurysm. Atherosclerotic calcifications are\nnoted within the descending abdominal aorta, bifurcation, and common iliac\nbranches.\n\nPELVIS: ___ pelvic sidewall or inguinal lymphadenopathy.\n\nBONES AND SOFT TISSUES: ___ suspicious lytic or sclerotic bony lesion. \nMulti-level degenerative changes are noted with loss of intervertebral disc\nheight and prominent anterior osteophytes common notably in the lower thoracic\nand upper lumbar spine. There is a tiny fat containing umbilical hernia.", "output": "1. Acute-on-chronic diverticulitis with extensive inflammatory change -\noverall worse from ___ CT. ___ large amount of free air or drainable\nfluid collection. A soft tissue component along the mesenteric border\ncontains gas and could represent a sinus tract. ___ bowel obstruction or signs\nof septic thrombophlebitis. A surgical consult is advised - this\nrecommendation was discussed with Dr. ___ at 4 pm.\n\n2. Grossly stable bilobed pancreatic head cystic lesion, statistically likely\nside branch IPMN as on MR in ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a calcified granuloma in the liver, likely\nrepresenting prior granulomatous infection. A 1.2 cm hypodensity is noted in\nthe right hepatic lobe, likely hepatic cysts or biliary hematoma (series 2:\nImage 14), seen on prior PET-CT without FDG avidity. Otherwise, the liver\ndemonstrates homogenous attenuation throughout. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nperforation of a segment of rectosigmoid colon, possibly due to acute\ndiverticulitis, although no definite focal causal diverticulum is noted,\nversus colitis (series 2: Image 59 and series 601: Image 37). There is\ndiffuse colonic wall thickening and adjacent inflammatory fat stranding noted\nin the region of the rectosigmoid colon. Extraluminal air seen within the\nperitoneum but predominately in the retroperitoneum. The remaining rectum is\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a large fibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is levoconvex scoliosis of the lumbar spine. No evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Perforated rectosigmoid colon with retroperitoneal and intra-abdominal free\nair, possibly due to acute diverticulitis, although no definite focal causal\ndiverticulum is seen, versus colitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:15 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid of the ascending colon colon is noted. There is significant wall\nthickening, hyperemia of the adjacent vessels and fat stranding around the\nsigmoid diverticuli, concerning for diverticulitis. Tiny punctate foci of air\nadjacent to the diverticuli likely represent micro perforations. There is a\nsmall amount amount of fluid collection near the affected loop of bowel, which\nis not organized and demonstrate no rim enhancement. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild compression deformity of L1.\n\nSOFT TISSUES: There is a small umbilical hernia.", "output": "1. Diverticulitis of the sigmoid colon with possible microperforation and\nsmall amount of fluid in the pelvis. No abscess. Colonoscopy in ___ weeks\nafter resolution of the infection is recommended for further evaluation, if\nclinically indicated.\n\nRECOMMENDATION(S): Colonoscopy in ___ weeks after resolution of the infection\nis recommended for further evaluation, if clinically indicated.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:52 AM, 5 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Visualized lung fields are notable for mild dependent\natelectasis. The heart is normal in size. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is an unchanged 1 cm cyst in the left kidney. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is diffuse\ncolonic diverticulosis involving the entire colon with persistent concentric\nwall thickening of an approximately 11.5 cm length of the sigmoid colon\nlocated in the mid pelvis with significant fat stranding of the pericolonic\nfat with perforation and locules of extraluminal air tracking into the right\nlower quadrant and communicating with a rim enhancing collection containing\nfluid and air. This collection measures 4.1 x 5.7 x 5.8 cm (2:76) and is\nclosely adherent to small bowel loops in the right lower quadrant. Located\nimmediately beneath the right lower anterior abdominal wall is a 2.2 x 5.6 x\n2.5 cm (2:68) rim enhancing collection that does not communicate with the\npreviously mentioned fluid collection. Numerous small bowel loops containing\noral contrast demonstrate mild wall thickening, and is likely reactive to\nsurrounding inflammation without obstruction. The remaining colon and rectum\nare within normal limits. The appendix not definitely identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild thickening of the right rectus muscle without\nintramuscular fluid collection, with findings likely related to the adjacent\ninflammation. The abdominal and pelvic wall is otherwise within normal\nlimits.", "output": "1. Perforated sigmoid diverticulitis with two distinct 5.8 and 5.6 cm rim\nenhancing collections containing locules of gas\n2. Reactive thickening of the right rectus muscle without intramuscular\ncollection.\n3. Mild reactive thickening of adjacent right lower quadrant small bowel loops\nwithout obstruction.\n\nNOTIFICATION: The findings were discussed with Dr ___. by ___,\nM.D. on the telephone on ___ at 4:18 ___, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: There is minimal left basilar atelectasis. There is no evidence\nof pleural or pericardial effusion. Heart is enlarged, with markedly enlarged\nright atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nWithin hepatic segment 4A there is a 2.3 x 1.7 cm lesion which measures above\nfluid density and is most likely a proteinaceous/ hemorrhagic cyst as seen on\n___. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nmain pancreatic ductal dilatation in the head neck or body. There is mild\nperipancreatic stranding involving pancreatic tail, suggesting pancreatitis. \nNo pancreatic necrosis. Patent splenic vein.\n\nAt the pancreatic tail there is a multilobulated low-attenuation cystic\nabnormality measuring 2.7 cm x 2.0 cm, compared with 2.3 cm x 1.4 cm on ___.\nThere is also a 1.3 cm cystic lesion of the pancreatic neck which measured 0.7\ncm on ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber.\n\nStatus post right hemicolectomy. There is abnormal mucosal thickening, hyper\nenhancement involving descending, sigmoid colon, rectum, and to lesser degree\nascending colon, distal transverse colon. Similar findings in the neo\nterminal ileum. Findings consistent with infectious colitis. Inflammatory\nbowel disease, ischemia are on likely. There is fluid throughout the colon\nand rectum.\n\nPELVIS: Urinary bladder is distended and is unremarkable There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged. No pelvic mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is ectasia of bilateral common iliac arteries, measuring 1.7\ncm on the right, stable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the spine, bilateral hips, sacroiliac joints.\n\nSOFT TISSUES: Surgical changes of the anterior abdominal wall. No soft tissue\nmass. Few benign calcifications are seen overlying the left greater\ntrochanter subcutaneous soft tissues. Right inguinal hernia repair.", "output": "1. Status post right hemicolectomy. Long segment areas of wall thickening of\nthe colon, with mucosal hyper enhancement, similar changes in the neo terminal\nileum, findings favor infectious enteritis. .\n\n2. Mild acute pancreatitis.\n\n3. There are 2 well-circumscribed cystic abnormalities involving pancreas,\nmeasuring 2.7 cm, 1.3 cm each, have increased since prior, suggesting side\nbranch IPMN." }, { "input": "LOWER CHEST: There is mild bibasilar atelectatic change.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is a tiny bubble of air projecting\nover the medial segment of the left lobe, near the falciform ligament. I\nsuspect this represents a tiny amount of pneumobilia, perhaps secondary to\nrecent intraoperative cholangiogram. This is unlikely to represent portal\nvenous gas as an unremarkable appearing portal vein is seen coursing just\nbelow this gas bubble. The gallbladder has been recently removed. There is a\nsmall amount of fluid in the gallbladder fossa, as well as a small amount of\nsimple density ascites in the abdomen and pelvis, which has not changed\nsignificantly as compared to previous scan. In general, fluid in the\ngallbladder fossa post cholecystectomy may represent post op fluid / ascites\nor possibly biliary leak, although given the fact that there has been no real\nprogression in the amount of free fluid, the changes may simply be\npostoperative in nature. Nonetheless, close clinical correlation is\nrecommended. If needed, this could be further evaluated with a dedicated HIDA\nscan.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA simple appearing 2.1 cm renal cyst is seen in the interpolar region of the\nleft kidney. There are no suspicious renal lesions identified. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is revisualization of the previously seen small bowel\nobstruction with single transition point. The degree of dilation has worsened\nwhen compared to previous, now measuring up to 5.8 cm in maximal diameter,\npreviously 4.3 cm. The transition point occurs near an anterior abdominal\nwall hernia. This obstruction is likely this anterior abdominal wall hernia,\nalthough there are many conglomerate bowel loops seen in this region, and a\nfocal adhesion is not entirely excluded.\n\nWithin this abdominal wall hernia there is simple density free fluid noted,\nwhich measures 4.3 x 8.6 cm. There is no rim enhancement. This fluid is\nlikely the result of intra-abdominal ascites coursing through the knee defect.\nThere are small amount of gas bubbles noted within this collection, likely\nrelated to the patient's recent postoperative status. There is a focal\nherniated loop of bowel seen at this level. It appears only a portion of the\nwall has herniated, suggestive of an underlying Richter's hernia.\n\nThere are uncomplicated colonic diverticula. Rest of the visualized small and\nlarge bowel loops are unremarkable.\n\nThere is a nasogastric tube with tip seen in the body of the stomach.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is anterolisthesis of L4 over L5. There are no suspicious bony\nlesions or fractures.", "output": "1. Persistent small bowel obstruction with transition point seen near the\nlevel of an anterior abdominal wall hernia. Degree of dilation appears worse,\nwith the small bowel loops measuring up to 5.8 cm (previously 4.3 cm).\n2. Anterior abdominal wall hernia with single herniated loop of bowel. Only a\nportion of this bowel loop is herniated, suggestive of an underlying Richter's\ntype hernia.\n3. Simple density free fluid noted within the hernia sac measuring 4.3 x 0.6\ncm.\n4. Small amount of fluid in the gallbladder fossa, which has not increased\nsignificantly since the previous examination. Although fluid in the\ngallbladder fossa after cholecystectomy raises the possibility of bile leak,\ngiven the lack of progression this is felt less likely. Nonetheless, close\nclinical evaluation is recommended. If needed, this could be further assessed\nwith dedicated HIDA scan.\n5. Other findings as detailed above." }, { "input": "LOWER CHEST: With the exception of minimal dependent bibasilar atelectasis,\nvisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2 cm parapelvic simple renal cyst is noted. An exophytic 9 mm enhancing\nright interpolar lesion is incompletely assessed (02:27). No hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: Prominent left inguinal lymph nodes are most likely reactive\n(2:76). Otherwise, there is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPars defects of L4 are noted with grade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: There is a midline surgical incision with a rim enhancing simple\nfluid attenuation collection measuring 5.3 x 10.0 x 10.0 cm (AP by TRV by CC).\nThere is associated subcutaneous stranding. There is a portion of the\ncollection at the level of the anterior inferior iliac spines that may extend\ninto the rectus muscle (2:60).", "output": "1. 5.3 x 10 x 10 cm rim enhancing fluid collection in the midline anterior\nabdominal wall could reflect an infected postoperative seroma or abscess,\nparticularly given the history of fever, erythema and leukocytosis. There is\npossible extension of the collection into the rectus muscle.\n2. Incompletely assessed exophytic 9 mm enhancing right interpolar lesion. \nRecommend further characterization with nonurgent renal ultrasound.\n\nRECOMMENDATION(S): Nonurgent renal ultrasound." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal gland is thickened and nodular without focal\nlesions identified. The right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are atrophic but of symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized however no secondary signs of\nappendicitis are seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple coarse calcifications are seen within the uterus\ncompatible calcified fibroids. The bilateral adnexa are within normal limits\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine with mild L5 on S1\nanterolisthesis and without evidence of worrisome osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No focal findings within the abdomen or pelvis to correlate with patients\nsymptoms.\n2. Diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere small foci of calcification the liver parenchyma consistent with prior\ngranulomatous disease (2:13, 12). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 2.3 cm right adrenal nodule, this is indeterminate in\nappearance on this single phase post-contrast study (02:22). This could be\nfurther characterized with an MRI adrenal protocol or CT adrenal protocol on a\nnonurgent basis. The left adrenal gland is unremarkable in appearance.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypoattenuating lesions in the bilateral kidneys are too small\nto characterize but statistically likely represent cysts (601b:47, 46, 45). \nNo hydronephrosis. No renal calculi seen, please note small nonobstructing\ncalculi may be obscured by excreted contrast.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is unremarkable in appearance\nin the right lower quadrant (601b:36).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No calcified atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSmall sclerotic foci in the proximal left femur are consistent with bone\nislands. Moderate degenerative disc disease at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. No\nevidence of an inguinal or femoral hernia.", "output": "1. Indeterminate right adrenal nodule measuring 2.3 cm, this could be further\ncharacterized with an MR adrenal or CT adrenal protocol.\n2. No cause for the patient's abdominal pain identified on this study." }, { "input": "LOWER CHEST: Clear lung bases. Please review dedicated same day CT thorax for\ndetails.\n\nABDOMEN:\n\nHEPATOBILIARY: No lesion or ductal dilation. Patent hepatic vasculature. \nUnremarkable gallbladder.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY: No nephrolithiasis or hydronephrosis. No mass.\n\nGASTROINTESTINAL: No intestinal obstruction. Unremarkable appendix.\n\nPELVIS: Unremarkable rectum and bladder. Hypodense uterine lesion measures\n2.9 cm, likely fibroid, unchanged.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Patent aorta and major branches.\n\nBONES AND SOFT TISSUES: Similar 1.9 cm left iliac bone ground-glass sclerotic\ndensity, other adjacent smaller foci, likely fibrous dysplasia. No suspicious\nosseous or soft tissue masses.", "output": "No abdominopelvic disease." }, { "input": "LOWER CHEST: Please review same day dedicated chest CT report.\n\nABDOMEN:\n\nHEPATOBILIARY: No suspicious lesion or ductal dilation. Unremarkable\ngallbladder.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY: No hydronephrosis.No discrete lesion.\n\nGASTROINTESTINAL: No intestinal obstruction. Unremarkable appendix.\n\nPELVIS: Unremarkable rectum and bladder. 26 mm exophytic uterine hypodensity\nposteriorly, likely fibroid, unchanged.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Patent aorta and major branches.\n\nBONES AND SOFT TISSUES: Similar 1.9 cm left iliac bone ground-glass sclerotic\ndensity, other adjacent smaller foci, likely fibrous dysplasia. Unchanged L1\nbone island in the posterior spinous process.", "output": "1. No abdominopelvic disease." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal in appearance without\nevidence of appendicitis. A small appendicolith is identified within the\nappendix.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nThere is a 2.2 cm left adnexal cyst identified which is most likely\nphysiologic in nature in this premenopausal female. A tampon is identified in\nthe vagina.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are stable sclerotic lesions in the left iliac bone.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence for lymphoma recurrence within the abdomen or pelvis." }, { "input": "ABDOMEN:Bibasilar atelectasis is noted. The non contrast appearance of the\nvisualized portion of the liver is unremarkable. Multiple gallstones are\nnoted, similar to the previous study. The pancreas, visualized spleen and left\nadrenal gland are unremarkable. Again seen is a right adrenal adenoma\nmeasuring 1.4 x 1.4 cm which is unchanged since the prior exam. A hypodense\nlesion in the interpolar region of the right kidney measures 3.3 x 2.8 cm and\nis most likely a cyst, though incompletely evaluated without contrast. There\nis mild atherosclerotic calcification of the aorta. There is no free fluid,\nfree air or lymphadenopathy within the abdomen. The visualized bowel is\nunremarkable.\n\nThere no bony lesions of concern.", "output": "1. Stable 1.4 cm right adrenal adenoma.\n2. Cholelithiasis.\n3. Hypodense lesion in the interpolar region of the right kidney is most\nlikely a cyst, though incompletely characterized without contrast." }, { "input": "LOWER CHEST:\n\nThere is no pleural or pericardial effusion in the visualized lung bases.\n\nABDOMEN:\n\nThe liver is homogeneous in density without evidence of focal mass. There is\nno intrahepatic or extrahepatic biliary dilatation. The gallbladder is\ncontracted without evidence of cholelithiasis. Spleen is within normal limits.\nThe pancreas is unremarkable.\n\nThe adrenal glands are not enlarged. There is symmetric renal enhancement and\nexcretion of intravenous contrast. There is no renal mass. There is no\nevidence of hydronephrosis. Urinary bladder is under distended preventing\ndetailed evaluation, however there is no gross abnormality.\n\nThere are no dilated loops of bowel. There is no bowel wall thickening. There\nis no intraperitoneal free air or free fluid. There is no evidence of right\nlower quadrant inflammatory change. There are no enlarged inguinal, iliac\nchain, retrocrural, or retroperitoneal lymph nodes. The abdominal aorta as\nnormal course and caliber without evidence of atherosclerotic calcification.\nThere is no suspicious osseous lesion. There is a simple appearing right\novarian dominant follicle measuring 4.3 x 3.0 cm.\n\nThere is a new 2.9 x 1.7 cm density within the right anterior abdominal\nsubcutaneous fat likely related to medication injection site.", "output": "No acute abdominal process. No evidence of enteritis or colitis.\n\nIncreased density within the right anterior abdominal subcutaneous fat likely\nsecondary to medication injection site." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple hypodense irregular rim enhancing lesions in the liver, the\nlargest measures 2.6 x 3.2 cm in hepatic segment II, decreased in size\ncompared to prior, and concerning for metastases. There is mild intrahepatic\nbiliary dilatation, which appears more prominent compared to prior. The CBD\nis mildly enlarged and similar to prior. The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout. A hypodensity in\nthe pancreatic tail measuring 1.2 x 2.1 cm is seen, which appears decreased in\nsize and is not as well visualized as on the prior exam (2; 23). The\npancreatic duct is prominent measuring up to 3 mm in the body of the pancreas.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Peripheral\nareas of hypodensity in the spleen are likely perfusional, recommend attention\non follow-up (2; 20).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia, otherwise the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits. There is no adnexal\nabnormality.\n\nLYMPH NODES: Soft tissue density at the porta hepatis measuring up to 2.4 cm\nlikely represents a conglomerate of lymph nodes appears less bulky compared to\nprior. (2; 23, 25). There is no retroperitoneal lymphadenopathy. There is\nno pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Interval decrease in size of primary pancreatic mass, multiple hepatic\nmetastases, and porta hepatis lymph nodes.\n2. Mild intrahepatic biliary dilatation, slightly more prominent compared to\nprior with stable size of the CBD.\n3. No evidence of cholecystitis." }, { "input": "A heterogeneous masses in the right breast measures 16 mm. Previously there\nwas a partly imaged nodule measuring only 7 mm. Platelike focus of\natelectasis is found in the left lower lobe.\n\nMass in the left lateral segments of the liver measures up 47 x 36 mm in axial\n___ compared 32 x 26 mm on the prior study, representing a substantial\nshort-term increase in metastatic disease. Several metastatic lesions have\nalso increased substantially in the right lobe of the liver, and a few very\nsmall new ones have also appeared.\n\nThere is moderate, increased intrahepatic biliary dilatation. Extrahepatic\nbiliary ducts measure up to as much as 15 mm in diameter, compared 9 mm\nbefore, with a suspected new distal stricture, noting a new discrete caliber\nchange. Main pancreatic duct is not dilated, however. A mass along the\npancreatic tail, previously 21 x 12 mm, now measures up to 29 x 19 mm in axial\n___. Bandlike area of relative hypodensity in the spleen may be due\nischemia, whereas other small hypoattenuating lesions have decreased in the\nspleen. Adrenals are unremarkable. There is no evidence for solid masses or\nhydronephrosis involving either kidney.\n\nThe stomach and small bowel appear normal. Large bowel is also unremarkable.\n\nBladder appears normal. Moderately large gonadal varices are present\nbilaterally. No adnexal masses found. Uterus is unremarkable. Major\nvascular structures appear widely patent. Athero sclerotic calcifications are\nmild-to-moderate. The main portal vein is markedly narrowed, a increased\nfinding.\n\nIncreased poorly defined periportal masses resemble necrotic lymph nodes. \nLargest discrete component of this, previously 24 x 16 mm, now measures up 33\nx 25 mm (02:24). Small necrotic celiac node has also increased, measuring 15\nmm compared 10 mm before. There is no free air or ascites.\n\nThere are no suspicious bone lesions. Moderate degenerative changes affect\nlower lumbar facet joints. There is a transitional lumbosacral vertebral\nbody. Vertebral body heights and interspaces are preserved. Vertebral bodies\nare preserved in height.", "output": "Substantial increase in metastatic disease including new extrahepatic biliary\nstricture with upstream intrahepatic and extrahepatic biliary dilatation as\nwell as marked narrowing of the main portal vein." }, { "input": "LOWER CHEST: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nHEPATOBILIARY: The liver is normal in size and attenuation. A geographic area\nof hypodensity adjacent to the falciform ligament is likely reflect focal fat\ndeposition. The portal vein is patent. The patient is status post\ncholecystectomy. There is no biliary ductal dilatation.\n\nSPLEEN: Normal.\n\nPANCREAS: The pancreas shows normal enhancement. There is no pancreatic duct\ndilatation or peripancreatic fat stranding.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys display symmetric nephrograms with no evidence of\nhydronephrosis or mass lesion in either kidney. The ureters are symmetrical\nin their course to the bladder.\n\nGASTROINTESTINAL: The stomach is within normal limits. Small bowel loops are\nnormal in caliber and there is no evidence of bowel obstruction. There is no\ndefinite evidence of colonic wall thickening. There is equivocal thickening\nof the cecum however evaluation is limited as the cecum is mostly\ndecompressed. Small lymph nodes in the right lower quadrant may be reactive\nmeasuring up to 9 mm in short axis. The appendix is not definitely visualized\nhowever there are no secondary signs of appendicitis in the right lower\nquadrant.\n\nLYMPH NODES: No pathological adenopathy.\n\nVASCULAR: Normal caliber aorta.\n\nPELVIS: The bladder is normal. The rectum and sigmoid colon are within normal\nlimits.\n\nREPRODUCTIVE ORGANS: The uterus is prominent for a patient of this age with\nfluid noted within the endometrial cavity outlining rounded submucosal lesions\nwhich could represent fibroids or endometrial polyps. The patient is status\npost tubal ligation.\n\nBONES AND SOFT TISSUES: No suspicious osseous lesions.", "output": "1. Endometrial cavity fluid with rounded submucosal lesions which could\nrepresent fibroids versus polyps. A nonemergent pelvic ultrasound may be\nperformed to further assess.\n2. Equivocal mild thickening of the ascending colon, series 601b, image 32;\ndifficult to exclude a mild colitis in the correct clinical setting. ___\nconsider a nonemergent colonoscopy to exclude underlying lesion.\n\nNOTIFICATION: These findings and recommendations were entered into the\ncritical results dashboard by Dr. ___ on ___ at 09:08." }, { "input": "LOWER CHEST: There is patchy non dependent consolidation in the right middle\nlobe (___). There is moderate atelectasis in the bilateral lower lobes. No\npleural or pericardial effusion is seen.\n\nABDOMEN:\n\nLIVER: A subcentimeter hypoattenuating lesion near the hepatic dome (05:21) is\ntoo small to characterize but is unchanged. No new focal lesions are\nidentified.\n\nBILIARY: Patient is post gastrocholecystostomy, with stent in situ. Air\nwithin the nondistended gallbladder is compatible with stent patency. No\npericholecystic free fluid, fluid collections or new soft tissue stranding is\nseen. A 1.5 cm stone in the region of gallbladder neck is unchanged. There is\nno biliary dilatation.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: Subcentimeter hypoattenuating lesions in the right kidney are too\nsmall to characterize, but are unchanged. There is no hydronephrosis.\n\nGASTROINTESTINAL: There is no gastrointestinal obstruction. Anastomosis\nsutures are seen in the anterior abdomen. Fluid is noted in the colon,\nwithout additional imaging findings to suggest colitis.\n\nPELVIS: There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no evidence of abdominal, pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: Patient is post aorta bi-iliac graft repair for an infrarenal\nabdominal aortic aneurysm. The aneurysm sac is unchanged, measuring up to 3.5\nx 3.3 cm in maximum axial dimension (5:66), previously 3.5 x 3.3 cm. There is\nno evidence of endoleak. Extensive atherosclerotic disease is noted. \nIncidental note is made of a common origin of the celiac axis and SMA.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Postsurgical changes are noted in the anterior abdominal wall.", "output": "1. Post gastrocholecystostomy with gastrocystostomy in place. No surrounding\nsoft tissue stranding or drainable fluid collections.\n2. Bibasilar atelectasis and patchy airspace disease in the right middle lobe\nwhich is likely infectious/inflammatory.\n3. Fluid in the colon can be seen in the setting of diarrhea. No other\nimaging findings to suggest colitis.\n4. Additional chronic findings, as above." }, { "input": "LOWER CHEST: Apart from minimal dependent atelectasis in both lower lobes,\nvisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the lower pole the left kidney is too small to\nfully characterize, likely a cyst. There is no evidence of concerning focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Rectum appears\nnormal without evidence for a perirectal abscess. The colon is within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.Extensive rim enhancing interconnected perianal fluid\ncollections containing foci of gas are seen extending from the posterior\naspect of the levator ani in a horseshoe configuration and coursing inferiorly\nand anteriorly along the medial aspects of the ischioanal fossa bilaterally. \nThe largest horseshoe fluid collection measures up to 5.0 x 3.0 x 5.1 cm, with\nthe second largest located just superior and anterior to this collection\nwithin the left perianal region (2:87) and measures up to 2.3 x 1.2 x 2.7 cm. \nFindings are compatible with extensive perianal abscess formation and perianal\nfistula formation.\n\nREPRODUCTIVE ORGANS: There are multiple prominent para ovarian veins with\ndilatation of the gonadal veins bilaterally which can be seen in pelvic\ncongestion syndrome. The uterus and bilateral adnexae are otherwise within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are endplate degenerative changes at L2-L3 as well as mild grade\n1 anterolisthesis of L4 on L5. There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Extensive perianal abscess disease with perianal fistula formation. The\nlargest abscess which horseshoe along the posterior aspect of the levator ani\nmeasures up to 5.0 x 3.0 x 5.1 cm while the second largest located in the left\nperianal region just superior and anterior to this horseshoe collection\nmeasures 2.3 x 1.2 x 2.7 cm.\n2. Prominent para ovarian veins with dilated gonadal veins which can be seen\nwith pelvic congestion syndrome, but clinical correlation is needed." }, { "input": "LOWER CHEST: Visualized lung bases are clear. There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo kidney stone. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are better assessed on\nsame-day pelvic ultrasound.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute findings to account for pain." }, { "input": "LOWER CHEST: There is scarring/linear atelectatic change noted at the left\nbase, unchanged from previous. There is moderate degree of cardiomegaly,\npartially imaged. The lung bases are otherwise unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder contains gallstones without wall thickening or evidence of\ninflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 2.5 x 2.2 cm right adrenal myelolipoma is seen. The left adrenal\ngland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof suspicious focal renal lesions within the limitations of an unenhanced\nscan. There is no hydronephrosis. A millimetric nonobstructive stone seen at\nthe right lower pole. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nThere is edema involving the transverse me is a colon and anterior peritoneal\ncavity, with no clear underlying etiology identified. The appearance of this\nis not significantly changed compared to the patient's prior examinations, and\nmay be the result of lymphatic/vascular congestion. No underlying acute bowel\nabnormality is seen to explain the finding at this time.\n\nPELVIS: Evaluation of the pelvis is limited by metallic artifact, however\ngrossly the bladder appears unremarkable. There is trace amount of free fluid\nnoted in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is bilateral spondylolysis at the L5-S1 level, without\nsignificant listhesis. There is mild diffuse osteopenia noted, without focal\nsuspicious bony lesion identified. The patient is status post right hip\nhemiarthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite cause for the patient's abdominal pain is identified.\n2. Persistent infiltration and edema along the transverse mesial colon and\nanterior peritoneum as detailed above, unchanged from previous." }, { "input": "LOWER CHEST: Nodular scarring with probable superimposed adjacent atelectasis\nis noted at the lung base. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion within the limitation of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout. Two 1.0 cm\nhypodensities in the tail of the pancreas (series 2, image 14) are\nincompletely characterized. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A right adrenal adenoma is incidentally noted, as seen on prior. \nThe left adrenal gland is unremarkable.\n\nURINARY: A sub cm hypodensity in the upper pole the left kidney likely\nrepresents a simple renal cyst. A subcentimeter hypodensity in the upper pole\nof the right kidney likely represents a simple renal cyst. There is mild\nhydronephrosis and proximal hydroureter on the right with a 4 mm obstructing\nstone seen in the proximal right ureter.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness. The colon and rectum are within normal\nlimits. The appendix is normal. Persistent increased attenuation seen in\nassociation with the mass and narrowing in region of the omentum of uncertain\nsignificance, seen on multiple prior older exams a well.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRight hip arthroplasty changes are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild right hydronephrosis with a 4 mm obstructing stone in the proximal\nright ureter.\n2. Multiple sub cm cystic lesions in the pancreatic tail are incompletely\ncharacterized, however unchanged from ___. MRI is recommended for\nfurther evaluation.\n3. Cholelithiasis without evidence of cholecystitis." }, { "input": "LOWER CHEST: Few enlarged epipericardial lymph nodes are noted, largest\nmeasuring 2 x 1.2 cm (4:7). Please refer to separate report of CT chest\nperformed on the same day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: In comparison to ___ MR there is no significant\nchange in moderate distal intrahepatic biliary duct dilatation primarily\ninvolving the right anterior biliary system due to a 5.0 x 4.4 cm (05:10 7)\ncentrally hypo enhancing irregular mass lesion within segment ___ with\nperipheral hyper enhancement. There is no progressive central enhancement on\n15 minutes delayed imaging which would typically be seen with a\ncholangiocarcinoma. Again seen is extension towards the porta hepatis with\ncircumferential encasement of the main portal vein (5:119) with evidence of\nmoderate stenosis without tumor thrombus. No capsular retraction. No common\nbile duct dilatation. No additional hepatic lesions identified. The\ngallbladder is decompressed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The esophagus and stomach are unremarkable. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. The appendix is not visualized\nhowever no secondary signs of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nmoderate amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable with a physiologic left\nfollicular ovarian cyst. No large adnexal mass.\n\nLYMPH NODES: There is a 5.1 x 3.1 cm (5:121) GDA node, 2.3 x 1.8 cm (5: 120)\nportal caval node, and 2.8 x 2.3 cm (5:91) paraesophageal lymph node with\ncentral necrosis. Few scattered retroperitoneal lymph nodes do not meet CT\nsize criteria for enlargement, largest measuring 0.7 cm in short axis (5: \n129). There is a 1.8 x 1.3 cm (5: ___ enlarged right inguinal lymph node. \nNo left inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: 0.6 cm densely sclerotic lesion within the right superior pubic ramus\nis consistent with a bone island. Mild degenerative changes centered at L4-L5\nwith endplate sclerosis, subchondral cyst formation and joint space narrowing.\nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral breast implants are noted. The abdominal and pelvic\nwall is within normal limits.", "output": "1. 5 cm segment ___ irregular hepatic mass with moderate right anterior\nbiliary duct dilatation with moderate narrowing of the patent portal vein does\nnot demonstrate progressive central enhancement on delayed imaging that is\ntypically seen with cholangiocarcinoma. Given the extensive lymphadenopathy\nand atypical hepatic mass enhancement findings are most suspicious for\nlymphoma.\n2. Multiple enlarged lymph nodes involving the epipericardial, GDA, portacaval\nregion, paraesophageal, and right inguinal region as described above.\n3. Moderate amount of free pelvic fluid." }, { "input": "LOWER CHEST: Please see separate report for intrathoracic findings from\nsame-day CT chest, including the right breast implant. .\n\nABDOMEN:\n\nHEPATOBILIARY: Compared to ___, interval decrease in size of a large\nsegment ___ hypodense lesion (___), measuring 3.7 x 3.2 cm, previously 5.9 x\n5.6 cm. As before, there is circumferential encasement of the main portal\nvein. Again seen is occlusion of the right superior portal vein (___). No\ncapsular retraction. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is relatively contracted, limiting\nevaluation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Interval decrease in the size of multiple enlarged lymph nodes. \nIndex lesions:\n- GDA node, measuring 3.0 x 2.4 cm (___), previously 5.1 x 3.1 cm\n- portacaval node, 2.1 x 1.4 cm (___), previously 2.3 x 1.8 cm\n- right inguinal node, 1.4 x 1.0 cm (___), previously 1.8 x 1.3 cm\n-a previously-seen paraesophageal lymph node is no longer visualized.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged sclerotic focus in the right superior pubic ramus, likely\nrepresenting a bone island (___). There are degenerative changes at L5-S1,\nas before.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Compared to ___, interval decrease in size of multiple enlarged\nlymph nodes throughout the abdomen and pelvis, as described above.\n2. Interval decrease in size of a large segment ___ hypodense lesion which\nagain demonstrates circumferential encasement of the main portal vein and\nocclusion of the right superior portal vein.\n3. Please see separate report for intrathoracic findings from same-day CT\nchest." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There has been interval decrease of the hypodense segment ___\nlesion now measuring 2.8 by 2.5 cm, previously measuring 3.7 x 3.2 cm (series\n5, image 50). Again noted is circumferential involvement of the main portal\nvein with occlusion of the right anterior portal vein. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status posthysterectomy.\n\nLYMPH NODES: Several pathologically enlarged lymph nodes are overall decreased\nin size and conspicuity. In particular, previously seen enlarged GDA node\nmeasures 2.8 x 2.3 cm, previously 3.0 x 2.4 cm (series 5, image 64). Enlarged\nportacaval node measures 1.6 x 1.2 cm, previously 2.1 x 1.4 cm (series 5,\nimage 67). Enlarged right inguinal node measures 1.0 x 1.0 cm, previously 1.4\nx 1.0 cm (series 5, image 118).\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: Stable appearance of sclerotic lesion in the right superior pubic\nramus, likely representing a bone island. There is no evidence of worrisome\nosseous lesions or acute fracture. There are degenerative changes of the\nspine, particularly severe at L5/S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Note is\nmade of bilateral breast implants.", "output": "1. Interval decrease in size of hypodense segment ___ liver lesion which again\ndemonstrates circumferential encasement of the portal vein and occlusion of\nthe right anterior portal vein.\n2. Interval decrease in size of multiple enlarged abdominal and pelvic lymph\nnodes.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Visualized lung are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The ascending to\ndescending colon are unremarkable. However, at the rectosigmoid junction,\nthere is diffuse mural edema, mucosal hyper enhancement and engorgement of the\nmesenteric vessels, concerning for acute infection. In addition, there is\nthickening of the peritoneal reflection pelvis, concerning for peritonitis\n(2:71). However, there is no drainable fluid collection or perforation. The\nappendix is top-normal in caliber (601:25, 27). There is no associated fat\nstranding or fluid collection nearby.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is in mid position, and contains an IUD. The\nuterus is normal in size. Mild inflammation lies adjacent to the bilateral\nnecks a (series 2, image 71), which is in close proximity to the inflamed loop\nof rectosigmoid junction and peritoneal lining.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Moderate active colitis at the rectosigmoid junction. No drainable fluid\ncollection or perforation.\n2. Inflammatory changes are seen across the bilateral adnexa, which lie\nadjacent to the inflamed rectosigmoid junction. This is likely reactive but\nplease correlate with any history of abnormal vaginal discharge to exclude the\npossibility of a gynecologic infection.\n3. Mildly prominent appendix without fat stranding or fluid collection.\n\nNOTIFICATION: The updated impression 2 was emailed to the ED QA nurses for\nfollow-up by Dr. ___ on ___." }, { "input": "LOWER CHEST: Extensive centrilobular emphysema is seen within the partially\nvisualized lungs bilaterally. Patchy parenchymal opacification at the right\nlung base, as well as within the lingula, which is new since ___, and is\nconcerning for an infectious process or aspiration. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are numerous subcentimeter hypodensities within the\nliver, which are too small to characterize, but likely represent cysts or\nbiliary hamartomas. The patient is status post percutaneous cholecystostomy. \nThe percutaneous drain appears to be appropriately placed within the\ngallbladder, however the gallbladder is not entirely decompressed. There\nappears to be a fluid collection adjacent to the gallbladder measuring\napproximately 3.3 x 2.4 cm (series 2, image 24). This fluid collection is\nintimately associated with the second part of the duodenum, however it appears\nto be separate, and there may be a small connection between this fluid\ncollection and the gallbladder (series 2, image 26). There is a moderate\namount of fat stranding surrounding this fluid collection. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.\n\nPANCREAS: Within the tail of the pancreas, there is a 1.6 x 1.3 cm partially\nperipherally calcified hypodensity (series 2, image 16), which is stable in\nappearance compared to ___. However, although present on the CT dated\n___, it is more conspicuous on the recent examinations. Otherwise,\nthe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a hypodensity within the interpolar region of the left\nkidney (series 2, image 27), which is too small to characterize, but likely\nrepresents a simple cyst. Otherwise, the kidneys are of normal and symmetric\nsize with normal nephrogram. There is no evidence of solid renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are multiple\nnondistended fluid-filled loops of small bowel, but no evidence of ileus or\nobstruction. A normal appearing anastomosis is seen within the right lower\nquadrant. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is not visualized.\n\nPELVIS: The patient is status post cystectomy with a neobladder. The\nneobladder is distended with fluid, however there is a large amount of air\nwith a mottled appearance within the neobladder, that is new since ___. \nThis air may be due to self catheterization, however it is more than would be\nnormally expected. There is no adjacent bowel wall thickening to suggest a\ncolovesicular fistula, however this is also a consideration. There is no free\nfluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. The abdominal\nand pelvic wall is within normal limits.", "output": "1. Status post percutaneous cholecystostomy with a drainage catheter\nappropriately positioned within the gallbladder.\n2. 3.3 cm adjacent fluid collection, which appears to be separate from the\nduodenum, and may have a small connection to the gallbladder.\n3. Status post cystectomy with neobladder formation. Large amount of air with\na mottled appearance within the neobladder is new and more than expected with\nself catheterization. There is no adjacent bowel wall thickening to suggest a\ncolovesicular fistula, however this is a consideration.\n4. Patchy parenchymal opacification at the right lung base and within the\nlingula, new since ___, concerning for pneumonia or aspiration.\n5. 1.6 cm partially calcified hypodense lesion within the tail of the\npancreas, indeterminate in etiology, but more conspicuous compared to ___.\n\nRECOMMENDATION(S):\n1. If the patient can tolerate PO, a repeat CT with oral contrast may be\nhelpful to distinguish the duodenum from the adjacent fluid collection. If\nthe patient is unable to tolerate PO, a fluoroscopy examination with contrast\ninjection through the cholecystostomy can be considered.\n2. In addition, oral contrast may be helpful to rule out a colovesicular\nfistula. Correlation with UA for signs of infection or fecal material is also\nrecommended.\n3. MRCP can be considered on an outpatient basis to evaluate the partially\ncalcified hypodense lesion within the tail of the pancreas." }, { "input": "LOWER CHEST: Limited assessment of lung bases demonstrates persistent right\nlower lobe ground-glass and slightly more confluent opacities with underlying\nsmall nonhemorrhagic pleural effusion. New subtle left lower lobe opacity is\nnoted with a new small left pleural effusion. There is persistent lingular\natelectasis as well as right middle lobe opacity with mucous plugging. The\nheart is normal in size. There is a persistent small nonhemorrhagic\npericardial effusion. No pneumothorax.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is decompressed with a percutaneous\ncholecystostomy tube. Again seen are radiopaque gallstones within the\ngallbladder. There is trace perihepatic and pericholecystic free fluid, which\nis unchanged since prior examination.\n\nPANCREAS: The pancreas has normal attenuation throughout. Again seen is a 1.4\nx 1.2 cm (04:24) partially calcified lesion within the pancreatic body/ tail,\nunchanged since prior examination. There is no pancreatic ductal dilatation. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: No hiatal hernia. The stomach is notable for persistent\nirregular wall thickening along the right lateral first and second portions of\nthe duodenum measuring up to 3.4 cm, grossly unchanged since prior examination\ngiven the limitations of a nonenhanced study. Again seen is loss of normal\nfat plane between the duodenum and gallbladder fossa. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. Few diverticulosis\nof the sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. Suture material is seen in the right lower quadrant consistent\nwith prior bowel surgery. The colon and rectum are otherwise unremarkable. \nThe appendix is not visualized, however no secondary signs acute appendicitis.\n.\n\nPELVIS: Patient is status post cystectomy with creation of neobladder. There\nis a Foley catheter within the neobladder. Again seen is extensive locules of\ngas within the neobladder which is diffusely thick-walled measuring up to 0.8\ncm. There is contrast opacification of the bladder secondary to renal\nexcretion of IV contrast received on ___ with small amount of\ncontrast seen within the bilateral renal collecting systems. Oral contrast\nreceived by the patient extends to the proximal and mid small bowel with\nminimal oral contrast within the bowel loops surrounding the neobladder. \nGiven adjacent bowel loops are without oral contrast and patient received IV\ncontrast 24 hours prior the contrast within the bladder is consistent with\nrenal excretion. No colovesical fistula. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Status post prostatectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine. No focal lytic or\nblastic lesions worrisome for malignancy.\n\nSOFT TISSUES: There is a small fat containing ventral hernia. The abdominal\nand pelvic wall is within normal limits.", "output": "1. No colovesical fistula in a patient who is status post cystectomy and\nprostatectomy with neobladder creation.\n2. Diffusely thickened bladder wall with extensive intraluminal gas may be\nrelated to self catheterization however infection would be similar in\nappearance.\n3. Persistent irregular wall thickening of duodenum with extension to the\ngallbladder most likely represents the pericholecystic collection previously\ndescribed on ___ CT, however further assessment of collection is\nlimited due to absence of IV contrast.\n4. Mild progression of multifocal pneumonia.\n5. Percutaneous cholecystostomy tube is in unchanged position.\n6. Stable partially calcified pancreatic body/tail lesion, incompletely\ncharacterized.\n\nRECOMMENDATION(S): Clinical correlation recommended for cystitis of\nneobladder.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:09 ___, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Re- demonstration of mild intrahepatic biliary ductal dilation.\nThere is persistent pneumobilia, especially within the left lobe of the liver,\nindicating CBD stent patency. The position and appearance of the CBD stent is\nunchanged. There are numerous arterially enhancing rounded areas seen\nscattered throughout the hepatic parenchyma, with no corresponding lesions\nidentified on the more delayed phases. These likely represent transient\nhepatic attenuation differences. However, re- demonstration of a 5 mm\nhypodensity within segment 4A, unchanged in appearance but again concerning\nfor focal metastatic lesion given its interval appearance over serial imaging.\nThere is moderate gallbladder wall thickening, without distention of the\ngallbladder itself. There is pericholecystic hyper enhancement noted on the\narterial phase of the study, in addition to a tract extending towards the\ncolon. There are 2 small fluid collections adjacent to the gallbladder. \nThese are new. The findings suggest underlying chronic cholecystitis, with\nstrong suspicion of impending chole-colonic fistula. The previously noted\nnecrotic porta hepaticus lymphadenopathy is seen, once again containing\nfiducial markers, it and measuring 3.1 x 3.7 cm, not significantly changed\nwhen compared to prior. Similarly, a perihepatic fluid collection is seen in\n___'s pouch measuring 5.1 x 6.5 cm, again not significantly changed.\n\nPANCREAS: There is persistent dilation of the main pancreatic duct, with\ntransition occurring at the level of the CBD stent. Suspect mild obstruction\ndue to the CBD stent. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Left parapelvic cysts are noted and are unchanged.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is an enlarged portacaval node which is centrally hypodense\nconsistent with necrosis measuring 3.8 x 3.1 cm. This is relatively stable in\nsize, previously measuring 4.1 x 2.5 cm. There is an inter aortocaval node\nthat measures 1.5 x 1.2 cm, previously 1.5 x 1.1 cm, also stable There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable of wall thickening and fat stranding surrounding the common bile\nduct stent consistent with cholangiocarcinoma\n2. Stable portacaval and inter aortocaval lymphadenopathy\n3. Stable 0.6 cm liver lesion in segment ___ A concerning for metastatic\ndisease\n4. Stable dilatation of the main pancreatic duct\n5. There is worsening wall thickening of the gallbladder with new small\ncontain fluid collections adjacent to the gallbladder and a new small tract of\nfluid extending towards the hepatic flexure of the colon. There is adjacent\nfat stranding. This is consistent with chronic cholecystitis with contained\nperforation and pending development of a cholecysto-colonic fistula.\n\nNOTIFICATION: The findings were discussed with The findings were discussed\nwith ___, M.D. by ___, M.D. on the telephone on ___\nat 4:01 ___, 10 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Incidental note is made of a small splenule.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis mild sigmoid diverticulosis without evidence of diverticulitis. Otherwise,\nthe colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nsclerotic focus in the L4 vertebral body is most consistent with a bone\nisland.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No CT findings in the abdomen or pelvis to correlate with patient's symptoms." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. There has been\ninterval excision of a perianal mass.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis a necrotic left inguinal lymph node, measuring similarly to the prior\nexamination (2.8 x 2.8 cm).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a peripherally enhancing metastatic implant within the\nrectus abdominus muscle on the left (image 101, series 5), measuring 2.2 cm AP\nx 2.0 cm transverse.", "output": "1. New, 2.2 cm peripherally enhancing metastatic implant within the left\nrectus abdominus muscle.\n2. Peripherally calcified, necrotic left inguinal node, similar in size to the\nprior examination, also likely metastatic.\n3. Interval resection of the patient's perianal mass." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. A pleural-based centrally\nhypodense lesion is noted in the left chest wall near the diaphragm (series\n11, image 8), new from prior. Multiple necrotic epicardial lymph nodes are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 1.4 x 0.8 cm left adrenal nodule is new from the prior\nexamination. In the right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nA hypodensity in the interpolar region of the right kidney is too small to\ncharacterize but likely represents a simple renal cyst, unchanged from prior. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Assessment of the rectum is limited,\nhowever there is some suggestion of mild lateral asymmetry, unchanged. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: Intermediate density collection with eggshell calcifications in\nthe left inguinal region is overall unchanged. A left external iliac lymph\nnode measures 1.1 x 1.1 cm (series 4, image 97), significantly increased from\nprior.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple heterogeneous masses in the left rectus abdominus are\nsignificantly increased in size from the prior examination. For example, an\napproximately 5.3 x 3.4 cm mass previously measured 2.2 x 2.0 cm in its\ngreatest dimension. A heterogeneous intra-abdominal mass measuring up to 6.1\nx 4.0 cm was not definitely seen on the prior examination. Portions of the\nmass eliminate fat planes between the greater curvature of the stomach and the\ntransverse colon. There is no evidence of invasion or obstruction. Multiple\nadditional intraperitoneal satellite nodules in the left hemiabdomen are also\nnew or significantly increased in size. Numerous soft tissue omental nodules\n(series 4, image 98, 99, 72, 77, 81, 54) are new from prior examination.", "output": "1. Extensive new left adrenal, omental, intraperitoneal and abdominal wall\nsoft tissue masses concerning for disease progression. Please see CT of the\nchest from the same date for intrathoracic findings. Assessment of the anus\nand rectum is technically limited." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable. Thickening of the left\nadrenal gland is not appreciably changed compared to prior, measuring 1.7 x\n1.3 cm, previously 1.6 x 1.2 cm\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: Necrotic left inguinal lymph node with peripheral calcification\nin the left inguinal region measures 2.6 x 2.6 cm, unchanged. Previously\ndescribed left external iliac chain lymph node is no longer seen. There is no\nretroperitoneal or mesenteric adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a lytic lesion in the left femoral head with a well-defined sclerotic\nborder, although not seen previously demonstrates no concerning features.\n\nSOFT TISSUES/OMENTUM:Omental nodularity/intraperitoneal lesions and left\nrectus abdominus/oblique intramuscular lesions have decreased substantially\ncompared to prior. For example, the largest lesion in the left rectus\nabdominus muscle now measures 1.9 x 1.4 cm, previously 5.0 x 2.7 cm (series 2,\nimage 96).\n\nAn omental nodule demonstrating decreased size includes a left lower quadrant\nnodule measuring 0.7 x 1.2 cm, previously 3.0 x 3.3 cm (Series 2, image 99). \nIn addition, a large partially necrotic omental mass measuring up to 6.5 x 3.2\ncm previously, has essentially resolved. No new omental or soft tissue\nlesions are identified.\n\nEnhancement in the region of the anus has also decreased, although CT\nevaluation of the anus is limited.", "output": "1. Significant interval improvement of metastatic disease with substantial\ndecrease in size of omental and abdominal wall metastases.\n2. Stable left adrenal lesion, likely a metastasis.\n3. No new sites of disease in the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 1.6 cm left adrenal metastasis is unchanged. The right adrenal is\nnormal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. Omental nodule\nagain noted, not significantly changed (image 99, series 4).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nPeripherally calcified necrotic left inguinal lymph node measures 2.3 by 2.5\ncm.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple intramuscular metastases noted along the abdominal\nwall, some of which have increased in size. For example: There is a pearly\nfully enhancing mass in the left rectus abdominus measuring 2.1 cm AP x 2.8 cm\ntransverse, previously 1.4 x 1.9 cm, using similar measurements. A more\ninferior mass measures 2.2 x 2.7 cm, previously 1.2 x 1.3 cm. Large\nmetastatic lesion in the left rectus abdominus (image 52 of series 4) is\nsimilar appearance to the prior examination.", "output": "Progression of disease, characterized by growing intramuscular metastases in\nthe abdominal wall as above. Omental and left adrenal metastases are\nunchanged." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 8.6 mm left adrenal metastasis appears decreased in size compared to\nprior exam performed ___ (series 2, image 57). The right adrenal\ngland is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. Re-demonstration a\nstable omental nodule, without significant change from prior exam (series 2\nimage 95).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. Again\ndemonstrated is a peripherally calcified necrotic left inguinal lymph node\nmeasuring 2.4 x 2.3 cm (series 2, image 112) that appears grossly unchanged\ncompared to prior exam.\n\nVASCULAR: There is no abdominal aortic aneurysm..\n\nBONES: Sclerotic inferior posterior endplate abnormality of the L3 vertebral\nbody and anterior superior endplate of the L5 vertebral body without interval\nchange compared to prior exam performed ___. Lytic lesion of the left\nfemoral head with a well-defined sclerotic border measures 1.2 cm (series 2\nimage 112 through 114) and appears increased in size compared to prior exam\nperformed in ___, and is concerning for a metastasis.\n\nSOFT TISSUES: Again demonstrated are multiple intramuscular metastases along\nthe abdominal wall. A 3.2 x 2.7 cm partially enhancing mass in the left\nrectus abdominus (series 2, image 102), previously 2.8 x 2.1 cm appears\nminimally increased in size. A more inferior mass measuring 1.8 x 1.1 cm\npreviously 2.2 x 2.7 cm appears decreased in size compared to prior exam\n(series 2, image 98). Previously described large metastatic lesion in the\nsuperior aspect of the left rectus abdominus appears decreased in size\ncompared to exam performed ___ (series 2, image 49).", "output": "1. Progression of a lytic lesion of the left femoral head compared to prior\nstudy performed in ___, is concerning for metastasis. Recommend bone\nscan for further evaluation.\n2. Minimal increase of a partially enhancing mass in the left rectus abdominus\ncompared to prior exam performed ___. Adjacent more inferior mass\nappears decreased in size compared to prior exam. No evidence of new or\nenhancing lesions.\n3. Decrease in size of a left adrenal mass compared to prior exam performed ___.\n4. Stable appearance of an omental nodule.\n5. Stable appearance of previously described necrotic left inguinal lymph\nnode.\n6. Additional findings as described above.\n\nNOTIFICATION: Was entered by Dr. ___ on ___ at 13:44 into\nthe Department of Radiology critical communications system for direct\ncommunication to the referring provider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged, measuring 13.9 cm\n\nADRENALS: The right adrenal gland is unremarkable. There is interval decrease\nin size of a left adrenal lesion, measuring 1.2 x 1.7 cm, previously 1.6 x 2.3\ncm.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon appears\nunremarkable. The previously described focus of enhancement along the left\nlateral aspect of the anus is unchanged (5:116). The appendix is not well\ndemonstrated.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. A\npreviously seen left pelvic sidewall mass may be contiguous with the larger\nleft anterior abdominal wall mass but also appears decreased in size compared\nto the prior study, measuring 3.2 x 2.5 cm, previously 4.1 x 2.9 cm (5:102). \nA calcified left inguinal lymph node is unchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: The lytic lesions in the left femoral head and inferior aspect of the\nleft-sided L3 vertebral body are unchanged since ___.\n\nSOFT TISSUES: There is similar appearance in the size of a soft tissue\nheterogeneous mass along the left upper anterior abdominal wall slightly\ninferior to the level of the sternum, measuring 3.8 x 3.7 cm, with persistent\nmass effect upon the left hepatic lobe (05:51). A heterogeneous enhancing\nsoft tissue mass seen encasing and invading the lower left ribs appears\nslightly increased in size, measuring 6.2 x 4.7 cm, previously 5.2 x 4.0 cm\n(05:53). There is interval decreased size of a heterogeneous mass along the\nleft lower anterior abdominal wall which measures 9.8 x 7.7 cm, previously\n12.5 x 8.4 cm (5:97), with persistent mass effect on the small and large\nbowel. Previously seen soft tissue lesions along the right rectus abdominus\nmuscle are not well seen on today's study.", "output": "1. Interval decrease in the size of multiple soft tissue metastatic lesions\nincluding left lower abdominal wall, right lower anterior abdominal wall, and\nleft adrenal nodule since ___.\n2. However, a left lateral wall lesion encasing the lower ribs appears\nslightly increased in size since the prior study. Other soft tissue lesions\nand known lytic osseous lesions are unchanged.\n3. Please refer to the same day CT chest exam for full description of\nintrathoracic findings." }, { "input": "LOWER CHEST: Large right epicardial and left pleural based metastatic foci are\nincreased in size compared to ___. Please refer to separate report of\nCT chest performed on the same day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Interval enlargement of the spleen currently measuring 16.4 cm,\npreviously 14.1 cm (09:25). No focal splenic lesions are identified.\n\nADRENALS: There has been interval enlargement of a left adrenal mass currently\nmeasuring 3.3 x 2.1 cm, previously 1.7 x 1.2 cm (06:55). The right adrenal\ngland is normal in size and shape. The\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized. Previously\ndescribed focus of enhancement along the left lateral aspect of the anus is\nless conspicuous on current exam (6: 118-119). New omental mass, suspicious\nfor a new focus of metastatic disease measures 3.9 x 3.1 cm (6:81).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. A\nheterogeneous left inguinal lymph node with rim calcification appears slightly\ndecreased in size compared to ___ currently measuring 1.6 x 1.3 cm,\npreviously 1.9 x 1.7 cm (6:108).\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. The left external iliac vein is not well demonstrated as it courses\nalong the lesser pelvis just inferior to the sacroiliac joint (6:94-100). \nThis is suspicious for occlusion, secondary to either thrombosis or\ncompression from overlying soft tissue metastatic disease, or combination of\nthe twp.\n\nBONES: Lytic lesions of the left femoral head and posterior aspect of the L3\nvertebral body are largely unchanged compared to ___ sees 6:110, 73).\nNo additional osseous lesions are identified.\n\nSOFT TISSUES: Compared to exam dated ___ there has been interval\nincrease in size of the majority of the known soft tissue metastatic foci,\nwith additional new foci of disease. For example a heterogeneous mass along\nthe left upper anterior abdominal wall, just inferior to the sternum currently\nmeasures 5.8 x 5.7 cm, previously 3.7 x 3.5 cm (06:54). This results in\ncontinued mass effect on the left hepatic lobe. There has been interval\nresolution of a previously described soft tissue mass of the left lower ribs\nwhich is not well demonstrated on current exam, however there continues to be\npersistent destructive changes of the left lower ribs. There has been\ninterval increase in size of a left lower abdominal/upper pelvic wall mass\ncurrently measuring 11.4 x 9.3 x 11.4 cm, previously 8.4 x 6.8 x 10.4 cm\n(6:97, 10:37). A previously described left pelvic sidewall mass is now\nincreased in size compared to prior exam currently measuring 6.4 x 3.0 cm,\npreviously 3.2 x 2.5 cm (6:101). More inferiorly there is a rim enhancing 3.4\nx 3.1 cm lesion posterior to the pubic symphysis which is new compared to\nprior exam and concerning for an additional foci of metastatic disease\n(6:110). This results in mild mass effect on the superior aspect of the\nbladder dome. There is a new heterogeneous mass in the left adductor brevis\nmeasuring 3.8 x 3.3 cm, suspicious for a new foci of metastatic disease\n(6:122). Small enhancing soft tissue mass overlying the skin of the anterior\nlower pelvis is new and also suspicious for a new focus of metastatic disease.\nThere appears to be overall increased soft tissue edema of the bilateral\nanterior thighs, left greater than right, likely secondary to obstruction of\nthe left external iliac vein as described above.", "output": "1. Interval progression of disease with new or enlarging metastatic soft\ntissue lesions of the anterior abdominal wall, pelvis, omentum, and right\nadrenal gland as described above.\n2. Occlusion of the left external iliac vein is likely secondary to either\nthrombosis or compression from overlying soft tissue metastases. This results\nin increased soft tissue edema of the left upper thigh.\n3. Interval resolution of a left lower rib soft tissue mass compared to ___.\n4. Increased splenomegaly measuring up to 16.4 cm, previously 14.1 cm.\n5. Please refer to separate report of CT chest for description of the\nintrathoracic findings.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:41 am, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Right epicardial and left pleural metastases are again seen,\nplease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic biliary\nductal dilatation likely related to post cholecystectomy status. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 16.1 cm, similar to prior and\ndemonstrates normal attenuation throughout, without evidence of focal lesions.\n\nADRENALS: There is a new 1.4 cm hypodense right adrenal lesion. A 3.5 x 2.6\ncm left adrenal nodule has increased in size compared to prior (previously 3.3\nx 2.1).\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions. There is moderate left hydronephrosis, new compared\nto prior. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: There is a heterogeneously enhancing mass seen within the pelvis which\ninvades into the anterior abdominal wall increased in size compared to prior, \nmeasuring 12.6 x 9.9 x 13.1 cm, previously 11.4 x 9.3 x 11.4 cm. This mass is\nseen extending through the inguinal canal into the left upper thigh. A rim\nenhancing lesion posterior to the pubic symphysis measures 4.1 x 3.2 cm,\npreviously 3.4 x 3.1 cm, and causes mass effect on the urinary bladder. There\nis a large volume of free fluid in the pelvis.The uterus and bilateral ovaries\nare not visualized.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. A mesenteric\ndeposit along the left anterior abdominal wall measures 5 x 4.8 cm, previously\n3.9 x 3.1. The left pelvic sidewall mass previously measured 6.4 x 3 cm and\nnow measures 6.9 x 3.5 cm. A heterogeneous calcified left inguinal lymph node\nis again seen and measures 1.8 x 1.4 cm, similar to prior.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. The left external iliac vein cannot be traced just distal to the\nbifurcation of the left common iliac vein scratch concerning for occlusion.\nThere is compression of the left renal vein by the superior mesenteric artery\nconcerning for nutcracker phenomenon.\n\nBONES: A 1.6 cm lytic lesion in the left femoral head in a 1.2 cm lytic lesion\nin the L3 vertebral body are not significantly changed compared to prior. \nThere is erosion of the ninth and tenth lateral left ribs secondary to\nenhancing soft tissue mass.\n\nSOFT TISSUES: A 6.9 x 6.1 cm hypodense mass is seen along the anterior chest\nwall inferior to the sternum involving the costochondral cartilage multiple\nmid thoracic ribs has increased in size compared to prior, previously\nmeasuring 5.8 x 5.7 cm. This lesion demonstrates mass effect on the liver. A\n8.6 x 4.1 cm lobulated mass is seen in the left thigh, which previously\nmeasured 3.8 x 3.3 cm. There are new soft tissue nodules within the anterior\nabdominal wall, measuring up to 8 mm (5; 87, 89). A left anterior pelvic soft\ntissue nodule has increased in size and now measures 1.5 cm. There is\nincreasing edema of the left thigh likely secondary to external iliac vein\nocclusion.", "output": "1. Interval progression of disease with new lesions, including a right adrenal\nnodule and soft tissues nodules along the anterior abdominal wall, and\nenlarging metastatic soft tissue lesions throughout the abdomen and pelvis as\ndescribed above.\n2. New moderate left hydronephrosis, likely due to ureteral compression by\npelvic metastases.\n3. Unchanged occlusion of the left external iliac vein with worsening left\nthigh subcutaneous edema.\n4. Stable splenomegaly.\n5. Please see the separate report for the same day CT chest for intrathoracic\nfindings." }, { "input": "LOWER CHEST: A partly imaged left paraspinal mass is bigger, now measuring up\nto 7.4 cm (5:9), previously 5.4 cm. A large, partly imaged 11.0 cm mass right\nlateral to the heart (5:12) is also bigger, previously 9.6 cm. A large mass\nencasing the left lower anterior costosternal cartilage is similar at 6.9 cm\n(05:25), previously 6.8 cm.\n\nModerate left and small right dependent pleural effusions are new. No\npericardial effusion is seen. There is mild bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The portal and hepatic veins are\npatent. Mild intrahepatic biliary ductal dilatation is similar and likely\nrelated to prior cholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen is enlarged at 15.1 cm, without focal lesions identified.\n\nADRENALS: A 2.8 cm right adrenal mass is bigger (05:24), previously 1.4 cm. A\n3.6 cm left adrenal mass (05:26) is not significantly changed, previously 3.5\ncm.\n\nURINARY: The kidneys are of normal and symmetric size. Moderate to severe\nleft hydroureteronephrosis is progressed, associated with asymmetrically\ndecreased in left kidney perfusion. Innumerable hypoattenuating lesions in\nthe bilateral kidneys are new and measure up to 1.4 cm in the right lower pole\n(05:34). There is no right hydronephrosis.\n\nGASTROINTESTINAL: There is no gastrointestinal obstruction. Moderate to large\nvolume abdominopelvic ascites is increased. No pneumoperitoneum.\n\nPELVIS:\nA large 13.8 x 12.3 x 16.1 cm (5:72, 07:23) peripherally enhancing, centrally\nnecrotic mass in the left pelvis is bigger, previously 12.6 x 9.9 x 13.1 cm. \nThis large masses is now contiguous with a separate large necrotic mass in the\nleft upper thigh, which is also larger at 13.3 cm, previously 10.2 cm, and a\nsmaller necrotic mass posterior to the pubic symphysis.\n\nThe urinary bladder is collapsed around a Foley balloon.\nThe uterus is grossly unremarkable (08:37). The ovaries are not seen.\n\nLYMPH NODES: Extensive conglomerated, necrotic retroperitoneal\nlymphadenopathy, which encases the aorta, is progressed. There is no new left\npelvic sidewall or left inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nThere is marked attenuation of the left main renal artery and main renal vein\nsecondary to surrounding masses. The left external iliac vein is again not\nseen and may be occluded or severely compressed from the adjacent pelvic mass.\n\nBONES: A lytic lesion in the inferior L3 vertebral body and lucency in the\nleft femoral head are unchanged. There are increased erosive changes to the\nposterior left tenth and eleventh ribs secondary to an enlarging conglomerated\nchest wall mass, which now measures up to 3.8 cm (05:21) in aggregate,\npreviously 2.4 cm. No new aggressive appearing osseous lesions are seen.\n\nSOFT TISSUES: Diffuse anasarca is worse. Additional soft tissue nodules in\nthe low anterior pelvic subcutaneous fat (5:67) are also bigger.", "output": "1. Compared to ___, there is progression of disease throughout the\nlower chest, abdomen and pelvis, and presumed innumerable new metastatic\nlesions to the kidneys, as detailed above.\n2. Worsening moderate to severe left hydroureteronephrosis is likely secondary\nto ureteral compression by the large left pelvic mass. Asymmetrically\ndecreased enhancement of the left kidney is compatible with decreased renal\nperfusion/function.\n3. Marked attenuation of the main left renal artery and vein secondary to\nsurrounding masses.\n4. Persistent occlusion of the left external iliac vein.\n5. Worsened diffuse anasarca." }, { "input": "Heart size is normal without significant pericardial fluid. Lung bases are\nclear.\n\nCT abdomen without contrast: The liver, gallbladder, spleen, pancreas and\nadrenal glands are normal in the context of a noncontrast study.\n\nObstructing density in the right lower pelvis measures 7 x 3 mm (601b:32). \nMild fullness of the right collecting system without frank hydronephrosis.\n\nThe stomach, duodenum and small bowel is normal caliber without evidence of\nobstruction. Large bowel is thin-walled and unremarkable without pericolonic\nfat stranding. Postsurgical changes from prior appendectomy.\n\nAbdominal aorta is normal caliber. A few scattered mesenteric lymph nodes are\nborderline enlarged measuring up to 10 mm. Scattered mesenteric and\nretroperitoneal lymph nodes are not pathologically enlarged. No ascites,\npneumoperitoneum or ventral abdominal hernia.\n\nCT pelvis without contrast: Bladder, rectum, uterus and ovaries are\nunremarkable. No free pelvic fluid or air. Inguinal and pelvic sidewall lymph\nnodes are not enlarged.\n\nRepeat acquisition with contrast: Mild fullness of the right renal collecting\nsystem without frank hydronephrosis. Kidneys present symmetric nephrograms\nand excretion of contrast without focal mass, hydronephrosis or perinephric\nstranding. The remainder of the visualized abdominopelvic structures post\ncontrast are unremarkable. The previously identified calcification in the\nright lower pelvis is mobile and has moved laterally between acquisitions.\n\nBones and soft tissues: No suspicious focal bone lesion.", "output": "Unremarkable CT examination of the abdomen and pelvis without explanation for\npatient's pain. An ovaloid density in the right lower pelvis is mobile and\nnot contained within the ureter, and does not represent a stone.\nNo evidence of stones or any other urological abnormality." }, { "input": "LOWER CHEST: Lungs are clear.\n\nHEPATOBILIARY: There is homogeneous hepatic enhancement with no suspicious\nmass lesions. Portal vein and hepatic veins are patent. Post\ncholecystectomy. There has been notable improvement in the main intrahepatic\nand extrahepatic biliary duct dilatation, with the common bile duct currently\nmeasuring 1.3 cm proximally compared to 2.5 cm previously.\n\nPANCREAS: There has been interval increase in the size of the anterior\npancreatic head/uncinate process hypoenhancing mass with associated cyst. \nThis currently measures 5 x 3.4 cm compared to 3.8 x 2.5 cm. The solid\ncomponent measures up to 4 cm. The mass abuts segment 4B but does not invade\nit. There is mild mass effect on the CBD as well. There is also show shaded\nmain pancreatic ductal dilatation which appears improved and measures 5 mm\ncompared to 8 mm previously.\n\nUpper abdominal arterial and venous branches are intact with no tumoral\ninvolvement.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Both adrenal gland are nodular and stable in appearance.\n\nURINARY:There is no hydronephrosis or nephrolithiasis or suspicious renal\nmasses. There are millimetric renal cortical hypodensities that are too small\nto characterize and stable compared to priors.\n\nGASTROINTESTINAL: Stomach is unremarkable. There is evidence of small bowel\nmalrotation with the small bowel loops appeared on the right side of the\nabdomen. Status post right hemicolectomy and sigmoidectomy. Areas of\nanastomosis are intact. Large bowel is on the left of the abdomen with\nscattered colonic diverticulosis and no diverticulitis.\n\nPERITONEUM: There is no ascites or peritoneal carcinomatosis.\n\nLYMPH NODES: There are subcentimeter peripancreatic.\n\nVASCULAR: There is high grade stenosis of the left renal artery. The\nabdominal aorta is moderately atherosclerotic. Given the presence of\nmalrotation, the SMA is on the right side of the SMV. Venous structures are\npatent as well with no vascular encasement or occlusion.\n\nPELVIS: Urinary bladder is unremarkable. There is notable mild rectal wall\nthickening with no mass lesions. There are no adnexal masses.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions. \nThere are degenerative changes of the thoracolumbar spine. There is incomplete\nfusion of the posterior spinous process L5. There is also pars defect of L5\nwith grade 1 anterolisthesis of L5 over S1.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Increasing size of pancreatic head mass, currently measuring up to 5 cm\nincluding the cystic component. No evidence of vascular invasion or\ninvolvement of the adjacent structures in the stting of bowel malrotation as\ndiscussed above.\n2. No distant metastatic disease.\n3. Improved common bile duct and pancreatic duct dilatation in spite of the\nincreasing size of pancreatic mass. Much of the mild dilation is likely from\nampullary stenosis or sphincteric dysfunction." }, { "input": "LOWER CHEST: Mild atelectasis is seen in the dependent aspects of both lower\nlobes.. There is no evidence of pleural or pericardial effusion. Right PICC\ntip terminates in the low SVC. Mild coronary artery calcifications are\ndemonstrated. Heart size is top-normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. Extensive pneumobilia is noted, likely reflecting sequela\nof hepaticojejunostomy. The gallbladder is surgically absent.\n\nAbutting the inferoposterior edge of hepatic segment IV B, there is a 1.7 x\n1.5 cm ovoid area of mixed fluid and gas (02:38). This appears to be in the\nsame location as the previously noted dilated common bile duct and likely\nreflects pneumobilia within the remnant common bile duct. Fluid/stranding in\nthe right upper quadrant surrounding the hepaticojejunostomy is nonspecific\nand may be related to recent operative procedure. No other definite organized\nfluid collections are seen.\n\nPANCREAS: Patient is status post ___'s procedure with postsurgical changes\nand multiple clips noted in the former area of the pancreatic head. The\nremaining pancreatic body and tail demonstrates normal attenuation, without\nevidence of focal lesions. There is been decrease in the size of the main\npancreatic duct, which now measures up to 4 mm in diameter. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions. Mild right-sided hydronephrosis\nis mildly improved from ___. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status post Whipple\nprocedure with hepaticojejunostomy and pancreaticojejunostomy. Fluid and\nstranding surrounds the hepaticojejunostomy and pancreaticojejunostomy in the\nright upper quadrant which are not opacified with oral contrast material. The\nsmall bowel loops otherwise are not dilated. Remaining small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nPatient is post right colectomy and sigmoid colectomy with intact anastomoses.\nDiverticulosis of the colon is noted, without evidence of wall thickening and\nfat stranding. Remainder of the colon and rectum are unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy. A\nmildly enlarged 8 mm mesenteric lymph node in the right lower quadrant (02:55)\nis bigger, previously 5 mm. Several additional prominent mesenteric lymph\nnodes in the right abdomen also appear larger, (02: 50, 51). There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Mesenteric malrotation is again noted, with the SMA on the\nright side of the SMV. Soft tissue stranding is noted about the root of the\nmesentery, likely due to postoperative changes.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nBilateral pars articularis defects are again seen at L5, with grade 1\nanterolisthesis of L5 on S1.\n\nSOFT TISSUES: Scattered foci of air in the subcutaneous fat of the anterior\nabdomen may be related to subcutaneous injections.", "output": "1. Status post Whipple procedure. Small amount of free fluid and stranding\nsurrounds the hepaticojejunostomy and pancreaticojejunostomy, nonspecific, and\nlikely postsurgical.\n2. 1.7 x 1.5 cm ovoid area containing an air-fluid level abutting the\ninferoposterior edge of hepatic segment IV B, at the previously seen location\nof the dilated common bile duct, likely represents pneumobilia within the\nremnant common bile duct. Differential also includes intraluminal contents\nwithin a bowel loop. A focal fluid collection or abscess is felt to be\nunlikely.\n3. Interval increase in size of several mesenteric lymph nodes, measuring up\nto 8 mm in the short axis, likely reactive. Attention on follow-up imaging\nrecommended." }, { "input": "LUNG BASES: Imaged lung bases are clear. There is partially visualized aortic\nvalvular calcification. Otherwise imaged portion the heart is unremarkable.\n\nABDOMEN: The liver enhances normally without concerning focal lesion. The\nmain portal vein is patent. No biliary ductal dilation. Gallbladder is\nnormal. Common bile duct is nondilated. The pancreas enhances normally. The\nspleen is normal in size. Adrenals are normal bilaterally. The kidneys\nenhance symmetrically. There is moderate bilateral hydroureteronephrosis\nwithout obstructing ureteral stone or discrete mass. Aorta is mildly\ncalcified and normal in caliber. No adenopathy, free air or free fluid. The\nstomach and the duodenum appear normal.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix is normal. The colon is thin walled and contains very mild fecal\nload. No free air or free fluid. The urinary bladder is markedly distended. \nThe prostate is enlarged measuring 6.1 x 4.9 cm. Findings suggest bladder\noutlet obstruction, likely the cause of bilateral moderate hydronephrosis and\nhydroureter. No pelvic sidewall or inguinal adenopathy is seen.\n\nBONES: No worrisome lytic or blastic osseous lesion.", "output": "Enlarged prostate likely causing bladder outlet obstruction with dilated\nurinary bladder and bilateral moderate hydroureteronephrosis." }, { "input": "LOWER CHEST: Left bibasilar dependent atelectasis is noted. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Splenic artery aneurysm with calcification is\nnoted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There has been\ninterval improvement of overall extent of fat stranding associated with acute\nsigmoid diverticulitis. No acute complication. Appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Splenic artery aneurysm with calcification is noted.\n\nBONES: Moderate degenerative changes L3-5. No evidence of acute fracture or\nworrisome osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Persistent sigmoid diverticulitis with mild interval improvement in overall\nextent of surrounding inflammation." }, { "input": "LOWER CHEST: New small right pleural effusion with compressive atelectasis. \nAgain seen is elevation of the left hemidiaphragm with intrathoracic stomach\nand herniation of the mesenteric fat, portions of the colon and portions of\nthe pancreas, as on prior.\n\nABDOMEN: Cholecystectomy changes are demonstrated with similar low-density\nlesion at the gallbladder fossa, either sequela of intervention or related to\ntrauma gallstones. The liver, spleen, adrenal glands and the kidneys are\nunremarkable, aside from stable hepatic and hypodense renal lesions too small\nto characterize. Stable 14 mm pancreatic cystic lesion at the head, likely a\nside branch IPMN. The hepatic vasculature is patent.\n\nGASTROINTESTINAL: No bowel obstruction or ascites. The appendix is\nunremarkable\n\nPELVIS: There is no free fluid in the pelvis. Nonspecific presacral edema\nlikely reflecting third spacing.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. New IVC filter. There is occlusive clot which extends\ninferior to the filter and involves the inferior vena cava, bilateral common\niliac veins, left internal iliac vein and proximal branches and a short length\nsegment of the distal (towards head) left external iliac vein. There is\nadditional nonocclusive thrombus involving the proximal left external iliac\nvein as well as the distal aspect of the left profunda femoral vein. On the\nright the occlusive thrombus involves the right internal iliac and branches as\nwell as the right external, common femoral and the visualized profunda femoral\nand+ femoral veins. The distal greater right saphenous is also thrombosed.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is new high attenuation within the psoas and left iliacus\nmuscles which appear mildly expanded concerning for intramuscular hemorrhage. \nInter resolution of prior left abdominal wall hematoma. Sequela of injections\nin the anterior abdominal wall and worsening anasarca are noted.", "output": "-Extensive thrombosis of the IVC inferior to the filter with occlusive\nthrombus involving most pelvic deep veins and femoral veins as described.\n-Small amount of intramuscular hemorrhage involving the left iliopsoas and\niliacus muscles.\n- Stable 14 mm pancreatic cystic lesion, amenable to follow up with MRI in\none year.\n- Additional findings as above.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 2:26 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: The imaged lung bases are clear.\n\nABDOMEN: The liver enhances normally without focal concerning lesion. Focal\nfatty deposition is noted along the periphery of segment 4B. The gallbladder\nappears normal. Main portal vein is patent. No biliary ductal dilation. The\npancreas appears normal. The spleen is normal. Adrenals are normal\nbilaterally. The kidneys enhance symmetrically and demonstrate prompt\nexcretion of contrast. No hydronephrosis or signs of pyelonephritis. The\nabdominal aorta is minimally calcified and normal in course and caliber. The\nstomach is decompressed. The duodenum is normal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is not visualized though there are no secondary signs of appendicitis\nin the right lower quadrant. There is colonic diverticulosis. At the level\nof the sigmoid colon, there is extensive perisigmoid fat stranding with a\nsmall developing abscess seen on series 601, image 32 measuring approximately\n2.0 x 5.5 x 2.4 cm. This collection abuts small bowel loops and there is an\nincomplete rim of peripheral enhancement suggesting a developing\nabscess/phlegmon. Additional pockets of fluid noted interposed between the\nsigmoid colon and the urinary bladder best seen on series 601, image 29\nmeasuring approximately 2.6 x 2.4 x 2.4 cm. There is trace extraluminal gas. \nFindings consistent with complicated diverticulitis. Reactive thickening\nalong the urinary bladder is noted without definite signs of fistula\nformation. No evidence of septic thrombophlebitis in the IMV. The prostate\ngland appears slightly prominent. Urinary bladder is not fully distended.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Complicated sigmoid diverticulitis with perisigmoid phlegmon and developing\nsmall abscesses, described above. Thickening of the adjacent urinary bladder\nlikely reactive without definite fistula formation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are no suspicious hepatic lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is no hiatal hernia oral contrast extends to the level\nof the ascending colon. There is no bowel obstruction. A left lower quadrant\npigtail drainage catheter is located adjacent to the sigmoid colon. Compared\nto prior examination there has been significant interval improvement of\ninflammatory changes of diverticulitis with mild sigmoid wall thickening and\nfat stranding still present. There are also a few scattered foci of\nextraluminal air adjacent to the sigmoid colon including a loculated pocket of\nair containing minimal fluid adjacent to the ileal small bowel loops in the\nmid pelvis (series 2, image 69). Small bowel in this location are mildly\nthickened. No drainable fluid collection is seen.\n\nPELVIS: There is persistent but improved thickening of the left bladder dome. \nNo air is seen within the bladder to suggest fistulization. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval improvement of inflammatory changes of sigmoid diverticulitis with\na few extraluminal locules of air, mild fat stranding, and mild sigmoid wall\nthickening still noted. Essentially complete resolution of multiple small\nabscesses, including the abscess surrounding the percutaneous pigtail drainage\ncatheter.\n2. Mild wall thickening of pelvic ileal loops and the left bladder dome,\nlikely reactive." }, { "input": "LOWER CHEST: Imaged lung bases are clear. Imaged portion of the heart is\nunremarkable. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver enhances normally without focal concerning lesion. No\nintrahepatic biliary ductal dilation. Main portal vein is patent. \nGallbladder is normal without radiopaque stones. CBD is nondilated.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is normal in size of focal lesions.\n\nADRENALS: The adrenal glands are normal in caliber and configuration.\n\nURINARY: The kidneys are symmetric and normal in size, demonstrating normal\nnephrograms and excreting contrast promptly. There is no hydronephrosis or\nconcerning focal lesion. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are normal\nin caliber, without wall thickening or evidence of obstruction. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Urinary bladder is decompressed. Numerous pelvic phleboliths are\npresent. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal mass. Ovarian\ntissue appears relatively normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no focal lytic or sclerotic osseous lesion to suggest neoplasm\nor infection.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.", "output": "No acute intra-abdominal abnormality to explain the patient's symptoms. No\nevidence of small bowel obstruction." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRight renal pelvic fullness with asymmetrically delayed contrast excretion\ncompared to the left kidney and evidence of a 4 mm calcified stone at the\nright UVJ (502 image 1), is consistent with right obstructive\nureterolithiasis. There is no evidence of focal renal lesions. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: IUD appears to be in appropriate position, otherwise the\nuterus is unremarkable. A 4.9 x 4.5 x 4.6 cm simple appearing left ovarian\ncyst (2:66) is likely physiologic. The right adnexa is unremarkable.\n\nRETROPERITONEUM AND MESENTERY: There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy. There is no\nabdominal aortic aneurysm. No atherosclerotic disease is noted. The\nmesenteric vessels appear patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 4 mm stone at the right UVJ with mild right hydroureter and delayed\ncontrast excretion from the right kidney.\n2. 4.9 cm simple appearing left ovarian cyst is likely physiologic. No\nfurther follow-up is necessary.\n3. Normal appendix." }, { "input": "LOWER CHEST: Imaged lung bases are clear. The imaged portion of the heart is\nunremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: There are several ill-defined hypodense liver lesions, largest\nresiding in segment 4B measuring approximately 13.1 x 10.3 x 11.2 cm. The\ngallbladder appears encased along its mid segment by this hepatic mass without\ndefinite signs of gallbladder obstruction. A stone is noted within the\ngallbladder neck corresponding to findings on recent ultrasound, measuring\napproximately 1.8 x 2.4 cm. Infiltration of the wall of the gallbladder is\ndifficult to exclude. There is extension of tumor beyond the hepatic capsule\nwith nodularity and fatty infiltration noted anteriorly to segment 4, with\nprobable involvement of the greater omentum. Additional smaller\nsimilar-appearing lesions likely represent metastatic deposits within the\nliver. Main portal vein is patent. Thrombosis of a second order branch of a\nhepatic vein can be seen in the right lobe on series 601b, image 28. Main\nportal vein is patent. There is mild intrahepatic biliary ductal dilation\nthough the CBD is nondilated. There is a prominent periportal lymph node seen\non series 601b, image 31 measuring 16 mm in short axis. A second adjacent\nprominent node measures 18 mm in short axis on series 2, image 17. A large\nportacaval lymph node measuring 27 mm in short axis on series 601 B image 35\n\nPANCREAS: The pancreas appears normal.\n\nSPLEEN: The spleen appears normal.\n\nADRENALS: Adrenals are normal bilaterally.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly. A\nsimple appearing left renal upper pole cyst measures 3.6 x 2.6 cm without\nconcerning features. No hydronephrosis or worrisome renal lesion.\n\nGASTROINTESTINAL: The stomach and duodenum appear normal. Loops of small\nbowel demonstrate no signs of ileus or obstruction. The appendix is normal. \nThe colon is thin walled without significant fecal loading. There is no\npelvic sidewall or inguinal adenopathy.\n\nPELVIS: Urinary bladder is decompressed. Distal ureters appear normal. Trace\nfree pelvic fluid is noted.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nVASCULAR: The abdominal aorta is moderately calcified without aneurysm. \nHowever there is an aneurysm of the right common iliac artery measuring up to\n2.4 cm in diameter seen best on series 2, image 58.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An incision line in the right upper quadrant reflect recent\nsurgery.", "output": "1. Large infiltrative mass centered in segment 4A of the liver is concerning\nfor primary hepatic cellular carcinoma. Tumor extends beyond hepatic capsule\nwith involvement of the adjacent omentum. Biopsy is recommended.\n2. Numerous metastatic foci within the liver as well as enlarged periportal\nlymph nodes.\n3. Tumoral encasement of the mid segment of the gallbladder - difficult to\nexclude invasion. No definite signs of acute cholecystitis, though gallstone\nalso noted at the gallbladder neck. Consider utility of percutaneous GB\ndrainage.\n4. Hepatic vein thrombosis ___ order), detailed above. No portal vein\nthrombosis.\n5. Incidental aneurysm of the right common iliac artery up to 2.4 cm.\n\nRECOMMENDATION(S): Liver lesion biopsy.\nPossible percutaneous cholecystostomy drainage." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypoenhancing hepatic lesions (average ___ 24), the majority of which\nare too small to further characterize, the largest in segment II/IV measuring\n1.8 x 1.7 cm (3:42). There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 1.2 x 0.9 cm enhancing nodule arising from the lateral limb of the\nleft adrenal gland ___ 28, postcontrast ___ of 163 and delayed\nphase ___ of 75) demonstrates approximately 65% washout, most likely\nrepresenting an adrenal adenoma. The right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities in the left kidney are too small to further\ncharacterize, though most likely represent simple cysts. No concerning focal\nrenal lesion identified. No hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is no gastric wall\nthickening or focal gastric lesion identified. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The right ovary is enlarged, measuring 3.6 x 3.0 cm. \nThere is an adjacent 3.0 x 2.2 cm simple right paraovarian cyst (3:104). The\nleft ovary and uterus are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple scattered hypoenhancing hepatic lesions, the largest in segment\nII/IV measuring up to 1.8 cm. These most likely represent simple hepatic\ncysts, though given patient's history of gastric adenocarcinoma, MRI is\nrecommended for further evaluation.\n2. 1.2 x 0.9 cm enhancing left adrenal nodule, with intrinsic characteristics\nsuggestive of adenoma. However, given the calculated percentage of washout\nand provided history of gastric adenocarcinoma, MRI should be performed for\nadditional characterization.\n3. 3.0 x 2.2 cm simple right paraovarian cyst.\n4. Please see separate, same-day CT chest report for description of\nintrathoracic findings.\n\nRECOMMENDATION(S): MRI abdomen for further evaluation of hypoenhancing\nhepatic lesions and left adrenal nodule.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:11 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypo attenuating liver lesions with the largest measuring 1.7 cm in\nsegment II/IV (series 4, image 43), and the remainder of which are too small\nto further characterize, likely representing simple cysts. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Enhancing nodule measuring 1.3 cm in the lateral limb of the left\nadrenal gland appears unchanged from prior study, consistent with previously\ncharacterized adrenal adenoma. Right adrenal gland is normal in appearance.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Enlarged right ovary measuring 3.6 x 3.4 cm, with\nadjacent simple right ovarian cyst measuring 2.2 x 2.1 cm, both of which\nappear unchanged from prior. The uterus and left adnexa are normal in\nappearance.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of recurrence or metastatic disease within the abdomen or\npelvis.\n2. Left adrenal nodule measuring 1.3 cm appears unchanged from prior study,\nconsistent with adrenal adenoma.\n3. Simple right ovarian cyst measuring 2.2 x 2.1 cm.\n4. For description of intrathoracic findings, please see dedicated report of\nCT chest performed on same day." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRe-demonstrated are multiple hypoattenuating liver lesions, the largest of\nwhich measures up to 1.7 cm in segment 4 (02:42). The remainder are too small\nto characterize, but likely represent cysts/hamartomas. There are no new\nfocal liver lesions. There is no evidence of intrahepatic biliary dilatation.\nThere is mild dilatation of the common bile duct, likely secondary to\ncholecystectomy. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A left adrenal nodule measures 1.3 cm (02:51), unchanged. This\nmeasured 6 ___ on noncontrast CT dated ___ and is consistent with an\nadrenal adenoma. The right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities bilaterally are too small to characterize, but\nlikely represent simple cysts. There is no evidence of suspicious renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post distal gastrectomy with loop\ngastrojejunostomy. Remaining small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized. A dropped cholecystectomy\nclip is seen in the right lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: As before the right ovary is enlarged measuring 3.7 x 3.2\ncm (previously 3.6 x 3.4 cm) with an adjacent right ovarian cyst measuring 2.7\nx 2.8 cm (previously 2.2 x 2.1 cm) (2:102, 103). The uterus and left adnexa\nare unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\npunctate focus of sclerosis in the right acetabulum is unchanged and likely a\nbone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite evidence of recurrence or metastatic disease in the abdomen or\npelvis.\n2. Enlarged right ovary with slight interval growth of the right ovarian cyst,\ncurrently measuring 2.7 x 2.8 cm (previously 2.2 x 2.1 cm). Given the\npatient's age, pelvic ultrasound is recommended for further evaluation.\n3. Stable left adrenal nodule measuring 1.3 cm is consistent with an adrenal\nadenoma.\n4. Please refer to dedicated CT chest performed the same day for description\nof intrathoracic findings.\n\nRECOMMENDATION(S): Recommend pelvic ultrasound for further evaluation of\nenlarged right ovary with adjacent right ovarian cyst." }, { "input": "LOWER CHEST: There is minimal scarring in the right lower lobe. The lungs are\notherwise clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is decompressed without\nradiopaque stones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions or hydronephrosis. There is no nephrolithiasis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. There is fat within the walls of the rectum and sigmoid\ncolon as well as the terminal ileum (series 2, image 60, 70, 65). There is no\nsurrounding fat stranding or wall thickening. The remainder of the colon is\nunremarkable. There is no evidence of free air or pneumatosis. The appendix\nis not visualized, however, no secondary signs of appendicitis are seen.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. The\nabdominal and pelvic wall is within normal limits.", "output": "1. No radiodense renal, ureteral, or bladder calculi. No collecting system\nobstruction.\n2. Fat within the wall of the rectum, sigmoid colon, and terminal ileum,\nconsistent with chronic inflammation, with a distribution suggestive of\nCrohn's IBD rather than ulcerative colitis. No active inflammation seen,\nwithin limitations of noncontrast technique." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder demonstrates gallbladder\nwall edema without evidence of distension, likely secondary to third spacing\nof fluid, hypoproteinemia, or hepatic dysfunction.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. Simple\ncysts are seen in the right kidney, the largest measures 1 cm in the lower\npole. There is no hydronephrosis. A 8 mm stone is seen in the lower pole of\nthe left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are seen\nmeasuring up to 1.1 cm (2; 66). There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. There is extensive atherosclerotic disease in the right\ncommon femoral artery, likely causing stenosis (2; 116).\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of intraabdominal or pelvic source of infection.\n2. Borderline enlarged retroperitoneal lymph nodes are nonspecific, recommend\ncomparison to prior if available, or repeat CT in ___ months with IV contrast\nif possible." }, { "input": "LOWER CHEST: Again seen are peribronchial opacities in the visualized\nbilateral lung bases, right greater than left, concerning for pneumonia. The\nleft lower lobe is completely collapsed, and there is dependent atelectasis in\nthe lingula and left upper lobe. There is partial atelectasis of the right\nlower lobe. There is occlusion of multiple segmental and subsegmental airways\nin both lower lobes. There are small bilateral pleural effusions. There are\ncoronary calcifications involving the LAD and left circumflex artery. \nFindings are unchanged compared to prior CT of the abdomen/pelvis from ___.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver demonstrates homogeneous attenuation throughout. A tiny\nhypodensity in segment III (02:31) is too small to characterize. There is no\nsuspicious hepatic lesion.\nIntra- and extrahepatic bile ducts are not dilated. Patient is status post\ncholecystectomy. Hematoma is again noted in the gallbladder fossa, similar in\nsize to the prior CT of the abdomen/pelvis from ___. Inferior\nperihepatic hematoma measures 5.5 x 1.8 cm, smaller than before (previously\n7.2 x 3.0 cm).\nA 5 mm round density adjacent to the inferior right hepatic lobe may represent\na dropped gallstone (02:43).\n\nPANCREAS: There is moderate diffuse fatty atrophy of the pancreas. There is\nno pancreatic duct dilation.\n\nSPLEEN: Spleen is normal size. Two small accessory spleens are noted in the\nregion of the splenic hilum.\n\nADRENALS: Bilateral adrenal glands are unremarkable.\n\nURINARY: Right kidney has been surgically resected. The left kidney\ndemonstrates normal corticomedullary differentiation. There is no focal left\nrenal lesion or hydronephrosis.\n\nGASTROINTESTINAL: A percutaneous gastrostomy tube is appropriately positioned\nin the stomach. Wall edema is identified in the gastric antrum, likely\nreactive to adjacent hematoma in the gallbladder fossa. Small and large bowel\nloops are normal in caliber. There are several scattered sigmoid diverticula.\n\nPELVIS: Beam hardening artifact from a left hip prosthesis limits evaluation\nof the pelvis. Bladder is underdistended and suboptimally evaluated.\n\nREPRODUCTIVE ORGANS: Central calcifications are noted in the prostate.\n\nLYMPH NODES: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVASCULAR: There is fusiform ectasia of the infrarenal abdominal aorta,\nmeasuring up to 2.8 x 2.6 cm in axial dimension. Aneurysmal bilateral common\niliac arteries measure 2.1 cm in diameter on the right and 2.2 cm on the left.\n1.0 cm penetrating atherosclerotic ulcer at the origin of right internal iliac\nartery is identified. Extensive atherosclerotic disease is noted. The common\nhepatic artery and SMA share a common origin, an anatomic variant. The\nsplenic artery arises separately from the aorta.\n\nBONES: Left hip prosthesis is present. Patient is post laminectomy and\nposterior spinal fusion at L3-5. Deformity at the left iliac wing may be\nsequelae of prior trauma or bone graft site. There is osteoarthritis of the\nright hip joint, as well as deformity and flattening of the right femoral\nhead.\n\nSOFT TISSUES: 2.2 cm thick-walled fluid collection anterior to the right\nacetabulum and posterior to the right femoral vessels remains unchanged. \nFocal areas of skin thickening and subcutaneous stranding in the right\nanterior abdominopelvic wall likely represent injection sites.", "output": "1. Hematoma in the gallbladder fossa is unchanged in size compared to CTA of\nthe abdomen/pelvis from ___. Inferior perihepatic hematoma is\nsmaller.\n2. Wall edema of the gastric antrum is similar to prior and is likely reactive\ndue to the adjacent hematoma.\n3. Fusiform ectasia of the infrarenal abdominal aorta measuring up to 2.8 cm\nin diameter. Aneurysmal bilateral common iliac arteries measuring 2.1 cm in\ndiameter on the right and 2.2 cm on the left.\n4. Peribronchial opacities in the visualized bilateral lung bases, right\ngreater than left, concerning for pneumonia. Complete collapse of left lower\nlobe and partial atelectasis of right lower lobe, and multiple occluded\nsegmental and subsegmental airways in bilateral lower lobes. Findings are\nunchanged from prior." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A gastric stimulator is again noted. PEG tube is in place.\nOtherwise, the stomach is unremarkable. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. The right ovary is\nunremarkable. The left ovary contains a 1.4 cm cystic structure, compatible\nwith a corpus luteum.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSmall sclerotic focus in the left femoral head is consistent with a bone\nisland.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Left corpus luteum. Otherwise, no CT findings in the abdomen and pelvis to\ncorrelate with patient's symptoms." }, { "input": "LOWER CHEST: Bibasilar atelectasis. There is no evidence of pleural or\npericardial effusion. Coronary artery calcifications. Mitral and aortic\nvalve calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic bilaterally. Large collections of\ncalcifications are seen in the right kidney. There is a relatively hypodense\nexophytic mass in the inferior pole of the right kidney, measuring 2.1 x 2.1\ncm, likely angiomyolipoma. There are two distinct well-circumscribed\nhypodensities in the interpolar region of the left kidney, measuring 3.8 x 2.5\nand 3.5 x 2.6 cm respectively, likely simple renal cysts. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a well-circumscribed hypodensity in the left\novary measuring up to 2.4 cm, likely a simple ovarian cyst. The reproductive\norgans are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite intra-abdominal or pelvic collection identified.\n2. Atrophic kidneys. 2.1 x 2.1 cm hypodense exophytic mass in the inferior\npole of the right kidney, likely AML. Probable left simple renal cysts." }, { "input": "CT OF THE ABDOMEN AND PELVIS WITH IV CONTRAST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nA 19 x 17 mm hypodensity along the periphery of hepatic segment. VI is\nunchanged since the ___ CT (series 2, image 58). No new hepatic mass\nis detected. The gallbladder appears normal.\n\nThe spleen size is normal. The stomach and intra-abdominal loops of small\nlarge bowel are within normal limits.\n\nAgain seen is a solid-appearing macrolobulated mass anterior to the right\nkidney, at the expected location of the right adrenal gland. While the\ncraniocaudal dimension, measuring 11 cm, appears minimally changed since ___, this lesion has decreased in size along the axial ___, with\nthe larger superior component measuring 5.7 x 4.2 cm (series 2, image 62) and\nsmaller inferior component measuring 5.6 x 5.0 cm (series 2, image 72).\nMultiple pancreatic metastases are difficult to define on this noncontrast\nexamination, but the dominant anterior mass measuring up to 2.1 cm\nanterioposteriorly (series 2, image 72) appears minimally changed. No new\nintra-abdominal or intrapelvic mass is obviously seen.\n\nMultiple hypodense lesions throughout the right kidney are unchanged, which\ndid not exhibit any appreciable internal contrast enhancement on prior\ncontrast-enhanced examinations, the largest arising from the posterior\ninterpolar aspect measuring 3.8 x 1.7 cm, more compatible with cysts. No new\nsolid right renal mass is identified.\n\nThe patient is post left nephrectomy and left adrenalectomy. No obvious\nrecurrent mass is seen at the resection site.\n\nThere are moderate atherosclerotic calcifications throughout the abdominal\naorta and iliac branches. A 3.7 x 2.9 cm infrarenal abdominal aortic aneurysm\nremains stable since ___ (series 2, image 79), but demonstrates\ngradual growth since the ___ CT.\n\nThe rectum and intrapelvic loops of small and large bowel are within normal\nlimits. The bladder and prostate are unremarkable.\n\nA 7.9 x 6.0 cm expansile mixed sclerotic and lytic mass left iliac mass is\nunchanged (series 2, image 92). No pathologic fracture is identified. No new\nosseous metastasis is seen. Mild retrolisthesis of L3 over L4 remains stable\n(series 602b, image 36).", "output": "1. Continued decrease in size of a right adrenal mass.\n2. Multiple pancreatic metastases are not well defined on this noncontrast\nexamination, but appear stable.\n3. Unchanged large expansile left iliac mass. No new osseous metastasis.\n4. Post left nephrectomy and left adrenalectomy, without obvious local\nrecurrence. Stable multiple right renal cysts.\n5. Unchanged segment VI hepatic lesion, previously characterized as a\nhemangioma.\n6. 3.7 cm infrarenal abdominal aortic aneurysm is unchanged since ___, but has gradually enlarged since ___." }, { "input": "Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nCT abdomen with contrast: Liver enhances homogeneously without focal lesion\nor biliary dilatation. Portal vein is patent. Gallbladder is unremarkable.\n\nSpleen, pancreas and adrenal glands are unremarkable. Small accessory spleen\nwithin the splenic hilum. Kidneys present symmetric nephrograms and excretion\nof contrast without focal lesion or hydronephrosis.\n\nRim enhancing hypodense mass within the proximal gastric body along the\ngreater curvature measuring 2.3 x 1.6 cm (601b:29), with a bilobed portion\nextending outside the gastric body measuring 2.0 x 1.8 cm (601b:28). Stomach\nis not distended and there is no evidence of obstruction. A segment of the\nsmall bowel beginning proximally from the third portion the duodenum into the\nproximal jejunum appears prominently thickened (601b:30) remainder of the\nsmall bowel loops are normal caliber without evidence of obstruction. Large\nbowel is thin-walled and unremarkable without pericolonic fat stranding or\nfluid collection. Millimetric appendicoliths are seen within an otherwise\nunremarkable appendix.\n\nAbdominal aorta is normal caliber. A few tiny perigastric lymph nodes are\npresent measuring up to 5 mm in short axis, not pathologically enlarged by CT\nsize criteria. Several prominent mesenteric lymph nodes in the left hemi\nabdomen measure up to 9 mm in short axis (3:74), not pathologically enlarged\nhowever some of these nodes demonstrate a somewhat rounded morphology such as\na 9 mm node in the jejunal mesentery (3:67) and some of these nodes\ndemonstrate abnormal surrounding inflammatory change (3:74).\n\nModerate fat containing umbilical hernia. No ascites or pneumoperitoneum.\n\nCT pelvis with contrast: Bladder, prostate and rectum are unremarkable. \nInguinal and pelvic sidewall lymph nodes are not pathologically enlarged.\n\nBones and soft tissues: No suspicious focal bone lesion.", "output": "1. Bilobed rim enhancing centrally necrotic mass involving the proximal\ngastric body along the greater curvature with extra serosal extension\ncompatible with the given diagnosis of lymphoma.\n2. Thickened small bowel starting from the third portion of the duodenum\nextending through to the proximal jejunum. While this may represent\nperistalsis, additional focus of lymphoma involvement cannot be excluded.\n3. Several prominent mesenteric lymph nodes measuring up to 9 mm, some with\nabnormal rounded morphology and a surrounding inflammatory change suggestive\nof additional sites of involvement.\n4. Several appendicoliths predisposes to appendicitis though there is no\ncurrent evidence of appendicitis.\n5. For thoracic findings, refer to the separately dictated report under clip\n___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Necrotic mass extending from the body of the stomach\nmeasuring up to 2.7 x 2.2 cm is similar in appearance to prior PET\nexamination. The mass inferiorly extends adjacent to multiple small bowel\nloops in the left upper quadrant and inflammatory changes around the mass\ncontact the splenic flexure of the colon. No free intraperitoneal air is\nvisualized. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There are numerous prominent mesenteric lymph nodes that overall\nappear similar to prior examinations. No new lymphadenopathy is visualized.\nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Fat containing umbilical hernia is noted.", "output": "1. Centrally necrotic mass involving the gastric body with extra serosal\nextension compatible with known lymphoma is not significantly changed from\nprior examination. Note that the mass contacts the small bowel in the left\nupper quadrant as well as the serosal surface of the splenic flexure of the\ncolon. No free intraperitoneal air.\n2. Numerous mesenteric lymph nodes are not enlarged by CT size criteria though\nmany around and not seen unchanged from prior examinations. These remain\nconcerning for additional sites of involvement of lymphoma." }, { "input": "LOWER CHEST: The partially imaged lower lungs are clear. No evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is not distended. No\ngallbladder wall thickening or pericholecystic fluid. No calcified\ngallstones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is not distended. No evidence of significant\nhiatal hernia. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Colonic stool burden is moderate. The colon and\nrectum are within normal limits. The appendix is normal. No organized fluid\ncollections. No free air. No bowel obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are normal. Normal follicular\nactivity are seen in the ovaries.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No CT evidence for an acute intra-abdominal or pelvic process. Nondistended\ngallbladder without evidence of gallstones or cholecystitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber without abnormal wall thickening or hyperemia. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed. There is a trace amount of\nphysiologic free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute findings in the abdomen or pelvis. Normal appendix." }, { "input": "LOWER CHEST: There is a 0.2 cm nodule adjacent to the pleura in the right\nlower lobe (___). There is mild bibasilar atelectasis. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is hepatic steatosis. The liver demonstrates homogenous\nattenuation throughout. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a sub-cm hypodense lesion in the upper pole of the left\nkidney (___), too small to characterize. The kidneys are of normal and\nsymmetric size with normal nephrogram. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is relatively contracted, limiting evaluation. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Moderate colonic stool burden. The colon and rectum are\notherwise within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is a retro-aortic left renal vein.\n\nBONES: The patient is status post L2-L4 PSIF with laminectomies at L3 and L4. \nThere is 1.1 cm anterolisthesis of L4 on L5. There is trace retrolisthesis of\nL5 on S1. There are multilevel degenerative changes.\n\nSOFT TISSUES: There is diffuse fatty replacement of the right gluteal\nmusculature (___). The abdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence for acute diverticulitis or appendicitis. No findings\ncorrelating with reported history of acute abdominal pain. No bowel\nobstruction.\n2. The patient is status post L2-L4 PSIF with laminectomies at L3 and L4. \nThere is 1.1 cm anterolisthesis of L4 on L5. Multilevel degenerative changes\nof the visualized spine." }, { "input": "Visualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation. There are no focal\nhepatic lesions however like lack of intravenous contrast limits evaluation. \nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 9 mm nonobstructing renal stone in the lower pole of the\nright kidney. There is a nonobstructing 5 mm renal stone in the lower pole of\nthe left kidney. There is no hydronephrosis or perinephric stranding. There\nis a 6 mm calcification in the region of the left ureterovesical junction.\nGiven the lack of surrounding periureteral stranding or proximal hydroureter/\nhydronephrosis, this likely represents a phlebolith.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. Bilateral nonobstructing renal calculi measuring up to 9 mm.\n2. 6 mm calcification at the region of the left UVJ is difficult to localize,\nbut given lack of periureteral stranding or proximal hydroureter/\nhydronephrosis, likely represents a phlebolith. Correlate with any current\nhistory of left groin discomfort." }, { "input": "LOWER CHEST: The lung bases are clear. There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a subcentimeter hypodensity in segment II of the liver, too small to\ncharacterize (series 2, image 17). Second punctate hypodensity at the right\nhepatic dome (series 2, image 12). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No hiatal hernia. No bowel obstruction. No small or large\nbowel wall thickening. Fecalized material in the terminal ileum, suggests\nincompetent ileocecal valve. Appendix not visualized but no secondary signs\nof appendicitis in the right lower quadrant. No intra-abdominal free fluid or\nfree air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are bilateral pars defects of L5 without significant\nanterolisthesis. There are no suspicious bony lesions.\n\nSOFT TISSUES: The superficial soft tissues are unremarkable. There is no\ninguinal hernia.", "output": "No acute intra-abdominal process. Specifically, no evidence of inguinal\nhernia." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is not visualized and may have been previously\nresected.\n\nPANCREAS: The pancreas is almost completely fatty replaced.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is atrophic with focal areas of cortical thinning in\nthe upper and interpolar region which may be secondary to prior infarction or\ninfection. The right kidney is normal in size. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. An enteric catheter is in\nplace with the tip in the body of the stomach. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is moderate fecal loading\nthroughout the large bowel without significant distention.\n\nPELVIS: The urinary bladder is collapsed around a Foley catheter.\n\nThere is no free fluid in the abdomen and pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is grossly unremarkable. There is a 3 cm cyst\nin the right hemipelvis. There is no left adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no suspicious bone lesion. Degenerative changes are noted. \nThere is severe compression deformity of T12 vertebral body of indeterminate\nage.\n\nSOFT TISSUES: There is a 2 cm oval-shaped hypodense lesion along the anterior\naspect of the lower chest wall (series 3, image 38).", "output": "1. No convincing evidence of malignancy in the abdomen and pelvis within the\nlimitations of this unenhanced study.\n2. 3 cm cystic lesion in the right hemipelvis may represent an\novarian/paraovarian cyst. Correlation with dedicated pelvic ultrasound is\nrecommended.\n3. 2 cm oval-shaped subcutaneous soft tissue mass in the lower anterior chest\nwall may represent a sebaceous cyst or epidermal inclusion cyst. Correlation\nwith physical exam is recommended." }, { "input": "LOWER CHEST: Bilateral pleural effusions, right greater than left. Please\nrefer to separate report of CT chest performed on the same day for description\nof the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is not distended but again seen is stable\ngallbladder wall edema.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. A punctate calcification is seen in the upper pole of the\nleft kidney, possibly a small nonobstructing renal calculi. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate ascites.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is extensive retroperitoneal lymphadenopathy encasing the\nIVC and the aorta and extending from the subdiaphragmatic region to the common\niliac vessels, similar to prior. Comparing to the prior study the lymph node\nconglomerate measures 12.5 x 8 cm, previously 13.8 x 7.5 cm (3; 75). External\niliac lymphadenopathy is again seen measuring up to 1.2 cm in short axis (3;\n103.) There is no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No significant interval change in extensive retroperitoneal lymphadenopathy\nand mild external iliac lymphadenopathy.\n2. Moderate ascites.\n3. Stable gallbladder wall edema.\n4. For thoracic findings please see the separate report from the same day CT\nchest." }, { "input": "LOWER CHEST: Re-demonstrated are bilateral pleural effusions and associated\ncompressive atelectasis. The pleural effusions have increased in size\nbilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout, and\nis hyperdense, as is the spleen, compatible with iron overload. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is unremarkable. There is\nmoderate ascites, slightly increased since the prior examination.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and homogeneous hyperattenuation, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. No definite\nrenal calculi are identified.\n\nGASTROINTESTINAL: The stomach is unremarkable. A transesophageal tube\nterminates at the pylorus. Oral contrast material extends through a\nsignificant portion of small bowel. There are prominent, fluid-filled loops\nof small bowel in the right lower quadrant, without discrete transition point\nwithin the limitations of this examination. The colon and rectum are within\nnormal limits.\n\nPELVIS: A Foley catheter seen within the decompressed bladder. Moderate\npelvic free fluid is similar in extent to the most recent comparison.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Re-demonstrated is a dominant retroperitoneal nodal mass which\nnow measures 11.2 x 6.7 cm, most recently up to 12.5 x 8.0 cm, and previously\nup to 13.1 x 7.3 cm. Bilateral external iliac lymph nodes are slightly less\nprominent on the current study than on the prior, and measure up to 7 mm in\nshort axis. There is no inguinal lymphadenopathy. Evaluation for mesenteric\nlymphadenopathy is limited given the lack of intravenous contrast.\n\nVASCULAR: There is no abdominal aortic aneurysm. At least moderate\natherosclerotic disease is noted.\n\nBONES: Re-demonstrated are stable degenerative changes in the lower thoracic\nand lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "-No definite small bowel obstruction. Prominent loops of fluid-filled small\nbowel are noted in the right lower quadrant, without discrete transition\npoint.\n-Improvement in retroperitoneal and external iliac lymphadenopathy since the\nmost recent comparison.\n-Stable ascites." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 1.6 cm splenule inferiorly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple subcentimeter hypodensities within the left\nkidney, which are too small to characterize, likely simple cyst. Otherwise,\nthe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of enhancing renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There appears to be an ulcerated anterior gastric wall mass\nat the level of the antrum (series 6, image 50 and 52), which is concerning\nfor a primary gastric malignancy. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is fluid within the endometrial canal with a\nlobulated 2.5 x 1.7 cm endometrial mass (series 6, image 99), consistent with\nthe patient's known endometrial carcinoma. There are numerous exophytic\nmasses arising from the myometrium, some of which are partially calcified,\nlikely representing fibroids.\n\nRETROPERITONEUM, MESENTERY, AND LYMPH NODES: There are numerous omental and\nperitoneal deposits (series 6, image 76, 94), the largest within the right\nupper abdomen measuring 3.5 x 3.2 cm (series 6, image 68), which is concerning\nfor metastatic disease. In addition, there are multiple enlarged mesenteric\nlymph nodes (series 6, image 57, 60), which are also concerning for metastatic\ndisease. There is an enlarged 2.1 x 1.6 cm right external iliac lymph node\n(series 6, image 98).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a moderate-sized fat containing umbilical hernia. \nOtherwise, the abdominal and pelvic wall is within normal limits.", "output": "1. 2.5 cm lobulated endometrial mass in addition to fluid within the\nendometrial canal, consistent with the patient's known endometrial carcinoma.\n2. Ulcerated gastric wall mass arising from the anterior wall of the antrum,\nwhich is concerning for primary gastric malignancy.\n3. Numerous omental and peritoneal deposits, as well as mesenteric\nlymphadenopathy, which is concerning for metastatic disease, which may be\ngastric or endometrial in origin. The largest omental deposit within the\nright upper abdomen measures up to 3.5 cm, and is amenable to percutaneous\nbiopsy.\n4. Multiple exophytic masses arising from the myometrium, likely representing\nfibroids.\n5. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 18:08 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is an intermediate density renal lesion in the lower pole of the right\nkidney that measures 3.6 cm. Additionally there are multiple bilateral\nsubcentimeter cortical renal hypodensities which are too small to characterize\nand likely represent renal cysts. There is no evidence of focal renal lesions\nor hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent. No adnexal abnormality\nis seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Posterior spinal fixation hardware is visualized at L2 through L4 with\nadjacent multilevel degenerative changes throughout the lumbar spine. There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No focal intra-abdominal or pelvic abnormalities to correlate with\npatient's symptoms, specifically no evidence of small-bowel obstruction.\n2. Indeterminate 3.6 cm right lower pole renal lesion for which nonemergent\nfollow-up ultrasound or MR is recommended." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. The gallbladder is surgically absent. The common bile\nduct is mildly dilated, measuring 1.0 cm (601:30), likely following\ncholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA right renal hypodensity is too small to characterize. There is no evidence\nof hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Otherwise, the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Scattered colonic diverticulosis, without\nevidence of acute diverticulitis. Otherwise, the colon and rectum are within\nnormal limits. The appendix is not definitively identified, but there are no\nsecondary signs of acute appendicitis.\n\nPELVIS: The bladder wall appears mildly thickened, which may be due to\nunderdistention. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrium measures approximately 1.7 cm (602:45). \nThe bilateral adnexa appear unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: A deformity of the left posterior eleventh rib appears chronic. Grade\n1 anterolisthesis of L4 on L5, likely degenerative in etiology. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The anterior portion of a segment of the transverse colon\nprotrudes into a shallow ventral abdominal defect compatible with a Richter\nhernia. Small, fat containing umbilical hernia.", "output": "1. The endometrium appears thickened and measures approximately 1.7 cm,\nconcerning for an endometrial abnormality. No pelvic adenopathy. Recommend\ngynecologic consult, along with a pelvic ultrasound or MRI for further\nevaluation as findings could reflect endometrial hyperplasia, polyp, or\nneoplasm, particularly if the patient is postmenopausal.\n2. Mild bladder wall thickening, which may be secondary to underdistention. \nRecommend correlation with urinalysis.\n3. Richter type ventral hernia containing a segment of the transverse colon. \nNo evidence of bowel obstruction.\n4. Scattered colonic diverticulosis, without evidence of acute diverticulitis.\n\nRECOMMENDATION(S): Recommend gynecologic consult, along with a pelvic\nultrasound or MRI for further evaluation of the endometrial thickening." }, { "input": "LOWER CHEST: Please see the separate dedicated chest CT report dictated by\nthe cardiothoracic imaging section.\n\nABDOMEN:\n\nHEPATOBILIARY: There is an unchanged a subcentimeter hypodense lesion in\nsegment ___ (___), too small to characterize. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. After the as\nbefore, the patient is status post proctectomy and sigmoid colectomy with a\nterminal colostomy within the left lower quadrant. The ostomy appears patent\nwithout evidence of obstruction. The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS:\n\nThe patient is status post abdominoperineal resection with residual\npostoperative changes. Again seen are uterine and inferior bladder prolapse\ninto the lower pelvis. There is no pelvic sidewall or inguinal\nlymphadenopathy by CT size criteria. No free pelvic fluid.\n\n\nThe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is unchanged grade 1 anterolisthesis of L4 on L5. There are multilevel\ndegenerative changes.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. The abdominal\nand pelvic wall are otherwise within normal limits.", "output": "1. Compared to ___, no evidence of recurrent or metastatic disease\nwithin the abdomen or pelvis.\n2. As before, the patient is status post proctectomy and sigmoid colectomy\nwith left lower quadrant colostomy.\n3. Unchanged uterine and inferior bladder prolapse.\n4. Please see same day CT chest for thoracic findings." }, { "input": "LOWER CHEST: Limited evaluation of the lower chest demonstrates cardiomegaly,\ncoronary artery calcifications, bilateral pleural effusions with atelectasis\nand consolidations.\n\nABDOMEN:\n\nHEPATOBILIARY: Left hepatic lobe hypodensity not well characterized on this\nexam but likely representing cyst. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Gastrostomy tube is noted. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits.\n\nPELVIS: The bladder is collapsed with a Foley catheter and contains a small\nfocus of gas.\n\nREPRODUCTIVE ORGANS: The uterus is not well visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes of the lumbar spine, particular at L5-S1. There\nis a dense sclerotic appearance of the L1 vertebral body of uncertain\netiology, but vertebral body height is maintained and was present as far back\nas at least ___.\n\nSOFT TISSUES: Diffuse anasarca. Scattered soft tissue densities possibly from\nsubcutaneous injections. Calcified granulomas in the bilateral buttocks. \nSmall right fat containing inguinal hernia.\n\nThere is a retroperitoneal hematoma in the left psoas muscle and a large\namount of hemorrhage in the retroperitoneal space lateral to the psoas muscle\nand extending down into the pelvis. The hemorrhage displaces the left-sided\nabdominal organs anteriorly and medially including bowel and left kidney.", "output": "1. Large left retroperitoneal hemorrhage as detailed above with displacement\nof adjacent organs. Source is not identified on this noncontrast exam.\n2. Limited view of the lower chest shows bilateral pleural effusions with\natelectasis and consolidations.\n3. Anasarca.\n\nNOTIFICATION:\nThe findings were discussed with ___, M.D. by ___, M.D. on the\ntelephone on ___ at 5:54 ___, 2 minutes after discovery of the findings." }, { "input": "The lung bases are clear.\n\nThe liver, spleen, adrenal glands, kidneys, and pancreas are unremarkable.\nPatient status post cholecystectomy. The stomach is relatively decompressed.\nSmall bowel is not distended. Fluid seen throughout the nondistended colon.\nThe appendix is not visualized although there are no inflammatory changes in\nthe right lower quadrant noting evaluation is somewhat limited due to lack of\noral contrast and paucity of intra-abdominal fat. Uterus is unremarkable.\nAdnexa are not well assessed due to paucity of intra-abdominal fat. Bladder is\nunremarkable. There is no intraperitoneal fluid, free air nor intra-abdominal\nadenopathy. Abdominal aorta is normal in caliber.\n\nNo suspicious osseous lesions identified.", "output": "Fluid throughout the nondistended colon which can be seen in setting of\ndiarrhea. Otherwise, unremarkable abdominal CT." }, { "input": "LOWER CHEST: Mild right basilar atelectasis. Dense calcifications are seen\nin the right basilar pleural surface. Otherwise, the visualized lung fields\nare within normal limits. There is no pleural or pericardial effusion. The\ntip of a partially visualized right central line terminates at the cavoatrial\njunction/right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Patient is status post cholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Mildly atrophic kidneys. Multiple bilateral renal hypodensities,\nmany of which are too small to further characterize, the largest arising from\nthe upper pole of the left kidney measuring up 1.4 x 0.9 cm, likely simple\ncysts. Multiple bilateral renal calculi are again seen without\nhydroureteronephrosis. No focal concerning renal lesion identified. No\nperinephric abnormality identified.\n\nGASTROINTESTINAL: A percutaneous GJ tube is seen with tip terminating in the\njejunum. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. Extensive diverticulosis without evidence of wall\nthickening and fat stranding. Mild circumferential rectal wall thickening\n(2:83-___) may reflect mild proctitis. The appendix is normal.\n\nPELVIS: A suprapubic catheter is noted within a decompressed urinary bladder.\nA left percutaneous nephrostomy tube is seen with tip terminating within an\ninferior major calyx. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is not well-visualized. Seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Bones are diffusely demineralized. Moderate left convex scoliosis\ncentered at the lower thoracic spine. Mild-to-moderate multilevel\ndegenerative changes of the lumbar spine. Multiple rounded sclerotic foci are\nagain seen in the bony pelvis, the largest in the left ilium measuring up to 7\nmm, likely bone islands. Moderate bilateral femoroacetabular degenerative\nchanges. No worrisome osseous lesions identified. No acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild apparent circumferential rectal wall thickening may be due to a mild\nproctitis. Extensive diverticulosis without evidence of diverticulitis. No\nbowel obstruction.\n2. Re-demonstrated bile nonobstructing renal stones.\n3. Mild right basilar atelectasis. Right basal pleural calcifications." }, { "input": "LOWER CHEST: There is heterogeneous enhancement of the bilateral lower lobe\nconsolidations (2:3), though the consolidations are chronic. Calcification in\nthe right pleural space likely represents sequela prior asbestos exposure. \nThe heart is enlarged, unchanged from prior exam. There is no pleural\neffusion or pericardial effusion. There is mild bronchiectasis in the right\nlower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubtle hypodensity in the right lobe of the liver is again noted, too small to\ncharacterize by CT (02:14). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size. Subcentimeter hypodensity in the spleen\nis unchanged (02:20), which may represent a cyst. Accessory spleen measures\n10 mm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nCortical thinning in the right upper pole is nonspecific, though possibly a\nsequela of prior infection. Multiple subcentimeter hypodensities in the\nkidneys are too small to characterize by CT, though likely simple cysts. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status post\ngastrojejunostomy with tip terminating in the proximal jejunum, unchanged from\nprior exam. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The sigmoid colon is redundant. Large amount of\nstool is seen throughout the colon with focal dilation of the rectosigmoid\njunction, which is filled with stool. The appendix is normal.\n\nPELVIS: Patient is status post suprapubic catheter placement with nondependent\nair in the bladder, likely secondary to instrumentation. The bladder is\ncollapsed with diffusely thickened wall, which may be secondary to under\ndistension. The mucosa appears slightly hyperemic. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is moderate to severe degenerative changes of the bilateral hip\njoints with bone-on-bone contact. There is no evidence of worrisome osseous\nlesions or acute fracture. There is diffuse osteopenia.\n\nSOFT TISSUES: Previously described right posterior thigh collection not imaged\non today's exam.", "output": "1. Status post suprapubic catheter placement in the bladder, which is\ncompletely collapsed. Diffuse wall thickening may be secondary to under\ndistension and chronic underlying process.\n2. Heterogeneous enhancement of the lower lobes, potentially slightly worse on\nthe left. Chronic consolidation on the right.\n3. Status post gastrojejunostomy with tip in unchanged positioning, in the\nproximal jejunum." }, { "input": "LOWER CHEST: Imaged lung bases are clear aside from mild dependent\natelectasis. The imaged portion of the heart is unremarkable. No pleural or\npericardial effusion is seen.\n\nABDOMEN: The liver enhances normally focal hypodensity in segment 4 a, series\n2, image 21 measuring 1.5 x 1.6 cm, this lesion is most consistent with a\nsimple appearing cyst. Main portal vein is patent. No intrahepatic or\nextrahepatic biliary ductal dilation. The gall bladder appears normal as does\nthe pancreas and spleen. 2 discrete splenules are noted. The adrenal glands\nare normal. Kidneys enhance symmetrically and excretion is prompt and equal. \nThere is a small cortical hypodensity in the left renal upper pole, too small\nto characterize, 8 mm though appears most compatible with a simple cyst. No\nsigns of pyelonephritis, worrisome renal lesion or hydronephrosis. The\nabdominal aorta and major branches are widely patent and normal in course and\ncaliber. No retroperitoneal adenopathy. The stomach is decompressed. The\nduodenum appears normal.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix is clearly visualized and appears normal. The: Contains mild\nfecal loading and is without wall thickening or signs of acute inflammation. \nThere is a left adnexal cystic structure measuring 3.9 x 3.9 x 4.8 cm, may\nrepresent a cyst. The retroverted anteflexed uterus is small. The right\novary is unremarkable. The urinary bladder is only partially distended with\ndistal ureters appearing normal. No pelvic sidewall or inguinal adenopathy. \nNo free air or free fluid is seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "-Normal appendix.\n-Left ovarian cystic structure measuring up to 4.8 cm, please correlate for\nfocal pain and if there is concern for torsion, emergent ultrasound advised. \nIf patient is postmenopausal, a nonemergent ultrasound is recommended to\nfurther assess.\n\nRECOMMENDATION(S): Pelvic ultrasound, emergently if there is concern for left\nadnexal torsion, non emergently if patient is postmenopausal." }, { "input": "LOWER CHEST: Bibasilar atelectatic changes are noted. Visualized lung fields\nare otherwise within normal limits without evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Within hepatic segment ___ there is a 2.0 x 1.3 cm focal\nhypodensity most consistent with a simple hepatic cyst, slightly larger in\nappearance in comparison to the prior exam (04:22). A smaller focal\nhypodensity at the peripheral aspect of the right hepatic lobe is too small to\ncharacterize. The gallbladder is unremarkable.\n\nPANCREAS: The pancreas demonstrates normal attenuation throughout without\nevidence of concerning focal lesion or ductal dilatation. No peripancreatic\nstranding.\n\nSPLEEN: The spleen demonstrates normal size and attenuation without evidence\nof concerning focal lesion. Two distinct splenules are again noted.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: Kidneys are of normal symmetric size within normal nephrogram. \nWithin the interpolar region of the left kidney there is with a cortical\nhypodensity which is too small to characterize, although benign etiology is\nfavored such as a simple renal cyst. There are no concerning focal renal\nlesions or hydronephrosis. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is almost entirely collapsed is not well\nassessed on CT. Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The colon and rectum are unremarkable. The\nappendix is normal. No ascites.\n\nPELVIS AND REPRODUCTIVE ORGANS: Re-demonstrated is a prominent left adnexal\ncyst measuring 4.0 x 3.7 x 5.0 cm (CC x TV x AP) which when accounting for\ndifferences in measurement technique is similar in size and appearance\ncomparison to the prior exam (measuring 3.8 x 3.9 x 5.0 cm on the prior exam).\nAt the posterior aspect of this lesion there is a component of soft tissue\ndensity which likely represents normal ovarian tissue (4:65). Right ovary\nappears unremarkable. Foci of hypodensity within the uterus are compatible\nwith history of uterine leiomyomas. No free fluid.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No evidence of\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: No evidence of abdominal aortic aneurysm. No atherosclerotic\ndisease is noted.\n\nBONES: No acute fracture. No worrisome osseous lesions identified. Multilevel\ndegenerative changes are noted about the thoracolumbar spine, minimally\nprogressed in comparison to the prior study. Vacuum disc phenomenon is noted\nat L4-L5.\n\nSOFT TISSUES: The soft tissues of the abdominal and pelvic walls are within\nnormal limits.", "output": "1. Prominent left adnexal cyst, similar in size and appearance in comparison\nto the prior study dated ___. In the setting of new acute pain,\nfollow-up evaluation with a pelvic ultrasound is recommended to better\nevaluate the internal complexion of the lesion and also to further evaluate\nthe right adnexa.\n2. Incidental findings as described above.\n\nRECOMMENDATION(S): Dedicated pelvic ultrasound.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 13:43 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: There is bibasilar small consolidations an small nonhemorrhagic\npleural effusions, left worse than right. Evaluation of the lungs are mildly\nlimited due to respiratory motion and beam hardening artifact. However, the\nright lower lobe consolidation appears slightly heterogeneous in enhancement,\nconcerning for pneumonia. The heart is mildly enlarged. Pacemaker leads are\nseen in the right atrium and right ventricle. Dense coronary artery\ncalcifications and calcifications in the aortic and mitral valves are noted.\n\nABDOMEN:\n\nThere is moderate pneumoperitoneum mostly in the upper abdomen with scattered\nfoci of air along the anterior abdomen and pelvis inferiorly. In addition,\nthere is moderate amount of air between the abdominal musculature and the\nperitoneal fascia along the right anterior abdomen, which may represent\nloculated foci of air between the fascial layers, likely leakage through the\nprior peritoneal catheter tract; this includes an air-fluid collection\nmeasuring 14.7 x 2.9 cm (02:54).\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is distended with sludge.\nThe wall appears within normal limits. There is mild fat stranding near the\nfundus of the gallbladder (601:28).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys are extremely atrophic. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis of the descending and sigmoid colon. There is asymmetric fluid\nlayering along the left paracolic gutter. In addition, there is lobulated,\nseptated fluid-air collection at the mid sigmoid colon (601:27), likely\nrepresenting perforation from diverticulitis. The abscess measures at least\n4.1 x 3.7 cm. The appendix is normal (2:65). There are other small loculated\nfluid collections in the mid anterior abdomen (02:45), measuring 4.9 x 1.3 cm,\nand along the right flank, measuring 5.3 x 1.3 cm (02:52).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is unremarkable. The seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Heavy calcifications of the major tributaries of the great\nvessels are noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is asymmetric enlargement of the right psoas muscle with\nheterogeneous enhancement, likely representing hematoma measuring 12.5 x 6.1 x\n5.0 cm (series 601 image 35, series 2, image 51). Along the right posterior\nretroperitoneum, small amount of hyperdense fluid is seen, likely representing\nhematoma.", "output": "1. Perforated sigmoid diverticulitis with a 4.1 x 3.7 cm air-fluid\ncollection at the sigmoid, with the following:\n\n-Gross pneumoperitoneum/spillage tracking into the extraperitoneal space\nanteriorly, likely via a prior peritoneal catheter tract.\n-14.7 x 2.9 cm anterior abdominal collection.\n-4.9 x 1.3 cm mid anterior abdominal collection.\n-5.3 x 1.3 cmr ight flank collection.\n2. 12.5 x 6.1 x 5.0 cm right psoas retroperitoneal hematoma. No active\nextravasation detected.\n3. Right lower lobe consolidation with heterogeneous enhancement, concerning\nfor pneumonia.\n\nNOTIFICATION: Updated findings discussed with Dr. ___ with Dr. ___\ntelephone at 09:30 ___. See OMR regarding communication and drainage\nconsultation with the ACS team." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is fluid-filled and dilated\nmeasuring up to 9 mm with hyperemic walls, concerning for acute appendicitis. \nThere is no evidence of perforation or associated abscess.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is visualized within the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute uncomplicated appendicitis." }, { "input": "A medial right basilar opacity suggests chronic atelectasis although somewhat\nimproved. There are no pleural effusions. The heart is normal in size. The\nchest appears hyperinflated with partly visualized emphysematous changes, as\nbefore.\n\nABDOMEN:\n\nA previously noted hyperenhancing focus in segment IV of the liver appears\nunchanged again measuring 6 mm, doubtful in significance.\nThere is no biliary dilatation. The spleen is normal in size. The gallbladder,\npancreas, and adrenal glands are unremarkable. The right kidney is atrophic\nwith multiple cystic lesions, none of which appear suspicious. The left kidney\nis normal in size and also demonstrates several cystic lesions that for the\nmost part appear either simple or too small to characterize. However, along\nthe upper pole there is an exophytic hyperdense lesion measuring up to 29 x 21\nmm in axial ___. However, comparison with pre-contrast imaging shows\nnon-enhancement diagnostic for a hemorrhagic or proteinaceous cyst. Renal\nlesions also show no significant change.\n\nThe stomach and small bowel are unremarkable. Diverticulosis of the sigmoid\nis moderate to severe.\n\nPELVIS:\n\nThe prostate shows a central defect suggesting prior transurethral dilatation\nsurgery. The bladder and seminal vesicles are unremarkable. There are no\nenlarged lymph nodes. A few calcified periportal nodes again suggest a prior\ngranulomatous process. New trace ascites is present in the pelvic cul-de-sac.\n\n\nANGIOGRAPHY:\n\nA fusiform intrarenal abdominal aortic aneurysm appears unchanged. It again\nshows extensive mural thrombosis and extends to the aortic bifurcation. The\ncentral coronal axis dimension of the aorta is 42 mm, the sagittal central\naxis measurement 39 mm, and the axial measurement 41 mm. The volume of the\naneurysm erythema measures 122.9 cc. From the inferior renal through the\naortic bifurcation, the volume is 139.1 cc and to the iliac bifurcation, 151.2\ncc. The coronal angle of the aneurysm measures 159 degrees. The sagittal\nangle is 153 degrees.\n\nThe left common iliac artery, as well as the external and internal iliac\narteries, are again occluded in their entirety. The left common femoral artery\nopacifies via epigastric collateral flow, but subsequently there is an\nocclusion of the superficial femoral artery shortly beyond its origin.\n\nOn the right side, the common external iliac artery is irregularly narrowed\nwith stenosis along the mid portion up to about 50% associated with mixed type\nplaque. The right internal iliac artery is occluded.\n\n\nThe origin of the right renal artery again appears narrowed, although more\ngenerally, the artery is relatively narrowed throughout its course up to the\nfirst bifurcation. The right artery arises immediately above a fusiform\nabdominal aortic aneurysm and is the more superior of the renal arteries. At\nthe ___ of the right renal artery, the aorta measures 25 mm in diameter; at\nthe level of the inferior renal artery, which is the left, it measures 35 mm\nindiameter; 5 mm below, 35 mm; 10 mm below, 39 mm; and at 15 mm below, 41 mm.\n\nBONES:\n\nModerate degenerative changes affect lower lumbar facets. The bones are\nprobably demineralized.", "output": "Stable abdominal aortic aneurysm (details given above)." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Diffuse hypoattenuation of the hepatic parenchyma is suggestive\nof steatosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Right adrenal gland is unremarkable. A 1.8 cm left adrenal lesion\nis unchanged from exam in ___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. A 1.7 cm simple cysts arise from the lower pole of\nthe left kidney. Numerous peripelvic cysts are noted. Additional\nsubcentimeter hypodensities too laterally too small to characterize. The\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: Evaluation is slightly limited by artifact from left hip arthroplasty.\nThe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. No adnexal abnormalities are\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLeft hip arthroplasty noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Hepatic steatosis.\n3. Colonic diverticulosis without diverticulitis. Normal appendix." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. An\napproximately 1.4 x 0.9 cm hypoattenuating lesion in the lateral aspect of\nhepatic segment V there is minimally changed since ___, probably\nreflecting a hemangioma. A tiny hypoattenuating lesion in the medial aspect\nof hepatic segment V probably reflects a hemangioma, cyst, or biliary\nhamartoma. No suspicious hepatic lesion identified. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation-the common bile duct is top\nnormal in caliber. Cholelithiasis without gallbladder wall edema.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation-the proximal main pancreatic\nduct is top normal in caliber. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nCortical thinning of the right lower pole probably reflects prior infectious\nor inflammatory insult. No renal lesion, hydronephrosis, or perinephric\nabnormality. There is a duplicated left renal collecting system.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Gas and stool are seen to the level of the\nrectum. The appendix is normal. There is small volume pneumoperitoneum, not\nunexpected postop day 2.\n\nPELVIS: There is a duplicated left renal collecting system. The urinary\nbladder is unremarkable. There is small volume a pelvic free fluid.\n\nREPRODUCTIVE ORGANS: Status-post bilateral salpingo oophorectomy. An\nintrauterine device is within the expected location.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral breast implants are partially imaged", "output": "1. Small volume pneumoperitoneum and ascites are not unexpected given recent\nbilateral salpingo-oophorectomy. The intrauterine device is in its expected\nlocation.\n2. No small bowel obstruction. Mild fecal loading with stool and gas seen to\nthe level of the rectum.\n3. Cholelithiasis." }, { "input": "LOWER CHEST: Mild dependent atelectasis is present in the bilateral lung\nbases. There dense atherosclerotic calcifications within the coronary\narteries. There is no pleural or pericardial effusion. There is a small\nhiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple up attic cysts are again noted, the largest of which\nin the caudate lobe again measures approximately 4.4 cm in maximal axial\ndimension. There is also a punctate calcification in the inferior right\nhepatic lobe, likely from prior granulomatous infection (02:24). There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size. There is no evidence of\nhydronephrosis. Subcentimeter hypodensities are again seen within the\nbilateral kidneys, too small the accurately characterize, but most likely\ncysts. In the anterior interpolar left kidney, there is a punctate\ncalcification, likely a nonobstructing stone. Along the posterior aspect of\nthe left upper pole, there are layering hyperdensities, compatible with small\ncrystals within a cyst. There is no evidence of suspicious focal renal\nlesions within the limitations of an unenhanced scan. A 3 mm rounded\ncalcification along the anteromedial left psoas muscle is likely within a\nlymph node, and anterior to the left ureter (02:51).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\n\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: Fat stranding and small locules of gas are noted in the soft\ntissues of the lower anterior left abdominal wall (02:43), compatible with\nsubcutaneous injections. Calcifications are noted along the gluteal muscles\nbilaterally.", "output": "1. No acute abdominopelvic pathology.\n2. Nonobstructing punctate left renal stone. No evidence of hydronephrosis\nbilaterally.\n3. Sigmoid diverticulosis, with no evidence of diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is top-normal in size measuring 13 cm with normal\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia is noted.", "output": "No acute intra-abdominal or pelvic findings to correlate with patient's\nsymptoms. Specifically, no evidence of colitis." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis is visualized. A 6 mm nodularity is\nvisualized at the left lung base which may represent atelectasis versus a true\npulmonary nodule. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent. \nSmall volume abdominal ascites is visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring up to 15.8 cm with normal attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There small\nvolume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is an acute compression fracture of L4 with retropulsion of the\nmiddle column by 4 mm resulting in mild canal narrowing and anterior extrusion\nof the anterior component by 6 mm resulting in mass effect on the aorta. \nAdditional acute compression fractures are visualized at T12 and T11. Healed\nleft-sided rib fractures re-demonstrated there is no evidence of worrisome\nosseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute compression fracture of L4 with retropulsion of 4 mm resulting in\nmild canal narrowing and anterior column extrusion by 6 mm causing mass effect\non the aorta.\n2. Splenomegaly. No additional focal intra-abdominal or pelvic abnormalities\nto correlate with patient's symptoms.\n3. Left lung base nodularity measuring 6 mm which may represent atelectasis\nversus true pulmonary nodule.\n4. Additional acute compression fractures are seen at T11 and T12.\n\nRECOMMENDATION(S): Recommend ___ year follow-up chest CT to document stability\nand/or resolution of left lung base nodularity.\n\nNOTIFICATION: The updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:05 am." }, { "input": "LOWER CHEST: Mild atelectatic changes are seen in the lung bases. Otherwise,\nthe visualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent. A\nsmall amount of biliary air is noted in the liver, likely postprocedural.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions,. A small segmental region of pancreatic ductal dilatation is\nnoted proximally (2:28), with normal appearance of the distal pancreatic duct,\nunchanged from prior exams. Tiny calcifications are noted in the head and\nbody of the pancreas, compatible with chronic pancreatitis. There is no\nevidence of acute pancreatitis. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.1 cm hypodensity is noted in the interpolar region of the right kidney,\nlikely a cyst. There is no evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Incidental note is made of a small hiatal hernia. \nOtherwise, the stomach is unremarkable. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of acute pancreatitis. Small segmental proximal pancreatic\nductal dilatation with calcifications are unchanged from prior exams, and\ncompatible with chronic pancreatitis.\n2. A small amount of biliary air is noted in the liver, likely postprocedural.\n3. 1.1 cm right renal cyst." }, { "input": "LOWER CHEST: Visualized lung fields are notable for bilateral lower lobe\natelectasis. The heart is normal in size. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is top-normal in size measuring 13 cm with normal\nattenuation throughout. No evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost appendectomy with interval development of a 3.6 x 2.8 x 6.5 cm rim\nenhancing complex fluid collection within the right lower quadrant adjacent to\nthe appendectomy sutures and cecal base. Cecal wall edema primarily along the\nlateral wall extends up to the ascending colon is reactive due to underlying\ninflammation. No pneumatosis. No extraluminal gas. No extravasation of\ncontrast. The remaining colon and rectum are within normal limits. No\nobstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small amount\nof intermediate density fluid within pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: 1 x 0.6 cm densely sclerotic lesion (2:67) adjacent to the right\nsacroiliac joint as well as a 0.8 cm left femoral head lesion are most\nconsistent with bone islands. There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: Mild periumbilical fat stranding is consistent with postsurgical\nchanges. The abdominal and pelvic wall is otherwise within normal limits.", "output": "1. Status post appendectomy with interval development of a 3.6 cm complex\nright lower quadrant collection highly concerning for an abscess. No\nextraluminal air.\n2. Reactive cecal and ascending colonic wall edema due to underlying\ninflammation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Mild bilateral\npleural effusions are present. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is mildly distended\nwithout wall thickening. There is mild pericholecystic fluid likely secondary\nto third spacing. There is moderate volume ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is distended with mild thickening and lobulation\nof the wall. There is mild-to-moderate free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is mildly enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild diffuse anasarca.", "output": "1. The gallbladder is mildly distended without wall thickening. Mild\npericholecystic fluid likely secondary to third spacing.\n2. Small bilateral pleural effusions are present.\n3. The urinary bladder demonstrates mild wall thickening and trabeculation may\nbe secondary to chronic bladder outlet obstruction .\n4. Moderate volume ascites." }, { "input": "LOWER CHEST: There is minimal ground-glass opacity in the medial aspect of the\nright lower lobe (02:11). There is no pleural or pericardial effusion.\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a incompletely characterized 1.7 cm hypodensity at dome of the liver\non the right. Smaller hypodensity seen in the left lobe as well. There is no\nevidence of other focal lesions within the limitations of an unenhanced scan. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 3 mm stone in the right mid ureter (02:56) with mild\nupstream right-sided hydroureteronephrosis. There is mild to moderate\nperinephric stranding of the right kidney. There is minimal stranding of the\nleft kidney. There is no hydronephrosis or calculus in the left ureter or\ncollecting system of the left kidney. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is sigmoid diverticulosis\nwithout evidence of diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild vascular calcifications\nin the infrarenal aorta and left common iliac artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes seen at the lumbosacral junction.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "An obstrucing 3 mm calculus in the mid right ureter with upstream mild\nhydroureteronephrosis and right perinephric stranding. Appendix is normal." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder demonstrates subtle gallstones without\ndistention, wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Scattered\nsubcentimeter renal hypodensities are too small to characterize, though likely\nrepresent cysts. There is no evidence of gross solid renal lesions within the\nlimitations of an unenhanced scan. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended with ingested material though is\notherwise unremarkable. The duodenum and distal small bowel loops are normal\ncaliber without obstruction. There is mild sigmoid predominant colonic\ndiverticulosis without inflammatory change. The large bowel and rectum are\notherwise thin-walled without surrounding fat stranding or fluid collection. \nThere are changes from right colectomy without obstruction at this level.\n\nPELVIS: The bladder is decompressed around a Foley catheter. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate multilevel degenerative changes of the spine, worse in the\nlumbar spine, with scattered Schmorl's nodes and scattered areas of vacuum\ndisc phenomenon.\n\nSOFT TISSUES: There is moderate diffuse superficial soft tissue stranding\nconsistent with anasarca.", "output": "1. No acute findings or evidence of malignancy in the abdomen or pelvis. No\nlymphadenopathy.\n2. Cholelithiasis.\n3. Diffuse soft tissue anasarca.\n4. Post right hemicolectomy.\n5. Please refer to the separately dictated report for thoracic findings." }, { "input": "The visualized lung bases appear clear. There are no pleural effusions.\n\nIn segment V of the liver, a small hypoattenuating focus in the liver\nmeasuring 7 mm in diameter is too small to optimally characterize, but likely\nrepresentative of a small cyst or biliary hamartoma. A hypodense focus of 3\nmm in segment VI is also too small to characterize. The gallbladder,\npancreas, spleen, and adrenal glands appear within normal limits. There is no\nevidence for stones, solid masses or hydronephrosis in either kidney.\n\nThe stomach, small large bowel appear within normal limits.\n\nThe prostate, seminal vesicles, distal ureters, and bladder unremarkable. The\nmajor mesenteric arteries and veins appear patent. There is no ascites or\nlymphadenopathy.\n\nThere are no suspicious bone lesions.", "output": "No specific cause for hematuria identified." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions with atelectasis. The\nheart is mildly enlarged. There are atherosclerotic calcifications of the\ncoronary arteries and calcification of the mitral annulus.\n\nCT ABDOMEN WITH CONTRAST: The liver is grossly normal without focal lesions\nor duct dilation. The gallbladder surgically absent. The portal vein is\npatent. The pancreas is atrophic. The spleen and adrenal glands are\nunremarkable. The kidneys excrete contrast symmetrically. There are multiple\nareas of renal cortical scarring bilaterally but no worrisome masses. There is\nno hydronephrosis.\n\nThe stomach, small and large bowel are normal in caliber without obstruction.\nThere is no free air or free fluid. There is no mesenteric or retroperitoneal\nlymphadenopathy. Abdominal aorta and iliac arteries are heavily calcified but\nnormal in caliber. There is a small ventral hernia containing mesenteric fat.\n\nCT PELVIS WITH CONTRAST: The urinary bladder and rectum are normal. 7.4 x 6.2\ncm right adnexal cyst has been previously evaluated by ultrasound.\n\nBONES AND SOFT TISSUES: Although evaluation is limited by a motion artifact,\nlateral arch deformity of the left eighth rib suggestive of a fracture though\nof unclear chronicity (02:12). There are no worrisome blastic or lytic\nlesions. There is severe degenerative change in the right hip and leftward\ncurvature of the lumbar spine. There is disc vacuum phenomenon at L3-L4 and\nT11-T12.", "output": "1. Deformity of the lateral arch of the left eighth rib fracture, question\nacute fracture. Please correlate with site of pain.\n2. Small bilateral pleural effusions.\n3. Mild cardiomegaly. Severe atherosclerosis. Small fat containing umbilical\nhernia.\n4. 7.4 x 6.2 cm right adnexal cyst present since at least ___ and previously\nevaluated by ultrasound. Stability over time suggests a benign entity." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.\nA long segment of distal ileum measuring approximately 12 cm demonstrates\nconcentric wall thickening with adjacent prominent vasa recta and mesenteric\ninflammation. Pseudo sacculation is noted within this inflamed segment (4:62\nand 6:12). There is adjacent creeping fat reaction suggesting an underlying\nelement of chronicity. The small bowel loops at adjacent ends of this\ninflamed segment are mildly dilated. No skip lesions identified.\nThere is a heterogeneously enhancing soft tissue in the presacral region with\nat least 2 fistulae arising from the inflamed distal ileum extending to the\npresacral soft tissue seen on series 7, image 39 and 35. No drainable abscess\nnoted. The phlegmon measures approximately 4.3 x 2.7 x 3.1 cm (4:67 and\n06:22). There is mild tethering of additional noninflamed small-bowel loops\nto the presacral phlegmon (4:60).\nThere is mild concentric wall thickening of the rectum and adjacent sigmoid\ncolon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Numerous scattered subcentimeter short axis mesenteric lymph\nnodes are likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Active inflammation involving an approximately 12 cm length of the distal\nileum located in the right lower quadrant with at least 2 fistulae\ncommunicating with a heterogeneously enhancing phlegmon in the presacral\nregion without an associated drainable abscess at this site. The phlegmon\nmeasures up to 4.4 cm in maximum dimension.\n2. No skip lesions seen.\n3. Mild wall thickening of the rectum and adjacent sigmoid colon noted. The\npresacral phlegmon abuts the cranial aspect of the thickened sigmoid colon\nwithout a clear fistulous communication.\n4. Both ovaries are visualized separately and appear free of the inflammatory\nprocess.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:52 pm, 1 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Lung bases are clear. The imaged portion of the heart is\nunremarkable. No pleural or pericardial effusions seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach and duodenum appear normal. Proximal loops of\nsmall bowel are unremarkable. There is dilated distal small bowel which is\nfluid filled and measures up to 4.6 cm. An abrupt transition point is best\nseen on series 601, image 19. There is a long segment of inflamed, thickened,\nhyperemic small bowel involving the distal ileum, similar to the prior exam,\nrepresenting an acute on chronic Crohn's flare. There is no free air or\ndrainable fluid collection. However, on series 2, image 66 there is a focal\nsite of outpouching from the inflamed distal ileum which could represent a\ndeveloping sinus tract. In addition, in the presacral region at the site of\nprior phlegmon, there is soft tissue thickening though no drainable\ncollection. The colon is unremarkable. Appendix is not clearly identified.\n\nPELVIS: The urinary bladder is decompressed. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears normal. The right ovary appears\nnormal. The left ovary is not well visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute on chronic Crohn's flare involving a distal ileal segment, similar\ndistribution compared with recent prior CT exam. Resultant small bowel\nobstruction. Further details as above.\n2. Further decrease in presacral inflammation thought to reflect small-bowel\nfistulae, with mild residual presacral soft tissue thickening." }, { "input": "CT abdomen with contrast: Interval progression of several hepatic metastases.\nMany of these lesions are new. Index lesion in segment 6 today measures 41 x\n37 mm (02:52) previously measuring 13 x 12 mm. Largest new lesion is present\nin the hepatic dome and is indistinct measuring overall roughly 40 x 31 mm\n(02:37). A few of these hyperdense lesions such as an exophytic simple density\nlesion in segment 3 was not previously FDG-avid and is compatible with a cyst\n(02:47). No biliary dilatation. Portal vein is patent. Gallbladder is\ncollapsed and unremarkable.\n\nSpleen, pancreas and adrenal glands are normal.\n\nSeveral subcentimeter renal hypodensities are too small to fully characterize\nbut likely represent cysts. Kidneys otherwise present symmetric nephrograms\nand excretion of contrast without suspicious mass or hydronephrosis.\n\nStomach, duodenum and remainder of the small bowel loops are normal caliber\nwithout evidence of obstruction. Large bowel is thin-walled and unremarkable\nwithout pericolonic fat stranding or fluid collection.\n\nThe abdominal aorta is normal caliber. Scattered mesenteric and\nretroperitoneal lymph nodes are not pathologically enlarged and are stable\ncompared to prior examination. Note is made that several periaortic lymph\nnodes were FDG avid on prior PET-CT though they remain not pathologically\nenlarged. Most prominent retroperitoneal lymph node in the right periaortic\nstation is stable in size measuring 19 x 9 mm (2:69) but remains nonenlarged\nby CT size criteria.\n\nNo ascites or pneumoperitoneum. Re- demonstration of large supraumbilical\nventral abdominal hernia with special defect measuring 28 mm containing\nirritated fat.\n\nCT pelvis with contrast: Uterus and ovaries are absent. Bladder and rectum are\nunremarkable. No free pelvic fluid or air. Inguinal and pelvic sidewall lymph\nnodes are not pathologically enlarged. Note is made of that previous right\ninguinal lymph nodes were FDG avid though not enlarged. Largest of the right\ninguinal lymph nodes measures 9 x 8 mm, decreased in size compared to the\nprior PET-CT examination where it measured 13 x 10 mm.\n\nBones and soft tissues: No suspicious focal bone lesion. Thoracolumbar\ndegenerative changes are overall mild, focally severe at L5-S1 with a moderate\nposterior disk osteophyte complex.", "output": "1. Prominent disease progression with increase in both size and number of\nseveral hepatic metastases.\n2. Stable nonenlarged retroperitoneal lymph nodes and a minimal interval\ndecrease in size of right inguinal lymph nodes which were previously FDG avid\non PET-CT.\n3. Redemonstration of a supraumbilical ventral abdominal hernia containing\nirritated mesenteric fat with fascial defect measuring 28 mm.\n4. For thoracic findings, please refer to the separately dictated report under\nclip ___." }, { "input": "Heart size is mildly enlarged without significant pericardial fluid. Trace\nright base atelectasis. 4 mm left base nodule (02:18).\n\nCT abdomen with contrast: Liver is diffusely hypoattenuating compatible with\nsteatosis. Liver otherwise enhances homogeneously without focal mass or\nbiliary dilatation. Portal vein is patent. Gallbladder is absent with clips in\nplace.\n\nSpleen, pancreas and adrenal glands are unremarkable.\n\n29 mm partially exophytic right upper pole renal cyst is noted, a could be 2\nadjacent cyst or cyst with internal septation. Its margins are not well\nassessed due to artifact from patient body habitus, specifically peripheral\nnodularity is possible (602b:44). Kidneys are mildly atrophied. 10 mm\nintermediate density left upper pole renal lesion. Kidneys otherwise present\nsymmetric nephrograms and excretion of contrast without hydronephrosis.\n\nStomach, duodenum and remainder of the small bowel loops are normal caliber\nwithout evidence of obstruction. Prior sigmoid resection with primary colonic\nanastomosis without evidence of obstruction. Trace diverticulosis without\nevidence of diverticulitis. Large bowel is otherwise thin-walled and\nunremarkable without pericolonic fat stranding.\n\nAbdominal aorta is normal caliber. Mesenteric and retroperitoneal lymph nodes\nare not pathologically enlarged. No ascites or pneumoperitoneum. Small\ninfraumbilical abdominal wall hernia with sagittal defect measuring roughly 10\nmm containing irritated fat.\n\nCT pelvis with contrast: Bladder, seminal vesicles, prostate and rectum are\nunremarkable. Bilateral fat containing inguinal hernias. No free pelvic fluid\nor air. Inguinal and pelvic sidewall lymph nodes are not pathologically\nenlarged.\n\nBones and soft tissues: No suspicious focal bone lesion.", "output": "1. Small infraumbilical abdominal hernia containing irritated fat may be\nresponsible for pain.\n2. 4 mm left lung base nodule. If patient has high risk factors such as\nsmoking, followup examination is recommended in 12 months per ___\nsociety criteria. Otherwise no followup is necessary.\n3. 10 mm intermediate density left upper pole renal lesion, likely\nrepresenting a proteinaceous or hemorrhagic cyst however further evaluation\nwith nonemergent ultrasound is recommended. The right renal cyst should be\nevaluated that time the as well for assessment of possible internal septation\nor nodularity. If these cannot be characterized by ultrasound secondary to\npatient body habitus, MR may be necessary.\n4. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Stable\ncardiomegaly. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low attenuation throughout, consistent\nwith fatty liver. There is no evidence of focal lesions within the\nlimitations of an unenhanced scan. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Splenomegaly measuring 18.0 cm, slightly increased from prior when it\nmeasured 16.2 cm. No focal lesions are identified on this unenhanced scan..\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. In the right upper\npole, there is a 2.3 x 3.5 x 2.7 cm hypodense lesion with ___ of 6, consistent\nwith a cyst (601; 50). 4 mm hyperdensity in the right posterior interpolar\nregion is consistent with a renal calculus (2; 42). There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed and unremarkable. Distal ureters\nare unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is an umbilical hernia containing the anterior wall of a\nloop of small bowel (602; 57). There may be small bilateral fat containing\ninguinal hernias without involvement of bowel.", "output": "1. No definite intra-abdominal pathology to explain patient's pain.\n2. Nonobstructing 4 mm right renal calculus with no evidence of hydronephrosis\nbilaterally.\n3. Possible small bilateral fat containing inguinal hernias without\ninvolvement of bowel.\n4. Splenomegaly.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by Dr.\n___. on the telephone on ___ at 11:37 am, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nThere is a 1.2 x 1.0 cm hypodense cystic-appearing lesion at the medial aspect\nof the second portion of the duodenum (04:66), possibly representing\nduplication cyst vs cystic pancreatic lesions such as IPMN.\n\nPANCREAS: The pancreas otherwise has normal attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Colonic diverticulosis, with\na prominent diverticula of the sigmoid colon in the left pelvis with minimal\nsurrounding fat stranding. (04:101)\n\nPELVIS: The bladder contains gas, likely secondary to Foley catheter\nplacement. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease. Left femoral line is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No findings to explain patient's sepsis.\n2. Colonic diverticulosis, with a prominent diverticula of the sigmoid colon\nwith minimal surrounding fat stranding in the left pelvis. This may represent\nage indeterminate focal diverticulitis. While this could explain focal left\nlower quadrant pain, this is likely not a source of sepsis.\n3. There is a 1.2 x 1.0 cm hypodense cystic-appearing lesion at the medial\naspect of the second portion of the duodenum, possibly representing a\nduplication cyst vs cystic pancreatic lesions such as IPMN. When acute\nsymptoms resolve, recommend follow up MRI in ___ months.\n\nRECOMMENDATION(S): MRCP in ___ months." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate bilateral pleural effusions,\non the right greater than on the left, with multiple patchy opacities\ninvolving the left lower lobe, lingula, and right lower lobe, suggestive of\nmultifocal consolidation.\n\nABDOMEN: Moderate ascites within the abdomen and pelvis is noted. Enhanced\nperitoneum with areas of peritoneal thickening in the upper abdomen (series 6,\nimage 38), and omental caking (series 6, image 45), concerning for\ncarcinomatosis.\n\nHEPATOBILIARY: The liver overall demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is markedly\ndistended, without definite visualization of obstructing stones or sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is slightly enlarged, shows normal attenuation throughout,\nwithout evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are unremarkable.\n\nURINARY: There is right hydroureteronephrosis extending to the level of the\nright psoas. No ureteral calculus is evident. The right kidney is slightly\nenlarged and demonstrates cortical thinning compared to the left. A\nhypodensity in the interpolar region of the left kidney probably represents a\ncyst. There is no evidence of focal renal lesions.\n\nGASTROINTESTINAL: A hiatal hernia is noted. There is diffuse thickening of\nthe gastric wall, most notably in the body and antrum. Contrast filled small\nbowel loops are unremarkable. There is prominence of the air and fluid-filled\ntransverse colon. Otherwise, the colon is unremarkable all the way to the\ndistal sigmoid/upper rectum, where there is an area of apparent narrowing\n(series 6, image 167). Oral contrast is seen distal to this area.\n\nPELVIS: There is an indwelling catheter with a balloon noted within the\ncollapsed urinary bladder. Otherwise, the urinary bladder and distal ureters\nare unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Probably enlarged lymph nodes in the celiac axis and porta\nhepatis (series 6, image 58). Mesenteric or pelvic lymphadenopathy is not\nevident.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes in the lumbar spine and compression deformities in\nthe superior endplates of L3 and L4. Otherwise, there is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Anasarca, otherwise, the abdominal and pelvic wall is within\nnormal limits.", "output": "1. Moderate ascites in the abdomen and pelvis associated with areas of\nperitoneal thickening and omental caking concerning for carcinomatosis.\n2. Diffuse thickening of the gastric wall with possible lymphadenopathy in the\nceliac axis and porta hepatis.\n3. Focal narrowing in the distal sigmoid/upper rectum without definite\nevidence of obstruction.\n4. Right hydroureteronephrosis extending to the level of the right psoas,\nwithout evident ureteral calculus.\n5. Bilateral pleural effusion with multiple patchy opacities suggestive of\nmultifocal consolidation." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis is noted.\n\nABDOMEN: The liver, pancreas, adrenal glands and kidneys are unremarkable. \nThe gallbladder is within normal limits. No biliary ductal dilatation or\nhydronephrosis.\n\n\nGASTROINTESTINAL: No bowel obstruction or ascites. The appendix is\nunremarkable.\n\nPELVIS: There is trace free fluid in the pelvis.\nThe uterus is within normal limits. There is a large predominantly simple\nappearing cyst within the left adnexa measuring 5.5 x 4.9 x 5.2 cm. The\napparent enhancing component on series 3, image 134 is contiguous with the\novary on sagittal images\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is an eccentric partial filling defect within the common\nfemoral vein extending into the proximal external iliac vein (proximal vein,\ntwoards the feet), compatible with nonocclusive thrombus (3:158-174, 601:69).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Nonocclusive thrombus in the left common femoral extending into the\nproximal external iliac vein.\n2. 5.5 cm left adnexal cyst could be within physiologic range. Consider\npelvic ultrasound for further evaluation." }, { "input": "The study is slightly limited due to suboptimal bolus timing.\n\n'LOWER CHEST: Other than minimal bibasilar atelectasis, the partially imaged\nlower lungs are clear. No pleural or evidence of a pericardial effusion\n\nABDOMEN:\n\nHEPATOBILIARY: A 6-mm hypodensity in segment 2 of the left lobe is too small\nto accurately characterize on CT, statistically most likely a cyst or\nhemangioma (series 3, image 11). The liver otherwise demonstrates homogenous\nattenuation throughout. No evidence of concern focal hepatic lesions. No\nevidence of intrahepatic or extrahepatic biliary dilatation. The common bile\nduct is slightly prominent up to 6 mm. The gallbladder is decompressed and\nunremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is is distended with contrast ingested food\ncontents. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. No\nbowel obstruction. No free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable. Normal\nfollicular activity in the ovaries.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal or pelvic process on CT." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneously decreased attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is not\nvisualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA hypoattenuating lesion the left kidney is too small to completely\ncharacterize, but statistically likely reflects a simple cyst. There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions. A T10 anterior\ncompression deformity is unchanged to minimally progressed since ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No etiology identified for the patient's reported symptoms.\n2. Probable hepatic steatosis.\n3. A T10 anterior compression deformity is unchanged to minimally progressed\nsince ___." }, { "input": "LOWER CHEST: Minimal atelectasis is noted at the lung bases. No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. However, note is\nmade of ileocolic intussusception measuring approximately 5.3 cm in length\n(coronal series 601, image 22). Evaluation for an underlying neoplasm is\nlimited as there is incomplete oral contrast opacification of the terminal\nileum and cecum, however these findings are suspicious for an underlying\nneoplasm serving as a lead point. There is mild pericecal fat stranding. \nUncomplicated colonic diverticulosis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly.\n\nLYMPH NODES: Several prominent paraesophageal/periaortic lymph nodes are noted\nwithin the lower thorax (axial series 2, image 9). Single enlarged lymph node\nis noted within the small bowel mesentery within the left hemiabdomen (axial\nseries 2, image 46) measuring 10 mm. There is an additional cluster of\nmesenteric lymph nodes, which are nonenlarged but prominent in number\nfollowing an ileocolic distribution (axial series 2, image 50). 6 mm soft\ntissue nodule is noted within the right posterior pararenal space (axial\nseries 2, image 25), new from ___. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nFocal lucent lesions in the T12 and L4 vertebral bodies are stable dating back\nto ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Surgical\nclip is noted within the right hemiscrotum.", "output": "1. Ileocolic intussusception with mild pericecal fat stranding raises the\nsuspicion of an underlying mass lesion acting as a lead point, particularly\ngiven a previous history of melanoma. However, a discrete mass lesion is not\nclearly identified.\n2. Enlarged rounded mesenteric lymph node within the left hemiabdomen with\nadditional cluster of prominent but nonenlarged lymph nodes following an\nileocolic distribution.\n3. New soft tissue nodule within the right posterior pararenal space.\n4. Several prominent paraesophageal/periaortic lymph nodes within the lower\nthorax.\n\nRECOMMENDATION(S): Correlation with colonoscopy is recommended.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:18 pm, 3 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Patient is status post right hemicolectomy. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is surgically absent.\n\nPELVIS: Again, there is a 10 mm hyperenhancing nodule within the bladder at\nthe left UVJ, similar compared to prior (series 5, image 114). Otherwise, the\nbladder is normal in appearance. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged measuring 5.7 x 4.1 cm.\n\nLYMPH NODES: Multiple retrocrural lymph nodes within the lower chest are\nsimilar compared to prior measuring 7 mm in short axis on the right, and 8 mm\non the left (series 5, image 47). 6 mm nodule within the right posterior\npararenal space is unchanged (series 5, image 61). There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stranding within the midline anterior abdominal wall is likely\npostoperative in nature. Patient is status post right inguinal hernia repair.\nOtherwise, the abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged 10 mm hyperenhancing nodule within the bladder at the left UVJ,\nconcerning for a metastatic lesion or primary bladder malignancy. Unchanged 6\nmm nodule within the right posterior perirenal space. No new sites of\nmetastatic disease within the abdomen or pelvis.\n2. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No focal consolidations. No pleural\nor pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: Stable hypodensity at the dome of the liver is too small to\ncharacterize (series 2, image 5) likely a cyst or biliary hamartoma. No\nadditional focal lesion within the limitations of a noncontrast examination. \nOtherwise, liver demonstrates homogeneous attenuation throughout. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A 4 mm nonobstructing stone is seen within the interpolar region of\nthe right kidney (series 2, image 20). The kidneys are of normal and\nsymmetric size. There is no evidence of focal renal lesions within the\nlimitations of an unenhanced scan. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not definitively visualized, however there is\nno adjacent fat stranding to suggest appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abnormality within the abdomen or pelvis. Specifically, no\nhydronephrosis, diverticulitis, or appendicitis. 4 mm non-obstructing stone\nwithin the interpolar right kidney." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in bilateral left greater\nthan right lower lobes. There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 7\nmm intermediate density focus in the right lobe of the liver (2:6) is too\nsmall to characterize but is grossly unchanged from CT abdomen pelvis ___. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia, otherwise, the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Incidentally noted is a short segment\nenteroenteric intussusception. No secondary obstruction. The colon and\nrectum are within normal limits. The appendix is not visualized but there is\nno secondary sign of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abnormality in the abdomen or pelvis to explain patient's reported\nlower abdominal pain. Specifically, no evidence of obstruction or\ndiverticulitis. The appendix is not visualized but no secondary sign of acute\nappendicitis. No free fluid in the pelvis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Two\nhypoattenuating lesions in the right lobe measuring up to 1.3 cm (2:63) are\nunchanged and likely represent cysts or biliary hamartomas. Hyperenhancing\nareas in the right lobe (2: 52, 64) are also unchanged and likely represent\nhemangiomas. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 3.7 x 3.0 x 3.4 cm (2:60, 601:36) heterogeneous, enhancing mass at the right\nupper pole is unchanged in size, previously 3.6 x 3.0 x 3.3 cm, as remeasured\ntoday. No new focal renal mass lesions are identified. There is no\nhydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (601:31).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 3.7 cm right upper pole renal mass is unchanged in size. No new lesions\nidentified.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Redemonstration of ground-glass opacity in the right lower lobe,\nmeasuring 1.9 x 1.1 cm (previously 2.0 x 1.6 cm). There is no evidence of\npleural or pericardial effusion. Pacemaker lead terminates in the right\nventricle.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple punctate, too small to characterize, hepatic hypodensities are most\nrepresentative of hepatic cysts or biliary hamartomas. Stable 1.3 cm right\nhepatic lobe cyst in segment V (previously 1.5 cm). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again seen is a heterogeneously hyperenhancing mass arising from the\nthe upper pole of the right kidney, measuring 3.8 x 3.2 x 3.6 cm (previously\n3.8 x 3.1 x 3.4 cm in ___, and 3.5 x 2.6 x 3.1 cm in ___\n(series 5, image 24). It does not involve the right renal vasculature. No\nnew masses are seen. No evidence of hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Patent single bilateral\nrenal arteries and veins. Moderate atherosclerotic disease is noted. In\nparticular, the atherosclerotic plaques at the origin of the right renal\nartery does not cause stenosis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes to the thoracolumbar spine is again seen.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. 3.8 cm right renal mass is minimally enlarged from ___,\npreviously measuring up to 3.5 cm on the scan dated ___. No ipsilateral\nrenal vein involvement or renal hilar lymphadenopathy.\n2. No evidence of metastatic disease in the abdomen or pelvis.\n3. Nonspecific 1.9 cm ground-glass opacity in the right lung base, grossly\nunchanged from ___, attention on follow-up." }, { "input": "LOWER CHEST: Multiple peripheral nodules with central cavitation at the right\nbase, are unchanged from prior chest CT on ___ and consistent with\nseptic emboli. A moderate right parapneumonic effusion with mild loculation\nand a small left nonhemorrhagic effusion are unchanged. Moderate right\nbasilar atelectasis is unchanged.\n\nABDOMEN:\nHEPATOBILIARY: A heterogeneous centrally hypodense lesion in segment VI of\nthe liver in a subcapsular location with peripheral nodular enhancement\nmeasuring up to 4.3 x 4.3 cm is again seen. At the top of segment VII, there\nis a wedge-shaped hypodensity with some surrounding mildly increased\nenhancement, incompletely evaluated on this single phase study and\nnon-specific appearing. No additional focal concerning liver lesion is\nidentified. Multiple small rounded hypodensities in both lobes of the liver\nare too small to further characterize and are most likely cysts or biliary\nhamartomas. There is no evidence of intrahepatic or extrahepatic biliary\nductal dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple bilateral rounded renal hypodensities, the largest in the\ninterpolar aspect of the left kidney measuring up to 7.8 x 7.3 cm with an\naverage ___ of 10, are likely simple cysts. Otherwise, the kidneys are of\nnormal and symmetric size with normal nephrogram. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: A Foley catheter is present within a decompressed bladder. Otherwise,\nthe bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is significantly enlarged, measuring\nup to 6.1 x 6.0 cm, similar to prior MRI in ___.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no lytic or sclerotic lesion suspicious for malignancy. Mild\ndegenerative changes of the lower lumbar spine, most notable at L4-L5 with\nsclerosis of the inferior endplate of L4 with subchondral cyst formation and\nL5-S1 with loss of disc height and vacuum disc phenomenon.\n\nSOFT TISSUES: There is a small indirect right inguinal hernia without\nevidence of strangulation. The abdominal and pelvic wall is within normal\nlimits.", "output": "1. Unchanged 4.3 x 4.3 cm heterogeneous lesion in segment VI of the liver with\nperipheral discontinuous enhancement is likely a hemangioma. This does not\nhave an appearance of an hepatic abscess.\n2. 3 cm indeterminate wedge-shaped hypodensity in segment VII of the liver\nwith mild surrounding hyperenhancement is indeterminate. An ischemic focus in\nthe setting of septic emboli is possible. If patient's condition worsens or\nthere is increasing suspicion for infection, this could be followed-up by MRI.\n3. Unchanged multifocal peripheral nodules with central cavitation at the\nright lung base, most consistent with septic emboli.\n4. Moderate right parapneumonic effusion with mild loculation and small left\npleural effusion, both unchanged." }, { "input": "LOWER CHEST: Micro nodule in the right lower lobe (series 3, image 1) was not\nable to be fully appreciated on prior study. No follow-up is recommended. \nOtherwise, remaining visualized portion of the bilateral lower lobes are\nclear.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Bilateral adrenal glands are not well visualized on this exam.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small amount of contrast is visualized in the distal\nesophagus without evidence esophageal dilation and may be a consequence of\nreflux versus dysmotility, likely representing reflux. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout, without evidence of dilation. Air stool levels\nseen in the colon are consistent with history of watery diarrhea. There is no\nevidence of obstruction or inflammatory process. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: There is trace free fluid appreciated in the cul de sac.The urinary\nbladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Air stool levels in the colon are consistent with history of diarrhea. No\nevidence of colonic obstruction or inflammatory process. Small bowel appears\nnormal.\n2. Trace free fluid in the cul-de-sac.\n3. Incidentally detected right lower lobe micro nodule. No follow-up is\nrecommended.\n\nRECOMMENDATION(S): For incidentally detected nodules smaller than 6 mm in\nthe setting of an incomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:00 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "CHEST:\n\nHEART AND VASCULATURE: There is mild-to-moderate mass effect at the origin of\nthe main pulmonary artery (2:67; 602b:91) due to a 9.4 x 4.5 x 9.0 cm anterior\nmediastinal hematoma. A punctate ill-defined hyperdense focus in the\nretrosternal region along the inferior portion of the hematoma posterior to\nthe left internal mammary artery (2:104) is of unclear significance. No\ndefinite active arterial extravasation is noted in the chest. Pulmonary\nvasculature is well opacified to the subsegmental level without filling defect\nto indicate a pulmonary embolus. The thoracic aorta is normal in caliber\nwithout evidence of dissection or intramural hematoma. The heart,\npericardium, and great vessels are within normal limits. A small pericardial\neffusion is noted.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: Bilateral pleural effusions, trace on the right and moderate\nto large on the left, intermediate density consistent with hemorrhage in the\nsetting of recent trauma.\n\nLUNGS/AIRWAYS: There is bibasilar atelectasis. The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. There is no free\nintraperitoneal fluid or free air.\n\nPELVIS: The urinary bladder distended with previously administered contrast. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. An anterior mediastinal hematoma causes mild-to-moderate mass effect at the\norigin of the main pulmonary artery. A punctate ill-defined hyperdense focus\nin the retrosternal region posterior to the left internal mammary artery\n(2:104) is of unclear significance. No definite active arterial extravasation\nis noted in the chest.\n2. A punctate ill-defined hyperdense focus in the retrosternal region\nposterior to the left internal mammary artery (2:104) is of unclear\nsignificance. No definite active arterial extravasation is noted in the chest\nwithin the limitations of the study.\n3. Bilateral pleural effusions, trace on the right and moderate to large on\nthe left, consistent with hemorrhage in the setting of recent trauma.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:05 am, 10 minutes after\ndiscovery of the findings.\n\n The findings were discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 1:21 am, 15 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. No evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. No evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits. No\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNo concerning focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diffuse mild wall\nedema and hyperemia with surrounding fat stranding throughout the colon and\nrectum is demonstrated. No bowel obstruction. No intra-abdominal drainable\nfluid collection or free air. No diverticulosis. The terminal ileum appears\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. The minimal\namount of free fluid is demonstrated in the pelvis and is simple in\nattenuation.\n\nREPRODUCTIVE ORGANS: An IUD is demonstrated within the uterine cavity. The\nreproductive organs are otherwise unremarkable.\n\nLYMPH NODES: Multiple, likely reactive mesenteric nodes are visualized\nthroughout the abdomen. No pelvic sidewall or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A fat containing umbilical hernia is tiny. Otherwise, the\nabdominal and pelvic wall is within normal limits.", "output": "1. Procto-pancolitis which may be infectious or inflammatory in etiology. \nTerminal ileum appears normal. Several prominent mesenteric lymph nodes are\nlikely reactive.\n2. Minimal amount of free fluid in the pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nIncidental note is made of an anatomic variant Phrygian cap.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Incidental note is made of 2 accessory splenules.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\npersistent wall thickening and mucosal hyper enhancement of the rectum and\nsigmoid colon extending to a lesser degree throughout the remainder of the\ncolon. Notably, there is new, near complete loss of haustral folds throughout\nthe entire length of the colon. There is prominence of the vasa rectae, but\nno adjacent fat stranding or fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is appropriately placed within the uterus.\n\nLYMPH NODES: Prominent mesenteric lymph nodes are not pathologically enlarged\nby CT size criteria. There is no retroperitoneal, pelvic, or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Persistent pancolitis without abdominal or pelvic fluid collections." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis and a trace left pleural\neffusion. Visualized lung fields are otherwise within normal limits. There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is a small amount of simple fluid adjacent to the inferior-most aspect\nof the liver.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Incidental note is made of 2 accessory spleens.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The patient is status-post\ntotal colectomy with end ileostomy. The ileostomy protrudes through the right\nabdominal wall with adjacent fat stranding, subcutaneous emphysema, and two\nsubcutaneous fluid collections, likely postsurgical. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nContrast opacifies the rectal stump without any evidence of leak, although\nthere is a significant amount of debris within the rectal stump. Superior to\nthe rectal stump, there is a 1.2 x 2.2 cm simple appearing (16 ___ fluid\ncollection without rim enhancement (5:67). There is a moderate amount of\npneumoperitoneum within the upper abdomen in addition to scattered locules of\nair in the groove of the falciform ligament and scattered throughout the\nmesenteric fat.\n\nPELVIS: A small amount of intravesicular air may reflect recent Foley\ncatheter, correlation recommended. The urinary bladder is otherwise\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD appears appropriately positioned within an\nanteverted uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The ileostomy protrudes through the right abdominal wall. \nAdjacent to the ostomy, there is fat stranding, scattered subcutaneous\nemphysema, and 2 small fluid collections (5:62, 5:64). There are scattered\nlocules of air throughout the anterior pelvic and anterior/lateral abdominal\nwalls and subcutaneous tissues, likely postsurgical in nature.", "output": "1. A simple appearing fluid collection superior to the rectal stump is not rim\nenhancing. No evidence of leak. Significant amount of debris within the\nrectal stump.\n2. Scattered postsurgical changes include pneumoperitoneum, subcutaneous\nemphysema, and fat stranding and simple-appearing fluid collections within the\nsubcutaneous tissues adjacent to the ileostomy.\n3. A small amount of intravesicular air may reflect recent Foley catheter,\ncorrelation recommended." }, { "input": "LOWER CHEST: Visualized lung fields are notable for minimal right lower lobe\natelectasis. The heart is unremarkable. No pericardial effusion. No\ncoronary artery calcifications. No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 0.8 cm accessory spleen is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost total colectomy with right lower quadrant end ileostomy and rectal stump.\nContrast is seen up to the right lower quadrant. No contrast is seen within\nthe end ileostomy however this is likely related to early timing of study.\nMild mucosal enhancement of rectal stump is noted without significant fat\nstranding, or wall thickening. The appendix is surgically absent. No focal\nfluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is notable for an IUD. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild mucosal hyper enhancement of rectal stump without additional signs of\ninflammation. Finding may be postsurgical in nature however acute pouchitis\nwould be similar in appearance with differential including inflammatory,\ninfectious or ischemic etiology. Clinical correlation recommended.\n2. S/p total colectomy with right lower quadrant and ileostomy and associated\npostsurgical changes. No obstruction." }, { "input": "LOWER CHEST: There is an unchanged 5 mm pulmonary nodule within the left lower\nlobe (2:14). Known right lower lobe pulmonary nodules are not definitively\nvisualized on the current study, likely secondary to imaging technique. The\nlung bases are otherwise clear. No pleural or pericardial effusion.\n\nThe patient is status post bilateral ___ flap breast reconstruction. The\nbreast tissue is incompletely assessed on the current study. Surgical clips\nare seen within the soft tissues overlying the inferior anterior aspect of the\nthoracic cage. No discrete fluid collection or foci of soft tissue gas on\nlimited view.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver demonstrates homogeneous attenuation throughout. No\nevidence of concerning focal hepatic lesion. No evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout without evidence of\nfocal lesion or ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen demonstrates normal size and attenuation without evidence\nof focal lesion.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys are normal in size and are symmetric with a normal\nnephrogram. A 1.8 cm exophytic renal cyst is seen at the lower pole of the\nright kidney. A hypodensity within the interpolar region of the right kidney\nis too small to characterize. No evidence of concerning focal renal lesion or\nhydronephrosis. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is not well assessed on CT, but appears grossly\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement. There are diverticula within the sigmoid colon without\nevidence of diverticulitis. Otherwise the colon and rectum are unremarkable.\nThe appendix is not definitively visualized, there is no evidence fat\nstranding within the right lower quadrant.\n\nPELVIS: No free fluid within the pelvis. The urinary bladder and distal\nureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: No evidence of retroperitoneal or mesenteric lymphadenopathy. No\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild calcified atherosclerotic plaque is seen within the abdominal\naorta and great abdominal arteries. No abdominal aortic aneurysm.\n\nBONES: No evidence of worrisome osseous lesion or acute fracture.\n\nSOFT TISSUES: Re-demonstrated is a fat containing umbilical hernia. In\naddition, extensive surgical clips are seen in the lower abdominal wall also\ncompatible with the patient's prior reconstruction surgery. At the presumed\nprior surgical site there is a large horizontally oriented soft tissue defect,\nmeasuring approximately 4 x 15 cm (CC x TV). Packing material is noted within\nthe soft tissue defect. There is extensive associated soft tissue fat\nstranding surrounding the defect and extending laterally on the right to the\nregion of the external oblique muscle (2:59). There is no discrete abscess or\ndrainable fluid collection. The rectus abdominus muscles are without focal\ndefect. No evidence of infectious process within the intra-abdominal\nmesenteric fat.", "output": "1. The patient is status post ___ flap breast reconstruction. Within the\ninferior abdominal wall at the presumed prior surgical site there is a large\nhorizontally oriented soft tissue defect. Packing material is seen within the\ndefect. There is extensive associated soft tissue stranding but no discrete\nabscess or fluid collection.\n2. The breast tissue is not well assessed on the current study.\n3. Incidental findings as described above." }, { "input": "LOWER CHEST: A 3 mm nodule in the right lower lobe is noted (02:12). There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.9 x 1.3 cm hypodensity in the left hepatic lobe is noted. There is\nintrahepatic and extrahepatic biliary dilatation. The gallbladder is\ndistended. A punctate stone is seen within the gallbladder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A subtle hypodensity in the left renal upper pole is concerning for\nnephritis. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The ovaries are not enlarged. The uterus appears\nslightly enlarged and likely contains a fibroid.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Subtle hypodensity in the left renal upper pole is concerning for\nnephritis. Correlate with UA and symptoms.\n2. Distended gallbladder with both intra and extrahepatic biliary ductal\ndilation. Please correlate clinically and if needed, right upper quadrant\nultrasound may be performed to further assess.\n3. A 1.3 cm hepatic hypodensity should be further evaluated with nonemergent\nUS or MRCP.\n4. 3 mm pulmonary nodule in the left lower lobe. If patient is low risk no\nfollow-up is needed. If patient is high risk, recommend follow-up CT at 12\nmonths per ___ criteria.\n\nRECOMMENDATION(S): Right upper quadrant ultrasound and/or MRCP.\n\nNOTIFICATION: The findings were emailed to the ED QA nurses by ___\n___, M.D. on ___ at 9:00 ___, 20 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout,\nnoting mild generalized hypoattenuation suggesting steatosis. A subtle\nsegment VII hypodensities too small to completely characterize, but unchanged\nand statistically likely a cyst or biliary hamartoma (02:20). There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Incidental note is again made\nof a periampullary duodenal diverticulum. Small bowel loops otherwise\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. An inferior vena cava filter is noted. Incidental note is made of\na replaced left hepatic artery arising from left gastric artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nIrregularity of the anterior left iliac bone is unchanged\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Soft\ntissue nodules in the anterior abdominal wall are noted, possibly related to\nsubcutaneous injection (2:61, 2:66).", "output": "No etiology identified for the patient's reported symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneously hypodense, likely due to steatosis. \nA subcentimeter hypodensity seen within the right lobe of the liver (series 2,\nimage 23), too small to characterize, but likely represents a simple cysts or\nbiliary hamartomas. There is no evidence of enhancing lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The common bile\nduct is mildly prominent, however this unchanged. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The subcentimeter hypodensity within the upper pole of the left\nkidney is too small to characterize, but likely represents a simple cyst. The\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a small duodenum\ndiverticulum. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. An infrarenal IVC filter is visualized.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A few nodules within the subcutaneous tissues of the anterior\nabdominal wall are likely due to injections. The abdominal and pelvic wall is\nwithin normal limits.", "output": "1. No acute intra-abdominal process.\n2. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodensity in the right hepatic lobe is too small to\ncharacterize, and appears unchanged compared to ___ (series 2,\nimage 18). There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is not\nvisualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Incidentally\nnoted is a duodenum diverticulum. The colon and rectum are within normal\nlimits. The appendix is normal in size and caliber, and contains some\nhyperdense material which may be calcification.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Prominent lymph nodes are noted in the left inguinal region\nadjacent to fluid collection, which are likely reactive. There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic\nlymphadenopathy.\n\nVASCULAR: An IVC filter is in stable position with the tip at the level of\nthe renal veins. There does not appear to be mass effect on the iliac vessels\nby the left inguinal region fluid collection. Contrast study this phase is\nnot optimized for evaluation for DVT. There is no abdominal aortic aneurysm. \nNo significant atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a defect in the left iliac bone, which is presumably post-surgical.\n\nSOFT TISSUES: A hypodense organizing fluid collection with rim enhancement in\nthe left inguinal region measures 3.3 x 6.3 x 4.4 cm, which is similar in size\nto fluid collection seen on ___, although now all has rim\nenhancement (for example series 2, image 77 and series 601b, image 21). This\nmay represent a seroma or abscess.", "output": "1. 6.3 cm hypodense organizing fluid collection with rim enhancement with\nsurrounding fat stranding and reactive lymphadenopathy in the left inguinal\nregion is compatible with a postoperative seroma or abscess. It does not\nappear to be causing mass effect on the iliac vessels.\n2. IVC filter is seen in standard position with the tip at the level of the\nrenal veins." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal suspicious lesions. A tiny hypodensity within\nthe right hepatic lobe is unchanged and likely represents a cyst or biliary\nhamartoma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. A duodenal diverticulum is\nagain noted and appears unchanged (02:35). Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe colon is noted, without evidence of wall thickening nor fat stranding. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Uterus is unremarkable. No adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic lymphadenopathy. Prominent left inguinal lymph nodes are\nunchanged and likely reactive in nature.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. An infrarenal IVC filter is unchanged in position.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The patient is status post left femoral hernia repair, with\npostoperative changes and moderate residual fat stranding seen at these\nsurgical site (for example, 2:78). Multiple injection site granulomas are\nnoted overlying the abdominal wall.", "output": "1. No evidence of acute process within the abdomen and pelvis. Normal\nappendix.\n2. Stable postsurgical changes in the left inguinal region status post\nfemoral hernia repair.\n3. Colonic diverticulosis without evidence for acute diverticulitis." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. There is a small hiatal hernia.\n\nABDOMEN: Patient is status post recent cholecystectomy with clips in the\ngallbladder fossa. No fluid collection in the surgical bed. Mild prominence\nof the intrahepatic biliary tree likely reflects post cholecystectomy changes.\nThe main portal vein is patent. There are no worrisome liver lesions. The\nspleen is normal. The adrenals are normal. The pancreas is grossly\nunremarkable. The kidneys enhance symmetrically. Right renal cortical\nhypodensity is again seen likely a simple cyst. No signs of pyelonephritis. \nNo hydronephrosis. The abdominal aorta is moderately calcified and normal in\ncourse and caliber. The stomach and duodenum appear unremarkable. No\nadenopathy is seen.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is not definitively visualized though there are no secondary signs of\nappendicitis. The colon is unremarkable containing a mild fecal load. \nDiverticulosis is noted without convincing evidence for diverticulitis though\nevaluation somewhat limited given paucity of intra-abdominal fat. The bladder\nis thickened and hyperemic concerning for cystitis. There is mild pelvic\nfloor descent. The uterus is not well visualized. No adnexal mass is seen. \nThere is no pelvic sidewall or inguinal adenopathy.\n\nBones: The bones are demineralized and there is a mild dextroscoliosis of the\nlumbar spine. No worrisome lytic or blastic osseous lesion. Severe right hip\nosteoarthritis is noted.", "output": "1. Findings suggestive of cystitis. No evidence of an ascending infection or\npyelonephritis.\n2. Status post recent cholecystectomy without evidence of acute postoperative\ncomplication.\n3. Additional nonemergent findings as above." }, { "input": "ABDOMEN: Please see the chest CT from the same day for further details\nregarding intrathoracic findings CT patient is status post esophagectomy with\ngastric pull-through. The previously noted lesion in the hepatic dome is not\nclearly visualized on today's exam. No other focal lesions are identified. \nThe main portal vein is patent. Patient is status post cholecystectomy. The\npancreas, spleen and adrenal glands are unremarkable. The kidneys enhance and\nexcrete contrast symmetrically without any focal lesions or hydronephrosis. \nThe visualized stomach small intra-abdominal large bowel are unremarkable. A\njejunostomy tube is in appropriate position. A small amount of mesenteric\nstranding is likely postoperative. The aorta is of normal caliber without\nevidence of aneurysm. Prominent gastroesophageal node is decreased in size\nmeasuring 5 mm in short axis previously 12 mm. Prominent periportal lymph\nnodes are unchanged. There is no free fluid or free air within the abdomen.\n4\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions.", "output": "1. No evidence of intra-abdominal fluid collection or abscess.\n2. Please see the dedicated chest CT report for further details.\n3. Decrease in size of previously prominent gastrohepatic lymph nodes." }, { "input": "LOWER THORAX: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nHEPATOBILIARY: Linear area of hypoattenuation within segment 4B is unchanged\nfrom the prior study but new from ___. This is of uncertain etiology\nand could represent an area of focal fatty infiltration or be related to prior\ninjury. There is an additional area of hypoattenuation adjacent to the false\nform ligament, likely focal fatty infiltration. Stable hemangioma at the\nhepatic dome. Additional subcentimeter hypodensity within segment 8 (axial\nseries 5, image 45) is too small to characterize but appears to correspond to\na T2 hyperintense lesion on prior MRI from ___, also likely a small\nhemangioma. There is moderate intrahepatic biliary ductal dilatation which\nappears unchanged from previous. Status post cholecystectomy.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis. Unremarkable\nbladder.\n\nGASTROINTESTINAL: S/p total esophagectomy and gastric pull up. The small and\nlarge bowel are normal in caliber. Normal appendix.\n\nREPRODUCTIVE ORGANS: Multiple avidly enhancing uterine lesions are noted,\nlikely small fibroids. No adnexal mass.\n\nLYMPH NODES: No retroperitoneal or mesenteric adenopathy. No pelvic or\ninguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Unremarkable.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic calcification.\n\nBONES: No suspicious osseous lesion.\n\nSOFT TISSUES: There is an 8 x 15 mm soft tissue nodule within the subcutaneous\ntissues of the right buttock (axial series 5, image 91) new from ___.", "output": "1. Postsurgical changes from total esophagectomy and gastric pull up.\n2. New 8 x 15 mm soft tissue nodule within the subcutaneous tissues of the\nright buttock is nonspecific.\n3. Linear area of hypoattenuation within segment 4B, unchanged from ___ may represent an area of focal fatty infiltration.\n\nRECOMMENDATION(S):\n1. Focused ultrasound could be considered for further evaluation of soft\ntissue nodule within the subcutaneous tissues of the right buttock.\n2. MRI of the liver is recommended to definitely characterize linear area of\nhypoattenuation in segment 4B given interval development since ___." }, { "input": "LOWER CHEST: Moderate low-density pleural effusions are partially imaged. \nCompressive atelectasis at the lung bases is unchanged. Coronary and aortic\nannular calcifications are moderate. There is no pericardial effusion.\nAssessment of the lung parenchyma is limited by respiratory motion. The\npatient is status post median sternotomy. A partially imaged central venous\nline terminates in the right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is severely atrophic. There is no evidence of focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A G-tube is noted in the anterior abdominal wall. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Previously seen colonic wall thickening is essentially resolved. \nA left colonic anastamosis is without evidence of complication. The appendix\nis not visualized.\n\nPELVIS: A Foley catheter is noted in the urinary bladder. Otherwise, the\nurinary bladder and distal ureters are unremarkable. There is a small amount\nof low-density free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not definitively visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Assessment of the aorta is\nlimited without intravenous contrast. Heavy atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes are noted in the anterior abdominal wall. \nMild anasarca within the superficial soft tissues.", "output": "1. Previously seen colonic wall thickening is essentially resolved. No bowel\nobstruction.\n2. Trace intra-abdominal ascites.\n3. Heavy atherosclerotic, aortic annular calcifications.\n4. Bilateral low-density pleural effusions with associated atelectasis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is ill-defined hypodensity in the right lobe of the liver\nseen on series 2, image 37, may represent developing phlegmon/abscess. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is a small calcification\nin the pancreatic head. The pancreatic head and uncinate are displaced by the\nretroperitoneal hematoma. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Small accessory spleen is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic. There is a transplant kidney was of\nhypodensities the upper and lower poles likely simple cyst. There is air\nwithin the ureter extending into the very bladder likely from instrumentation.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is fluid within the endometrial cavity which is\ngreater than would be expected for age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Large right retroperitoneal hematoma has increased in size and\ndensity compared to prior examination. The greatest axial dimension and\ncurrently measures 15.5 x 14.9 cm, previously measured 12.2 x 12.4 cm. There\nis increased density within the collection likely resolve of intra bleed pain\nover the past 7 days. There is additionally a hyperdensity within the\niliopsoas muscle representing hematoma which appears slightly decreased in\nsize compared to prior examination. Hyper density within the iliacus also\nappears slightly decreased from prior examination.", "output": "1. Interval increase in size of retroperitoneal hematoma now measuring up to\n15.5 cm.\n2. New Ill-defined hypodensity in the right lobe of the liver concerning for\nphlegmon/developing abscess. No drainable collection.\n3. Air within the urinary bladder and transplant ureter likely related to\nrecent instrumentation, clinical correlation is recommended.\n4. Fluid density within the endometrial canal greater than expected for\npatient's age. A pelvic ultrasound is recommended for further evaluation.\n\nRECOMMENDATION(S): Pelvic ultrasound for further evaluation fluid within the\nendometrial canal." }, { "input": "LOWER CHEST: (right basilar atelectasis and trace pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: Slightly heterogeneous appearance of the left hepatic lobe of\nuncertain etiology (2:14), possibly perfusional in nature. There is no\ndrainable fluid collection. Previously ill-defined hypodensity within the\nright hepatic lobe are not seen today. The portal veins appear patent.\n\nThere is no radiopaque gallstones. There is no intrahepatic biliary duct\ndilation. The common bile duct appears mildly prominent and measures up to 6\nmm, not significantly changed overall in appearance relative to prior study.\n\nPANCREAS: The main pancreatic duct is minimally prominent, unchanged. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen is unremarkable. A accessory spleen superiorly measures 1.3\ncm (02:22).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral native kidneys are atrophic in appearance. A pelvic\ntransplant kidney is without hydronephrosis. Several cortical and parapelvic\ntransplant renal cysts are stable in size. Within the upper pole of the\ntransplant kidney is a 1.7 cm cortical lesion of intermediate density,\npossibly reflective of hemorrhagic are proteinaceous content (2:62). A lower\npole parapelvic cyst measures up to 2.0 cm (2:60). Previously identified focus\nof air within the transplanted ureter seen on CT dated ___ is no\nlonger present.\n\nGASTROINTESTINAL: There is been interval removal of an enteric tube with\nplacement of a percutaneous gastrostomy tube. The stomach is unremarkable.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. A rectal tube is\nagain noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Presacral\nedema is noted.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is normal in caliber without aneurysmal\ndilatation. A left femoral vein catheter traverses the IVC and into the\nvisualized portions of the right atrium. A right femoral venous line\nterminates within the right common iliac vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild body wall edema.\n\nA peritoneal drain enters the anterior abdominal wall to the left of the\nmidline in unchanged position.\n\nThe large right retroperitoneal hematoma is decreased in size currently 13 x\n19 cm in coronal dimension (301b:31). This appears to layer inferiorly within\nthe pelvis. There is also minimal decrease in size of left pelvic wall\nhematoma within the iliacus muscles measuring approximately 3.9 x 7.9 cm\n(301b:30) and extends along the lateral aspect of the right femoral artery\ninferiorly.", "output": "1. Right retroperitoneal hematoma and iliacus muscle hematoma appear stable\nto mildly decreased in size.\n\n2. Hypodensity within the right hepatic lobe seen on prior is not visualized\ntoday. There are no drainable fluid collections within the hepatic\nparenchyma.\n\n3. Bilateral lower lobe opacities are felt likely atelectatic in etiology\nthough superimposed infection cannot be entirely excluded. Trace bilateral\npleural effusions are unchanged." }, { "input": "LOWER CHEST: The visualized lung bases are clear. There is no evidence of\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are bilaterally atrophic. The transplant kidney\nis in the right lower quadrant, with a 1.7 x 1.8 cm hypodense cyst in the\nlower pole and 1.8 cm hyperdense cyst in the upper pole, unchanged from prior\nexam.\n\nGASTROINTESTINAL: G-tube in situ. The stomach is unremarkable. Small bowel\nloops demonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal. Moderate interval\ndecrease in size of retroperitoneal hematoma with similar density compared to\nprior study. Currently, it measures 6.0 x 4.8 x 6.6 cm (98 cubic centimeters),\npreviously 5.4 x 7.0 x 7.6 cm(149 cubic centimeters). There is new simple\nfluid (average ___ 6) seen in the perihepatic and perigastric spaces, most\nlikely old blood from a rupture within the retroperitoneal hematoma with\nsubsequent extension of fluid into the intraperitoneal cavity.\n\nPELVIS: A peritoneal dialysis catheter is in situ, with tip terminating in\nthe pelvis. The urinary bladder and distal ureters are unremarkable. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous skin ulcer in the right gluteal soft tissues is\nagain seen. There is no associated deep abscess or deeper extension. The\nabdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in size of right retroperitoneal hematoma with unchanged\nattenuation. New perihepatic and perigastric simple fluid, likely secondary\nto rupture of the retroperitoneal hematoma with extension of contents into the\nintraperitoneal cavity.\n2. Right gluteal subcutaneous skin ulcer without associated deep abscess or\ndeep extension." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post renal transplant. Bilateral native kidneys\nare atrophic. The hypertrophic transplanted kidney located in the pelvis\ncontains multiple hypodense cysts the largest measuring 2.3 cm. The\npreviously seen 1.8 cm hyperdense cyst in the upper pole is unchanged from\nprior study. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Gastrostomy tube is noted. There has been interval\nresolution of the perihepatic ascites with minimal stranding and fluid along\nthe Conal fascia in the right lower quadrant (2:53). The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nperipherally enhancing 4.1 x 1.5 x 2.6 cm fluid collection adjacent to the\nright psoas muscle with adjacent stranding. The peritoneal dialysis catheter\nis in situ with tip terminating in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: A right femoral arterial line is noted. There is no abdominal\naortic aneurysm. Moderate atherosclerotic disease is noted.\n\nBONES: Multilevel degenerative changes are noted. No evidence of osseous\nlesions for acute fracture is noted.\n\nSOFT TISSUES: Scarring over the mid anterior abdomen likely secondary to prior\nsurgical intervention. Previously seen right gluteal ulcer extending into the\nsubcutaneous tissue is again noted. No evidence of deep extension or abscess\nformation.", "output": "1. Evolving retroperitoneal hematoma with interval decrease in size shows\nperipheral rim enhancement. A superimposing infection cannot be excluded.\n2. Stable gluteal ulcer without deep extension or abscess formation.\n3. Interval resolution of the perihepatic ascites with minimal stranding and\nfluid along the right lower quadrant." }, { "input": "LOWER CHEST: Small bibasilar atelectasis is demonstrated. No pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The gallbladder is within normal\nlimits. Prominence of the common bile duct measuring up to 1.2 cm is again\ndemonstrated, which appears similar to prior. There is a 0.9 cm cystic mass\nin the pancreatic head which appears to communicate with the main common bile\nduct (series 2, image 27), which is unchanged in size from ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic bilaterally, with a simple cyst\ndemonstrate off of the left renal cortex as well as hypodensities too small to\ncharacterize by CT. There is a renal transplant in the right lower quadrant. \nNo hydronephrosis is demonstrated. A intermediate density cyst in the\ntransplant kidney measuring up to 2.2 cm is unchanged from prior. No\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcifications are again demonstrated along the periphery\nof the uterus, presumably due to fibroids. There is a new calcification which\nappears to be in the endometrium (series 602, image 37).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. A right groin central venous catheter terminates in the\nright atrium.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES/RETROPERITONEUM: Thickening of the perirenal fascia on the right\nis likely sequelae of prior right psoas abscess and is unchanged. The left\npsoas muscle is enlarged with a 2.0 x 1.2 cm region with what appears to be a\nhematocrit level (series 2, image 44) and relative hypodensity along the\nnondependent portion concerning for intramuscular psoas hematoma, no rim\nenhancement is identified.\n\nAlong the tunneled tract of the right groin central line, there is prominence\nof the canal with possible fluid along its course.", "output": "1. No acute gastrointestinal process to correlate with the patient's symptoms.\n2. New left psoas muscle thickening with concern for hematocrit level, psoas\nhematoma. No rim enhancement is identified.\n3. Persistent common biliary dilatation to 1.2 cm. No significant change in a\n0.9 cm cystic pancreatic head lesion which appears to communicate with the\nmain common bile duct compared to ___.\n4. New calcification appears to be within the endometrium, recommend\noutpatient follow-up with pelvic sonography.\n5. Along the tunneled tract of the right groin central line, there is\nprominence of the canal with fluid seen tracking along the course of the\ncatheter, infection not excluded. Recommend correlation with physical exam.\n\nRECOMMENDATION(S): Follow-up pelvic ultrasound for new endometrial\ncalcification which may be obtained as an outpatient.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:56 am, 10 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Dependent atelectasis is demonstrated in the lung bases without\nfocal consolidations. No pleural or pericardial effusion. Diffuse coronary\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: A 1.9 x 1.8 cm hypodensity is seen at the dome of the liver\n(series 2, image 9), likely a simple cyst. Otherwise, the liver demonstrates\nhomogenous attenuation throughout. There is no evidence of concerning focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. A radiolucent stone appears to be within the gallbladder (02:31).\nThere is no evidence of acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is an unusual, markedly lobulated configuration of the spleen\nwith multiple adjacent accessory spleens. No concerning focal splenic lesion\nis present.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The SMV courses to the left of the SMA and the duodenum does\nnot cross midline, consistent with malrotation. There is a small hiatal\nhernia. Otherwise, the stomach is unremarkable. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncecum and ascending colon are located within the midline and left abdomen and\nappear dilated and fluid-filled, measuring up to 11.7 cm in diameter, without\nwall thickening or pneumatosis. There is a focal transition point within the\nleft hemiabdomen, which involves the distal ascending colon with a\nmushroom-like appearance of mesenteric fat, likely representing an internal\nhernia (series 2, image 51) and decompression of the distal colonic loops of\nbowel. There is no colonic wall thickening. There is no evidence of\npneumoperitoneum or free fluid. Appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall volume of nonhemorrhagic free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is normal in appearance. No adnexal masses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Moderate dextroscoliosis of the lumbar spine. Severe degenerative\nchanges are seen within the right hip joint. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. Otherwise,\nthe abdominal and pelvic wall is within normal limits.", "output": "1. Malrotation with right colonic obstruction and a transition point within\nthe distal ascending colon, most likely due to an internal hernia. There is\nno evidence of pneumatosis or pneumoperitoneum. Small volume nonhemorrhagic\nfree fluid within the pelvis.\n2. Cholelithiasis without cholecystitis.\n3. Severe degenerative changes within the right hip joint.\n\nNOTIFICATION: The final impression was discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:40 ___, 5 minutes\nafter discovery of the findings." }, { "input": "Chest is reported separately.\n\nWithin the limitations of a non-contrast, no focal liver lesions are\nidentified. There is no biliary dilatation. Gallbladder appears normal. \nEach adrenal is mild-to-moderately thickened, as before. Spleen is normal in\nsize. There is no evidence for stones or hydronephrosis involving either\nkidney.\n\nStomach is unremarkable. Enteric contrast has flowed through the whole small\nbowel and into ileostomy site in the right lower quadrant. Patient is status\npost colectomy, sparing the distal sigmoid and rectum, with ___ pouch.\n\nThere is extensive broad-based but thin organizing collection immediately deep\nto the anterior abdominal wall, loculated but with incomplete rim. It is of\ngreatest extent in the axial plane at the level of the pelvis where it\nmeasures up to 175 x 35 mm in axial ___ (2:94). Few tiny anti dependent\nbubbles are found within the collection, but there is no contrast\nextravasation outside of bowel. Small bowel is fully opacified to the ostomy\nsite. Otherwise, there is less fluid in the abdomen, scant if any truly\nfree-flowing ascites. Edema in the mesentery is all is similar to the prior\nstudy. In general, small bowel is underdistended and difficult to assess but\nshows mild wall thickening. Trace quantities of air in a midline incision site\nare probably postoperative.\n\nProstate is mildly enlarged. Bladder is mostly empty and difficult to assess.\nSeminal vesicles appear normal. Aorta is normal in caliber. Atherosclerotic\nchanges are moderate.\n\nThere are no suspicious bone lesions.", "output": "Thin broad organizing collection along the immediately deep to the anterior\nabdominal wall. Small quantities of extraluminal air in the collection,\nnonspecific in the setting of recent surgery, but no enteric contrast\nextravasation. Evidence for edema and/or inflammation involving small bowel\nand mesentery." }, { "input": "LOWER CHEST: Subsegmental dependent atelectasis.\n\nABDOMEN: The liver, pancreas, spleen and adrenal glands are unremarkable aside\nfor a left 1 cm hepatic cyst. Cholecystectomy changes are noted\n\nURINARY: Multiple nonobstructing calculi are seen in the kidneys, the largest\non the right measuring 4 mm on the largest on the left measuring 8 mm. No\nureteral or bladder calculi are seen. There is a neo ureter reconstruction\nwith small-bowel on the left. No filling defects are seen in the collecting\nsystem bilaterally. Bilateral renal cortical hypodensities too small to\ncharacterize are present. No solid renal mass demonstrated.\n\nGASTROINTESTINAL: There is dilatation of the appendix with a round 5 mm region\nof enhancement at the tip and no associated surrounding soft tissue stranding.\nThese findings are suspicious for an appendiceal mucocele possibly with a\nsmall tumor/carcinoid at the tip. A small bowel anastomosis is noted. No\nintestinal obstruction or ascites.\n\nPELVIS: No pelvic free-fluid.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy\n\nVASCULAR: No abdominal aortic aneurysm.\n\nBONES: There is no worrisome osseous lesion. Surgical fusion of the L4 and L5\nvertebral bodies is demonstrated.\n\nSOFT TISSUES: There is a fat containing periumbilical hernia.", "output": "1. Bilateral nephrolithiasis. No solid renal mass, ureteral, bladder calculi\nor filling defects in the renal collecting systems.\n2. 6 mm enhancing lesion at the tip of a mildly dilated appendix, which may\nrepresent a mucocele with underlying 6 mm tumor such as carcinoid.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:22 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Surgical clips in the left upper quadrant consistent\nwith prior history of pyeloplasty. A left neo ureter is again seen, and\nappears unchanged from prior.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is some\napparent wall thickening in the ascending colon and cecum. Thickening within\nthe ascending colon is due to non mixing of fluid at the tip of the contrast\ncolumn. Apparent thickening within the cecum was not present in ___, and\ntherefore likely represents adherent stool. Colonoscopy may be considered if\nthere is clinical concern. The appendix has been surgically removed. A\ncalcified epiploic appendage is noted in the left posterior retroperitoneum\n(02:45). Diverticulosis of the sigmoid colon without evidence of\ndiverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains calcifications but otherwise within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is spinal fixation of L4 and L5. No evidence of aggressive\nosseous lesions.\n\nSOFT TISSUES: No fascial defects.", "output": "1. No fascial defect to suggest hernia.\n2. Apparent colonic wall thickening of the cecum was not present in ___\nand therefore likely represents adherent stool. Colonoscopy may be considered\nif there is clinical concern.\n3. Stable postoperative appearance of the left kidney and ureter." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings including numerous pulmonary\nmetastases.\n\nABDOMEN:\n\nHEPATOBILIARY: A segment VI hypodensity is a cyst or hamartoma. Other\nscattered hepatic hypodensities are too small to accurately characterize on CT\n(series 6, image 41, 46, 52, 59). No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder contains gallstones without wall\nthickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA left posterior renal cortical cyst is small. No evidence of concerning\nfocal renal lesions or hydronephrosis. An 8-mm density in the left posterior\nlateral pararenal space is thought to be a diverticulum filled with debris\n(series 9, image 39-40).\n\nGASTROINTESTINAL: A hiatal hernia is small. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic\ndiverticulosis is most pronounced in the sigmoid colon where it is severe. \nThe rectum is within normal limits. No bowel obstruction.\n\nPELVIS: The urinary bladder is distended. The distal ureters are\nunremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits. No adnexal masses.\n\nLYMPH NODES: No retroperitoneal, mesenteric, pelvic, or inguinal\nlymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic disease is\nnoted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture in the\nlumbar sacral spine. Mixed sclerotic and lytic lesions in the T11 and T12\nvertebral bodies with pathological fracture resulting in mild T11 and moderate\nT12 vertebral body height loss are compatible with metastases. T12 metastasis\nextends into the left pedicle. T11 metastasis extends into the bilateral\npedicles and spinous process. No retropulsion of fracture fragments. No\nprevertebral soft tissue swelling. Bone marrow irregularity in the right\nsacrum and bilateral iliacs are concerning for metastases (series 6, image 83,\n88). No obvious lesion identified in the left acetabulum.\n\nSOFT TISSUES: Fat containing umbilical hernia is tiny.", "output": "1. T11 and T12 vertebral body metastases extending into the pedicles and\nspinous processes as above with associated pathologic vertebral body\nfractures. No retropulsion into the adjacent spinal canal.\n2. Abnormal, heterogeneous density in the right sacrum and bilateral iliacs\nare concerning for additional osseous metastases; correlate with bone scan\nresults.\n3. No lymphadenopathy or definite solid organ metastases in the abdomen or\npelvis.\n4. Multiple nonspecific hepatic hypodensities.\n5. Cholelithiasis.\n6. Colonic diverticulosis.\n7. Please refer to detailed chest CT report performed concurrently at the same\ntime for intrathoracic findings." }, { "input": "LOWER THORAX: The lung bases are clear. No pleural or pericardial effusion.\n\nHEPATOBILIARY: Status post deceased donor liver transplant. Geographic areas\nof hypoattenuation involving the liver dome have improved in comparison to the\nprior study, with residual linear defect in segment ___ (axial series 3, image\n12; coronal series 6, image 32). No focal liver lesion. There is mild\ndilatation of the common bile duct measuring up to 11 mm, which has improved\nin comparison to the prior study where it measured 16 mm. Soft tissue with\nsurgical clips at the hepatic hilum, likely postoperative. The gallbladder is\nsurgically absent.\n\nPatient is status post stenting of the common hepatic artery which appears\npatent. There is focal narrowing at the junction of the right hepatic artery\nwith the proper hepatic (coronal series 6, image 22). Portal venous system is\npatent. Hepatic veins are patent.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Borderline splenomegaly measuring 13.1 cm in maximal ___,\nsimilar to previous.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis. Unremarkable\nbladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are\nnormal in caliber. Normal appendix.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric adenopathy. No pelvic or\ninguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Unremarkable.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic calcification. \nStatus post common hepatic artery stenting. There is kinking between the two\ncommon hepatic artery stents, with associated narrowing at this location. The\nhepatic artery appears patent, though there is focal dilatation of the\nproximal right and left hepatic arteries. There is marked narrowing at the\njunction of the right hepatic artery and proper hepatic artery, and the\naforementioned dilatation may be poststenotic. There is a focal abnormal\noutpouching along the midportion of proximal stent (sagittal series 7, image\n34; axial series 3, image 27). The hepatic and portal venous systems are\npatent. There has been prior embolization of left upper quadrant varices. \nMultiple para/periesophageal varices are again noted. Duplicated IVC.\n\nBONES: No suspicious osseous lesion.\n\nSOFT TISSUES: Unremarkable.", "output": "1. No evidence of malignancy within the abdomen or pelvis.\n2. Status post common hepatic artery stenting with patent hepatic arterial\nsystem. There is kinking of the vessel between the two hepatic artery stents\nwith associated narrowing, and there are additional areas of narrowing,\nparticularly at the junction of the right hepatic artery and proper hepatic\nartery. However, ischemic changes to the liver have resolved with minimal\nresidual chronic scarring involving the hepatic dome related to prior infarct.\n3. Focal abnormal outpouching at the level of the proximal hepatic artery\nstent.\n4. Stable borderline splenomegaly with para/periesophageal varices.\n\nRECOMMENDATION(S): Interventional Radiology consultation is recommended for\nfurther evaluation of hepatic arterial anomalies described above." }, { "input": "LOWER CHEST: Patchy parenchymal opacities are seen in the left upper lobe and\nright middle lobe, concerning for infection. Right effusion with overlying\natelectasis is unchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is again noted to have a nodular contour, consistent\nwith cirrhosis. The portal vein remains patent. No concerning liver lesions.\nNo intrahepatic biliary ductal dilatation. Vicarious excretion of contrast is\nnoted in the gallbladder. Mild amount of ascites is unchanged.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, as on the prior examination, measuring up to\n18 cm, not significantly changed. There has been propagation of previously\nseen thrombus in the splenic vein, with a new, large focus of thrombus, just\nbefore its confluence with the SMV. The portal vein and SMV remain patent. \nEmbolization material again noted in splenorenal varices.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval propagation of thrombus in the splenic vein. The portal vein and\nsuperior mesenteric veins remain patent. Splenomegaly is unchanged.\n2. Stigmata of cirrhosis and portal hypertension, with embolized splenorenal\nvarices, as on the prior examination.\n3. Unchanged ascites and right pleural effusion.\n4. New patchy parenchymal lung opacities, concerning for infection in the\nappropriate clinical setting.\n\nNOTIFICATION: Findings discussed with Dr. ___ by ___, M.D. ___ at 19:54." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver contour is nodular. The liver demonstrates\nhomogenous attenuation throughout. There is no evidence of focal lesions. \nThere is no evidence intrahepatic biliary dilation. The common bile duct is\ndilated at up to 9 mm, similar to prior exams. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged measuring 14.6 cm. There is no evidence of focal\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Visualized\nportions of the colon are within normal limits. The appendix is normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:\nThe TIPS is patent throughout its course. The right posterior portal vein is\nnot opacified. The left portal vein is patent. The middle and left hepatic\nveins are patent. The SMV is patent. The splenic vein is thrombosed\nbeginning at the portal confluence.\n\nThe hepatic arteries and SMA appear patent.\n\nThere are esophageal and gastric varices as well as tortuous vessels around\nthe splenic hilum with dense embolization material seen in the left upper\nquadrant\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominall wall is within normal limits.", "output": "1. Cirrhosis with sequela of portal hypertension and splenomegaly.\n2. Nonopacification the right posterior portal vein and splenic vein. The\nmain portal vein, right anterior portal vein, left portal vein, and SMV appear\npatent.\n3. Patent TIPS and patent hepatic veins." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is trace\ndependent atelectasis. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is not well visualized. The left adrenal\ngland is unremarkable.\n\nURINARY: There is an 8 x 6 mm oval obstructing stone at the right UVJ with\naverage density of 700 Hounsfield units (2:90, 601:35) which causes moderate\nupstream hydroureteronephrosis. There is a moderate degree of right\nperinephric stranding. No other stones are identified. The left kidney is\nunremarkable. There is no evidence of focal renal lesions within limitation\nof an unenhanced study.\n\nGASTROINTESTINAL: Stomach appears unremarkable, not well evaluated on CT. \nThere is no bowel obstruction. The colon and rectum are unremarkable.\n\nPELVIS: The right distal ureter is obstructed as described above. The left\ndistal ureter is unremarkable. No stones are identified within the bladder\nlumen. There is no evidence of stranding surrounding the appendix. There is\nno suspicious free fluid seen within the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: No lymphadenopathy within the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Moderate right hydronephrosis with an obstructive stone at the right\nureterovesicular junction." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: 1.5 x 2.3 cm hypodense lesion within the junction of segments\nVII and VIII is unchanged in size and demonstrates progressive peripheral\nnodular pooling of contrast matching blood pool consistent with hemangioma.\nScattered subcentimeter hypodensities throughout the hepatic parenchyma are\nunchanged likely represent cysts versus hamartomas. There is no evidence of\nsuspicious hepatic lesion. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits.\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesion. There is significant disc space\nnarrowing at L2-L3 with associated degenerative endplate changes.\n\nAreas of omental nodularity are re- demonstrated in the right upper quadrant\n(4:71, 74. Left subdiaphragmatic nodule is slightly decreased in size,\ncurrently measuring 3 mm previously 6 mm. Right subdiaphragmatic nodule\n(09:28) also appears slightly smaller measuring 5 x 2 mm, previously 7 x 4 mm.", "output": "1. Slight decrease in size in bilateral peridiaphragmatic nodules further\ndescribed in separate CT chest report. Overall grossly unchanged appearance of\nright upper quadrant soft tissue implants.\n2. Please see separate dictation CT chest dictation for thoracic findings." }, { "input": "The visualized lung bases are clear. Scarring is seen at the lung bases. \nThere is a small hiatal hernia. The heart is normal in size.\n\nABDOMEN:\n\nLIVER: The liver is normal with no focal lesions. There is no biliary ductal\ndilatation.\n\nGALLBLADDER: The patient is status post cholecystectomy.\n\nPANCREAS: The pancreas is slightly atrophic but otherwise unremarkable.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A left adrenal medial limb nodule is again seen, measuring 11 mm\nstable from prior exam. Normal right adrenal gland. The adrenal glands are\nunremarkable bilaterally.\n\nKIDNEYS: Multiple renal cysts and hypodensities too small to characterize but\nlikely representing renal cysts are seen in the bilateral kidneys. There is\nleft-sided parapelvic cyst. The kidneys are otherwise unremarkable.\n\nGI: The stomach, duodenum, and intra-abdominal loops of bowel are normal in\ncaliber and unremarkable. No evidence of appendicitis.\n\nRETROPERITONEUM: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: Moderate calcified atherosclerotic disease is seen in the aorta. \nNo fluid collection is seen in the abdomen.\n\nPELVIS: The sigmoid colon and rectum are normal in appearance. The distal\nureters and bladder are normal. The uterus is absent. There is no pelvic or\ninguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: No focal lytic or sclerotic osseous lesions suspicious\nfor infection or malignancy are seen. Degenerative changes are seen within\nthe spine.", "output": "No acute findings in the abdomen or pelvis to account for pain. Incidental\nfindings as described above including left adrenal nodule, renal cysts." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 15 mm nodule in the left adrenal gland, likely an adenoma, and an\n11 mm nodule in the right adrenal gland are stable since ___.\n\nURINARY: The kidneys are of normal and symmetric size. Multiple simple cysts\nare seen in the bilateral kidneys, measuring up to 2.5 cm. A stable\nhyperdense, likely hemorrhagic cyst, is seen in the interpolar region of the\nleft kidney. There is no hydronephrosis. There is no nephrolithiasis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: A large hiatal hernia is noted. A small hyperdensity within\nthe gastric wall is stable. Small bowel loops demonstrate normal caliber and\nwall thickness throughout. There are colonic diverticula. There is\nconcentric thickening of the rectal wall with surrounding fat stranding and\nthickening of the perirectal fascia as well as enlargement of several\nperirectal lymph nodes, measuring up to 6 mm (for example A1:57). These\nfindings are compatible with proctitis. A fluid collection is not excluded\ngiven the lack of intravenous contrast.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent and the vaginal cuff is\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nModerate levoconvex scoliosis of the lumbar spine is noted. There are\ndegenerative changes in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Findings compatible with acute proctitis. MRI pelvis with contrast would be\nmore sensitive in characterizing possible intramural abscess or any associated\ndrainable fluid collection. Evaluation with proctoscopy is recommended, only\nonce the acute inflammatory episode settles, to confirm absence of any\nassociated rectal mass..\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 4:29 pm, 10 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable. There is a 1.3 cm left\nadrenal nodule, unchanged since at least ___ and previously\ncharacterized as an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple cortical hypodensities bilaterally are consistent with simple cysts,\nthe largest measuring up to 2.6 cm in the left lower pole. Multiple\nadditional subcentimeter cortical hypodensities bilaterally are too small to\ncharacterize, however likely represent cysts. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. Again\nseen is rectal wall thickening and enhancement, predominantly involving the\nlateral and posterior walls superiorly, with circumferential wall involvement\ninferiorly, not significantly changed in extent compared with recent pelvic\nMRI (601:38). This mass has been better evaluated on rectal MRI. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nBilateral external iliac nodes measuring up to 8 mm in the short axis are not\nsignificantly changed(2:93, 97). Multiple small mesorectal nodes and\nsurrounding fascial thickening are not significantly changed (2:82, 92).\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There are mild multilevel degenerative changes and levoscoliosis of the\nlumbar spine. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No significant change in rectal wall thickening and enhancement, consistent\nwith a rectal mass, better evaluated on the recent pelvic MRI.\n2. No significant change in bilateral external iliac and mesorectal nodes\nmeasuring up to 8 mm in the short axis.\n3. No evidence of hepatic or osseous metastatic disease. Unchanged left\nadrenal adenoma measuring 1.3 cm in size.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: 3 chest tubes are again noted with one previously seen anterior\nchest tube now being repositioned posteriorly. Consolidation at the left lung\nbase is significantly improved. There is extensive new increased ground-glass\nopacity at the right lung base. Consolidation in the partially visualized\nright middle lobe is also worsened. Mitral valvular calcifications are dense.\nThere is a small pericardial effusion, unchanged. A small left pleural\neffusion appears unchanged. There is a posterior pigtail catheter at the\nright lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is mildly atrophic. The pancreas has normal\nattenuation throughout, without evidence of focal lesions within the\nlimitations of an unenhanced scan. There is no pancreatic ductal dilatation. \nThere is no peripancreatic stranding.\n\nSPLEEN: The patient status post splenectomy with a residual focus of probable\nsplenic tissue in the surgical bed measuring 28 x 21 mm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a percutaneous GJ tube. The patient is status post\ngastojejunostomy. Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is not\nvisualized. No retroperitoneal bleed is visualized.\n\nPELVIS: There is a Foley catheter in the urinary bladder. Contrast in the\nurinary bladder likely represents delayed excretion. There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There are numerous prominent retroperitoneal and mesenteric lymph\nnodes which do not meet CT size criteria for lymphadenopathy. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Embolization coils are noted in the midabdomen.\n\nBONES: Numerous bilateral healed rib fractures are noted laterally.\n\nSOFT TISSUES: There is diffuse anasarca.", "output": "1. Improved consolidation within the left lower lobe, however worsening\nconfluent ground-glass opacity at both lung bases and the right middle lobe\nare suggestive of pulmonary edema or ARDS.\n2. No retroperitoneal hematoma.\n3. Diffuse anasarca.\n4. Unchanged small pericardial effusion." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The sigmoid and\ndescending colon are somewhat decompressed, limiting evaluation, but otherwise\nappear within normal limits. No evidence of bowel obstruction. The appendix\nis normal (601:23).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace intermediate density fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is retroverted. A left adnexal cyst measures\nup to 1.7 x 1.1 cm. The right adnexa appears within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute findings in the abdomen or pelvis.\n2. Normal appendix.\n3. A 1.7 cm physiologic left adnexal cyst with trace intermediate density\nfluid in the pelvis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are two simple cysts arising from the lower pole the left kidney\nmeasuring up to 1.3 cm. Additional subcentimeter cortical hypodensities\nbilaterally are too small to characterize, however likely represent cysts. \nThere is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace simple free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There are degenerative changes in the lumbosacral spine and scoliosis. \nPunctate sclerotic foci in the right femoral head likely represent bone\nislands. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. Cholelithiasis, with no evidence of acute cholecystitis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "VASCULAR:\n\n CTA abdomen/pelvis:\n\n-Abdominal aorta:Patent\n-Celiac axis: Patent\n-SMA: Patent\n-___: Patent\n-Renal arteries: right, Moderate stenosis (<50%)Left, Patentwith stent in\nplace, with moderate grade stenosis just distal to the stent.\n-Left common iliac: Patent\n-Right common iliac: Patent\n-Left external iliac: Patent\n-Right external iliac: Patent\n-Left internal iliac: Patent\n-Right internal iliac: Patent\nCTA run-off RLE:\n\n-Common femoral artery: Patent\n-Superfical femoral artery: Severe stenosis (50-99%) distally spanning\napproximately 1 cm.\n-Deep femoral artery: Patent\n-Popliteal artery: Patent\n-Anterior tibial artery: Patent\n-Posterior tibial artery: Patent\n-Peroneal artery: Patent\n-Dorsalis pedis: Patent\nCTA run-off LLE:\n\n-Common femoral artery: Moderate stenosis secondary to atherosclerotic plaque\nat the mid common femoral artery.\n-Superfical femoral artery: There are 2 areas of severe stenosis in the distal\nSFA each spanning approximately 1 cm.\n-Deep femoral artery: Patent\n-Popliteal artery: Patent\n-Anterior tibial artery: Patent\n-Posterior tibial artery: Patent\n-Peroneal artery: Patent\n-Dorsalis pedis: Patent\nAtherosclerotic plaques: Moderate disease involving the distal abdominal aorta\nand bilateral common iliac arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is mildly atrophic likely related to renal artery\nstenosis. The right kidney appears unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy. Multiple\nphleboliths are noted in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nBONES: There is severe multilevel degenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There are 2 focal areas of severe stenosis in the distal left SFA. Patent\n3 vessel runoff.\n2. There is a 1 cm focal area of severe stenosis of the distal right SFA. \nPatent 3 vessel runoff." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis. Visualized lung fields are\notherwise within normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized, however\nthere are no secondary signs to suggest appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. Few\nmildly prominent retroperitoneal and inguinal lymph nodes are not\npathologically enlarged by CT size criteria. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abdominopelvic process. No CT findings correlating to the reported\nhistory of abdominal pain, diarrhea and fever. Specifically, the colon\nappears normal." }, { "input": "LOWER CHEST: Multiple bilateral well-circumscribed lung nodules also\npreviously noted in CT from ___ with the largest measuring 1.2 cm best seen\non image (5; 7). These lung nodules appear present and around the similar\nsize compared to the previous CT abdomen in ___. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder contains large nonobstructing gallstones that appears stable\ncompared to imaging from ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. Colonic diverticulosis without diverticulitis The appendix is\nnot well visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes of the lumbar sine spine is again noted with\nscoliosis and osteophyte formation and loss of intervertebral space with\nsubchondral sclerosis in the lumbar vertebrae. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The pelvic wall is within normal limits. Small umbilical\nhernia.", "output": "1. No nephrolithiasis, ureterolithiasis or stones in bladder.\n2. Bilateral multiple circumscribed lung nodules, that appears stable compared\nto previous CT abdomen pelvis from ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process. Normal appendix." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is mild\ndiverticulosis of the transverse colon. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an anterior uterine fibroid. No adnexal masses\nare present.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Incidental note is made of a retro aortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild vertebral body height loss at T10, similar to the prior exam.\n\nSOFT TISSUES: There is a tiny, fat containing umbilical hernia.", "output": "1. No etiology identified for the patient's reported left lower quadrant pain.\n2. Diverticulosis without evidence of diverticulitis.\n3. Chronic T10 vertebral body height loss.\n4. Anterior uterine fibroid." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple subcentimeter hypodensities are too small to characterize. A 1.1 cm\nhypodensity at the hepatic dome and a 2.0 cm hypodensity in the left hepatic\nlobe are likely hepatic cysts. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities in the kidneys bilaterally are too small to\ncharacterize but likely cysts. No evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, with evidence of wall thickening and fat stranding\nconcerning for acute diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes of the thoracolumbar spine.\n\nSOFT TISSUES: Patient is status post inguinal hernia repair with postsurgical\nchanges noted in the left inguinal region.", "output": "Diverticulitis of the proximal sigmoid colon. No evidence of a fluid\ncollection or extraluminal air." }, { "input": "LOWER CHEST: There is platelike atelectasis at the lung bases, bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hepatic hypodensities are too small to characterize, but likely\nrepresent simple cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis colonic wall thickening and inflammation involving an approximately 11 cm\nloop of sigmoid colon. There are multiple diverticula arising from this\nsegment, but they are overall not significantly inflamed relative to the\ndegree of bowel wall thickening. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There is a 3.0 cm cystic\nstructure arising from the left adnexa.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is grade 1 anterolisthesis of L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Sigmoid colitis, likely infectious or inflammatory. Diverticulosis without\nconvincing evidence for diverticulitis.\n2. 3.0 cm left adnexal cystic lesion. Nonemergent pelvic ultrasound is\nrecommended." }, { "input": "LOWER CHEST: Mild atelectasis is seen in both lung bases.. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities in bilateral kidneys are too small to\ncharacterize, likely simple cysts. There is no evidence of concerning focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Compared to the\nprior CT from ___, there is persistent wall thickening of the\nproximal sigmoid colon with surrounding multiple diverticula, worsening\nsurrounding mesenteric fat stranding and increased fascial thickening. A\nsmall focus of extraluminal gas is seen posterior and adjacent to the sigmoid\ncolon concerning for micro perforation (02:58), but no drainable fluid\ncollection. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is grade 1 anterolisthesis of L5 on S1, similar to prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Sigmoid diverticulitis with tiny extraluminal focus of gas compatible with\nmicroperforation and increased surrounding inflammation compared to the prior\nCT from ___. No drainable fluid collection." }, { "input": "LOWER CHEST: There are trace pleural effusions bilaterally. There is left\nlower lobe atelectasis (series 601 image 49) and basilar atelectasis on the\nright lower lobe, (series 2, image 9). There is no evidence pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no nephrolithiasis or ureterolithiasis. There is no hydronephrosis. \nThere is no perinephric abnormality. There is no evidence of focal renal\nlesions. There is no evidence of urothelial lesions. The distal ureters and\nbladder are unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient is\nstatus post sigmoid resection with primary anastomosis. Posterior to the\ncolonic anastomosis is a peripherally enhancing fluid collection with internal\nlocules of air, that may have been previously connected to the fluid\ncollection in the left upper quadrant, and measures 4.3 x 3.0 cm, (series 2,\nimage 53). The aforementioned finding is consistent with a contained leak. \nThe fluid collection in the left upper quadrant contains few peripheral air\nlocules, measures 4.0 x 4.0 cm, and does not exhibit peripheral enhancement\n(series 2 image 32). There is fat stranding surrounding the proximal\ndescending colon, (series 2, image 57).\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Re-demonstrated, is unchanged, grade 1 anterolisthesis of L5 on S1.\n\nSOFT TISSUES: There is a healing midline abdominal incision.", "output": "1. The patient is status post sigmoid resection with primary anastomosis.\n2. There is a peripherally enhancing fluid collection with internal locules of\nair, posterior to the colonic anastomosis which may been connected to the\nfluid collection in the left upper quadrant and measures up to 4.3 cm. The\naforementioned finding is consistent with a contained leak.\n3. The left upper quadrant fluid collection measures up to 4.0 cm. Drainage\nby interventional radiology may be considered." }, { "input": "LOWER CHEST: Limited assessment of lung bases are notable for bilateral lower\nlobe atelectasis. The heart is unremarkable. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Air-fluid levels\nare seen throughout the colon which is distended with fluid. No\ndiverticulosis. No colonic wall thickening is seen. The appendix is not\nvisualized however no evidence of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A 1.7 x 1.7 cm enhancing lesion within the uterine\nfundus is most consistent with a fibroid. The reproductive organs are\notherwise unremarkable. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 1.7 cm enhancing lesion within the uterine fundus is most consistent with a\nuterine fibroid. If additional evaluation is warranted, especially given\nirregular menses, consider non urgent pelvic ultrasound for further\nevaluation.\n2. Multiple air-fluid levels throughout the distended colon can be seen with\ndiarrhea. No obstruction." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Atrophic.\n\nADRENALS: Status post right adrenalectomy. The left adrenal gland is right\nnormal in size and shape.\n\nURINARY: Status post right nephrectomy. Left renal cortical thinning and\npersistent moderate hydronephrosis. Left ureteral ileal conduit.\n\nGASTROINTESTINAL: Right lower quadrant ileal ureteral diversion. Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout.\nColon and rectum are within normal limits. There is no evidence of mesenteric\nlymphadenopathy. Nonspecific misty mesentery is persistent but slightly\ndecreased compared to prior.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: Status post cystectomy. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prior prostatectomy. Stable to slightly increased size\nof residual prostate tissue measuring 4.4 x 3.3 cm (06:10 8), previously 4.0 x\n3.2 cm.\n\nBONES AND SOFT TISSUES: New expansile left acetabular lytic lesion causing\ncortical thinning measuring 2.1 x 1.9 cm (06:104). Unchanged large left\nventral hernia containing loops of small bowel. Right inguinal fat containing\nhernia.", "output": "1. Status post right nephrectomy and adrenalectomy, cystoprostatectomy, with\nleft ureteral diversion to ileal conduit.\n2. Stable to slightly increased size of residual prostate tissue status post\nprostatectomy.\n3. Expansile lytic anterior left acetabular lesion concerning for new\nmetastatic disease." }, { "input": "LOWER CHEST: Limited assessment of the lung bases demonstrates bilateral lower\nlobe atelectasis and small right pleural effusion increased since ___ CT. Bilateral diffuse parenchymal processes, right greater than left, is\nsimilar in appearance to prior exam. The heart is unremarkable. No\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is mildly prominent. No\ngallbladder wall thickening, gallbladder stones or pericholecystic free fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is atrophic.\n\nADRENALS: The left adrenal gland is unremarkable. The right adrenal gland is\nsurgically absent.\n\nURINARY: Patient is status post right nephrectomy. No nodular enhancing\nsoft tissue in resection bed to suggest disease recurrence. Left renal\ncortical thinning and persistent moderate hydronephrosis is stable. Left\nureteral ileal conduit is present.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Moderate stool is\nseen within the colon. The colon and rectum are otherwise within normal\nlimits. The appendix is not visualized.\n\nPELVIS: The urinary bladder is surgically resected with associated\npostsurgical changes. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient status post prostatectomy with a residual 3.4 x\n1.9 cm (2:82) soft tissue at resection site. (Previously 4.4 x 3.3 cm)\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is a 2.1 x 1.8 cm lytic lesion within the left acetabulum,\nunchanged since prior examination causing cortical thinning (previously 2.1 x\n1.9 cm)\n\nSOFT TISSUES: Again seen is nonspecific misty mesentery, unchanged since\nprior examination. A small bowel containing right anterolateral abdominal\nwall hernia is stable with a 1.4 cm defect in the abdominal wall. A small fat\ncontaining right inguinal hernia is again noted.", "output": "1. Bilateral lower lobe atelectasis with small right pleural effusion, has\nincreased since ___.\n2. Partially imaged again seen bilateral pulmonary parenchymal process may be\ndue to an infectious process with differential including crytogenic organizing\npneumonia.\n3. Mildly distended gallbladder without additional signs of acute\ncholecystitis.\n4. Status post right nephrectomy and adrenalectomy, cystoproctectomy with left\nureteral diversion to ileal conduit with stable residual prostatic tissue.\n5. Persistent findings including 2.1 cm expansile lytic lesion within left\nacetabulum, unchanged since prior examination." }, { "input": "LOWER CHEST: Bilateral intermediate -density pleural effusions are again seen,\nnot significantly changed compared to CTA chest obtained at 19:47 on the same\nday. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic without evidence of focal lesions. There\nis no main pancreatic duct dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Patient is status post splenectomy.\n\nADRENALS: The left adrenal gland uniform thickening is unchanged from prior\nexam. Patient is status post right adrenalectomy.\n\nURINARY: Patient is status post right nephrectomy. There is a 1.4 x 0.8 cm\ncentrally hypodense nodule in the surgical bed between the nephrectomy\nsurgical clips, new since ___. The left kidney is atrophic with\nstable hydronephroureter. Surgical clips are seen in the distal left ureter. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is marked\ndilation of the colon with thickened appearance of the rectal bowel wall,\nwhich may be due to high-density material within the rectum that is isodense\nto to rectal bowel wall, which surrounds the stool. The appendix is not\nvisualized. There is worsening mesenteric fat stranding, nonspecific.\n\nPELVIS: The urinary bladder is resected and distal ureters are unremarkable. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. While the ___ opacification is poor, this may be due to\ntiming of the bolus and not necessarily occlusion. Patient is status post\nright femoral artery catheter placement.\n\nBONES: There is bony destruction due to expansile mass in the right\nacetabulum, left superior pubic ramus, mildly involving the hip joint,\nunchanged in the extent of destruction compared to prior exam.\n\nSOFT TISSUES: There is anterior abdominal wall diastases, containing\nnondilated loops of small bowel. There is diffuse anasarca. Again seen is\nenlargement of the left adductor muscle, containing rim rim enhancing,\ncentrally hypodense masses, likely involuting hematomas, though super\ninfection cannot be excluded. There is interval increase in the left pelvic\nwall component, with increased fat stranding and increased cystic areas, now\nmeasuring 3.9 x 7.2 cm, previously 3.6 x 5.6 cm (to a: 61). There is mild\nmass effect on the rectum, displacing it rightward. There is stable right fat\ncontaining inguinal hernia.", "output": "1. Interval enlargement in the pelvic wall component of the left expansile\npelvic osseous mass, exerting mild mass effect on the rectum, compatible with\nknown metastatic disease. Interval rim enhancement of the adductor muscle\ncontaining hypodense fluid, while likely interval evolution of hematoma,\nthough superinfection cannot be excluded.\n2. Diffuse colonic dilation without transition point, likely colonic ileus.\n3. Worsening mesenteric fat stranding, nonspecific." }, { "input": "LOWER CHEST: Bibasilar atelectasis. Otherwise, visualized lung fields are\nwithin normal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized, but there\nare no secondary signs of appendicitis.\n\nPELVIS: The urinary bladder is mildly distended. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are postsurgical changes from prior L4-S1 fusion.\n\nSOFT TISSUES: 2 small fat containing ventral hernias. Otherwise, the\nabdominal and pelvic wall is within normal limits.", "output": "1. No evidence of traumatic injury in the abdomen or pelvis." }, { "input": "Heart, main PA and ascending aorta are normal caliber in the visualized\nportions. Aortic annular and 3 vessel coronary artery calcifications are very\nsevere. A central venous catheter tip appears to terminate in the high right\natrium. At least 10 new nodules at the left lung base measure up to 11 mm and\nare mainly in a perivascular distribution. Similar findings are noted in the\nright lung base, with largest nodule measuring 12 mm at the base of the right\nupper lobe (2:1). No effusion at the lung bases.\n\nCT abdomen: The liver enhances homogeneously without focal mass. There is mild\nprominence of the central intrahepatic biliary system without frank biliary\ndilatation. CBD is normal caliber. There are a few gallstones within a thin\nwalled, nondistended gallbladder with trace pericholecystic fluid.\n\nSpleen, pancreas and adrenal glands are unremarkable.\n\nKidneys present symmetric nephrograms without focal solid mass, hydronephrosis\nor perinephric abnormality. Simple left lower pole renal cyst measures 44 mm.\nKidneys appear moderately atrophied bilaterally.\n\nStomach, duodenum and remainder of the small bowel is normal caliber without\nevidence of obstruction. The colon is notable for diverticulosis without\nevidence of diverticulitis. Colon is otherwise thin walled and unremarkable\nwithout pericolonic fat stranding or fluid collection. Normal appendix tip is\nvisualized in the right lower quadrant (2:70).\n\nAbdominal aorta is normal caliber with extensive calcified atherosclerotic\nplaque burden within the aorta itself and all of its branch vasculature.\nMesenteric and retroperitoneal lymph nodes are not pathologically enlarged.\nThere is no ascites, pneumoperitoneum or ventral abdominal hernia.\n\nCT pelvis: The bladder and rectum are unremarkable. Ovaries are unremarkable.\nMultiple small calcified fibroids within the uterus. No free pelvic fluid or\nair. Inguinal and pelvic sidewall lymph nodes are not pathologically enlarged.\n\nBones and soft tissues: No suspicious focal bone lesion. Degenerative changes\nof the lumbar spine are mild with grade 1 anterolisthesis of L5 on S1.", "output": "1. No acute CT findings in the abdomen or pelvis. Specifically, normal\nappendix and no evidence of colitis.\n2. Dozens of new perivascular nodular opacities in the lung bases, as above,\nmeasuring up to 12 mm, likely infectious. Short-term followup CT in 3 months\npost therapy is recommended to ensure resolution.\n3. Extensive atherosclerotic disease, with pipe like configuration of much of\nthe arterial branch vasculature.\n4. Cholelithiasis. Though there is trace pericholecystic fluid, this is likely\ndue to third spacing and there is no evidence of cholecystitis." }, { "input": "Patient is status post coronary artery bypass graft surgery. There are vague\npatchy nodular mixed attenuation opacities in the lower lungs, greater on the\nleft than right which are new over the short interval. There are trace\npleural effusions bilaterally which have increased slightly.\n\nSmall foci of gas are present in the gallbladder fundus. These are apparently\nwithin the lumen. There is no pneumobilia. There is no gallbladder wall\nthickening. Gallbladder is full with several small calcified gallstones. \nThere is no biliary dilatation. No focal liver lesions are identified. The\nspleen is normal in size and appearance.\nThere is a small stone in the lower pole of the right kidney measuring 3 mm. \nIn the lower pole left kidney, there is a cyst measuring up to 49 x 41 mm in\naxial ___. Mild volume loss in the upper pole the left kidney appears\nchronic and unchanged. There is no hydronephrosis.\n\nThe stomach and small bowel appear within normal limits. The appendix appears\nnormal. Sigmoid diverticulosis is moderate but there is no evidence of\ninflammation.\n\nCalcified fibroids are present. Bladder is partly full and appears within\nnormal limits. Vascular calcification is moderately widespread. Major\nmesenteric arteries and veins appear patent. Mildly prominent left periaortic\nnode measuring up to 7 mm in shortest axis dimension is a not enlarged by size\ncriteria and appears unchanged.\n\nThere is unchanged grade I/II spondylolisthesis associated with bilateral L5\nspondylolysis. There are no suspicious lytic or blastic bone lesions.", "output": "1. Patchy new nodular mixed attenuation opacities in the lower lobes,\nprobably infectious. In the appropriate setting aspiration pneumonitis could\nperhaps also be considered.\n\n2. Small quantity of new gas in the gallbladder lumen; this is commonly due\nto prior sphincterotomy an infectious etiology seems unlikely.\n\n3. Small calcified gallstones." }, { "input": "LOWER CHEST: Visualized lung fields are notable for mild left lower lobe\natelectasis and new trace left pleural effusion. The heart is normal in size.\nCoronary artery calcifications noted. No large pneumothorax.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Mild periportal edema present. The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. A 7 mm\nmyelolipoma is seen within the left adrenal gland.\n\nURINARY: The kidneys are slightly atrophic with bilateral perinephric fat\nstranding, stable since prior examination. Bilateral subcentimeter renal\nhypodensities are too small to characterize. A 4.6 x 4.3 cm simple cyst in\nthe lower pole left kidney is stable. Stable wedge-shaped hypodensity along\nthe left upper pole is unchanged since ___ likely consistent with\nprior infarct or renal injury. There is no evidence of focal renal lesions or\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is decompressed. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. Mild circumferential wall thickening along the sigmoid colon is\nstable over multiple prior studies and most consistent with chronic\ninflammatory changes. No adjacent fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus noted. No large adnexal mass.\n\nLYMPH NODES: Stable top-normal 1.6 x 0.9 cm (02:35) left para-aortic lymph\nnode is present (previously 1.5 x 0.9 cm). There is no additional\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted. Common patent celiac trunk is noted with extensive\ncalcification at its origin and patent SMA.\n\nBONES: Degenerative changes are seen throughout the thoracolumbar spine with\nsubchondral sclerosis and disc space narrowing. Bilateral L5 spondylolysis\nwith anterolisthesis of L5 on S1 is noted. No evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute CT findings in the abdomen pelvis to explain patient's symptoms.\n2. Stable mild wall thickening of the sigmoid colon over multiple prior\nstudies without adjacent inflammatory changes is most consistent with changes\nrelated to chronic inflammation. If not previously assessed consider non\nurgent colonoscopy for further evaluation.\n3. Diverticulosis without evidence diverticulitis.\n4. Stable left upper lobe wedge-shaped hypodensity is consistent with prior\ninfarct or renal injury.\n5. Trace left pleural effusion.\n6. Extensive atherosclerotic calcifications.\n7. Cholelithiasis without evidence of acute cholecystitis." }, { "input": "LOWER CHEST: Coronary and aortic annular calcifications are dense. There is\nno pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is cholelithiasis. There is subtle hepatic hyperemia\nalong the superior and lateral aspect of the gallbladder. There is no intra\nor extrahepatic biliary ductal dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout. A 4 mm hypodensity\nin the head of the pancreas (series 2, image 30) likely represents a\nside-branch IPMN or focal fat and is unchanged. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A focal fatty lesion in the lateral arm of the left adrenal gland is\nconsistent with an adrenal myelolipoma.\n\nURINARY: The kidneys are somewhat atrophic, bilaterally. 2 mm nonobstructing\nrenal stones are noted, bilaterally. A large renal cyst is noted arising from\nthe inferior pole the left kidney. Delete\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. Stable thickening of the sigmoid colon is unchanged. The appendix\nis normal.\n\nPELVIS: The bladder is normal. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are calcified fibroids in the uterus.\n\nLYMPH NODES: Prominent retroperitoneal lymph nodes measure up to 8 mm (series\n2, image 40). There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is grade 1 retrolisthesis of L5 on S1.\n\nSOFT TISSUES: Numerous microcalcifications are noted in the breasts,\nbilaterally. Tiny soft tissue nodules in the pannus likely represent\ninjection granulomas.", "output": "1. There is subtle hepatic hyperemia adjacent to the gallbladder. Clinical\ncorrelation for evidence of cholecystitis is recommended. Of note, there is\nno significant pericholecystic fat stranding or fluid.\n2. Diverticulosis without definite evidence of diverticulitis. Wall\nthickening of the sigmoid colon is likely secondary to chronic inflammation\nand is unchanged. If one has not been recently performed an outpatient\ncolonoscopy is recommended.\n3. Numerous microcalcifications are noted in the breasts, bilaterally. If\nclinically indicated correlation with mammography is recommended.\n4. A hypodensity in the head of the pancreas likely represents a side-branch\nIPMN or focal fat and is unchanged from ___. If indicated, an MRI of\nthe abdomen could be obtained for further characterization.\n\nRECOMMENDATION(S): MRCP to evaluate for IPMN" }, { "input": "LOWER CHEST: There are bibasilar patchy opacities, left greater than right,\nwith ___ appearance concerning for bilateral lower lobe pneumonia or\naspiration. There is a trace dependent, layering, nonhemorrhagic left pleural\neffusion. Coronary calcifications are seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Vascular calcifications are seen throughout the\nsplenic artery and vein.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys appear atrophic, compatible with known history of\nend-stage renal disease. There has been interval resolution of previously\nnoted hydronephrosis from ___. There is a 4.1 cm simple cyst in the\nleft lower renal pole. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Sigmoid diverticulosis is\nidentified without evidence of acute diverticulitis. Otherwise, the colon and\nrectum are within normal limits. The appendix is normal with a small high\ndensity material noted within, likely appendicolith.\n\nPELVIS: The distal ureters are unremarkable. Diffuse thickening of the\nurinary bladder may be due to collapsed appearance, however, infection cannot\nbe excluded. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Popcorn calcifications are noted in the uterus, calcified\nfibroids.\n\nLYMPH NODES: There is interval decrease in the size previously noted left\npara-aortic lymph node, now measuring 1.0 cm, previously 1.2 cm cm in ___ (02:35). No evidence of mesenteric lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are noted throughout the lower lumbar spine,\nparticularly at the L5-S1 vertebral level with grade 1 anterolisthesis of the\nL5-S1 level.\n\nSOFT TISSUES: Multiple foci of density are noted in the anterior abdominal\nwall, likely subcutaneous injection sites.", "output": "1. Bibasilar patchy opacities, left greater than right, with ___\nappearance are concerning for bilateral lower lobe pneumonia or aspiration. \nSmall dependent, layering, nonhemorrhagic pleural effusion is noted in the\nleft lung base.\n2. Diffuse wall thickening of the urinary bladder may be due to collapsed\nappearance, however, infection cannot be excluded. Correlate with urinalysis.\n3. Atrophic bilateral kidneys, compatible with known history of end-stage\nrenal disease, with interval resolution of previously seen hydronephrosis from\n___.\n4. Extensive arterial calcifications.\n5. Calcified uterine fibroids." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. The patient is status post\nmedian sternotomy. There is three-vessel coronary artery calcification and\naortic valve calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: There is an unchanged 0.5 cm hypodensity in the pancreatic head\n(___), unchanged compared to previous and compatible with interdigitating\nfat. The pancreas otherwise has normal attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is an unchanged fat attenuation lesion measuring 0.9 x 0.7 cm\nin the left adrenal gland compatible with a myelolipoma. The left adrenal\ngland is unremarkable.\n\nURINARY: As before, the kidneys are mildly atrophic. There is an unchanged\nsimple cyst in the inferior pole the left kidney. No hydronephrosis. There\nis unchanged diffuse urothelial enhancement involving the left collecting\nsystem in ureter.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis\nwithout evidence of diverticulitis. The colon and rectum are otherwise within\nnormal limits. The appendix is normal.\n\nPELVIS: As before, the bladder wall is mildly thickened with increased\nurothelial enhancement. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is calcified, likely representing calcified\nfibroids.\n\nLYMPH NODES: There is an unchanged 1.1 cm left para-aortic lymph node (___),\npotentially reactive. There is an unchanged prominent 0.8 cm right external\niliac lymph node (___). There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. The superior mesenteric artery and celiac axis have a\ncommon origin there is prominent atherosclerotic calcification at the common\norigin.\n\nBONES: No acute fractures. Interval progression of multilevel degenerative\njoint disease with increased vacuum disc phenomenon at L5-S1 and new vacuum\ndisc phenomenon at L4-L5, L1-L2 and T12-L1. Unchanged grade 1 anterolisthesis\nof L5 on S1 due to bilateral L5 spondylolysis.\n\nSOFT TISSUES: Again seen are multiple soft tissue nodules in the pannus,\nlikely representing injection granulomas.", "output": "1. No evidence of small bowel obstruction, diverticulitis, or appendicitis.\n2. Bladder wall is thickened with increased urothelial enhancement. The\nbilateral ureters also demonstrate mildly increased urothelial enhancement. \nRecommend correlation with urinalysis as cystitis/ureteritis are possible.\n3. Interval progression of degenerative changes of the visualized spine. No\nacute fractures.\n4. Cholelithiasis without evidence of cholecystitis.\n\nRECOMMENDATION(S): Recommend correlation with urinalysis." }, { "input": "LOWER CHEST: Dependent atelectatic changes are seen. Otherwise the visualized\nlung fields are unremarkable. No pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Sub-centimeter hepatic hypodensities are too small to\ncharacterize but are favored to represent hepatic cysts or biliary hamartomas\nand are unchanged in comparison to the prior study. There is a focus of focal\nfatty sparing adjacent to the falciform ligament (07:26). The liver otherwise\ndemonstrates homogeneous attenuation throughout without evidence of suspicious\nfocal lesion. No evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is unremarkable.\n\nPANCREAS: The pancreas demonstrates normal attenuation throughout without\nevidence of concerning focal lesion or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen demonstrates normal size and attenuation without evidence\nof concerning focal lesion.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nnephrolithiasis on the right. There is a cluster of at least eight\nnon-obstructing renal stones in the lower pole of the left kidney. The largest\nof these measures 0.9 x 0.7 cm with an average density of 1485 Hounsfield\nunits (8:54). In comparison to the prior CT dated ___, the overall\nstone burden has increased. There is associated mild to moderate\nhydronephrosis, similar in appearance to the prior study dated ___.\nThere has been interval removal of ureteral stent. No perinephric abnormality\nbilaterally. No evidence of concerning renal or ureteral lesions.\n\nGASTROINTESTINAL: The stomach is not well assessed on CT but appears grossly\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. The colon and rectum are unremarkable. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. The distal ureters are without\nevidence of obstruction.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: No evidence of retroperitoneal or mesenteric lymphadenopathy. No\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. There is a mild amount of calcified\natherosclerotic plaque.\n\nBONES: Multilevel degenerative changes are noted about the thoracolumbar spine\nwithout evidence of acute fracture worrisome osseous lesion.\n\nSOFT TISSUES: The soft tissues of the abdominal and pelvic walls are within\nnormal limits.", "output": "1. No evidence of suspicious renal or ureteral lesions.\n2. Cluster of ileus eight non-obstructing renal stones within the lower pole\nof left kidney. The largest of these measures up to 0.9 cm with an average\ndensity of ___ Hounsfield units. In comparison to the prior CT dated ___, the overall stone burden has increased.\n3. Unchanged mild-to-moderate left-sided hydronephrosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. Normal caliber appendix. There is no free fluid or free air\nwithin the abdomen and pelvis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable in appearance.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abdominopelvic process identified to explain patient's symptoms. No\nnephrolithiasis or evidence of diverticulitis." }, { "input": "LOWER CHEST: There is mild basilar atelectasis bilaterally. The partially\nvisualized lower lung fields are otherwise clear. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There are multiple gallstones within the gallbladder, but no\nevidence of cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland appears normal. Again visualized is the\nnodule within the left adrenal gland measuring 1.5 x 1.9 cm with an average\nHounsfield density of 1, consistent with an adenoma.\n\nURINARY: Again visualized are multiple simple cysts throughout the kidneys\nbilaterally, the largest on the left measuring 6.6 x 7.6 x 7.7 cm. There is\nan ill-defined hyperdensity at the superior pole of the right kidney abutting\nthe liver parenchyma which measures approximately 1.4 x 1.7 cm. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is a moderate amount of\ndiverticulosis throughout the colon without any evidence of diverticulitis. \nThe colon and rectum are otherwise within normal limits. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcifications are noted within the prostate. Otherwise,\nreproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nare multiple homogeneous and symmetrically enlarged right inguinal lymph\nnodes, the largest measuring 1.3 cm in short axis, which are stable in\ncomparison to the prior examination.\n\nVASCULAR: Extensive atherosclerotic disease is noted. Again visualized is\nthe aortic stent-graft extending from just below the SMA to the common iliac\narteries bilaterally and into the right internal and external iliac arteries. \nThe aortic stent-graft appears unchanged in comparison to the prior\nexamination. Again visualized is a fem-fem bypass, which also appears\nunchanged. The infrarenal aortic aneurysm, which measured 4.2 x 4.1 cm on the\nprior examination, has enlarged now measuring approximately 4.2 x 4.5 cm. \nThere is no surrounding fat stranding.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate degenerative changes of the lumbar spine with moderate\ndextroconvex scoliosis centered about L2-L3. The punctate sclerotic foci\nwithin the right acetabulum, and the left femoral head likely represent bone\nislands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable appearance of aortic stent-graft and fem-fem bypass graft.\n2. Increased size of infrarenal aortic aneurysm now measuring 4.2 x 4 5 cm.\n3. Ill-defined hyperdensity within the superior pole may represent a\nhemorrhagic or proteinaceous cyst, however further evaluation is warranted.\n4. Stable left adrenal adenoma, gallstones, and diverticulosis.\n\nRECOMMENDATION(S): Renal ultrasound is recommended for evaluation of\nill-defined hyperdensity within the right kidney.\n\nNOTIFICATION: Pertinent critical findings were posted by Dr. ___\n___ on ___ at 10:41 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider." }, { "input": "Imaged lung bases are clear. The imaged portion of the heart is unremarkable.\n\nAbdomen: The liver appears slightly hypoattenuating relative to the spleen\nsuggesting a component of steatosis. An area of more focal fatty deposition\nis seen along the periphery of segment 4. Main portal vein is patent. No\nbiliary ductal dilation. The gallbladder is normal. The pancreas enhances\nnormally. The spleen is normal in size. Adrenals are normal bilaterally. \nThe kidneys enhance symmetrically without signs of pyelonephritis. However,\nthere is mild ureteral hyperenhancement which could reflect ureteritis from an\nascending infection. No definite ureteral stone is identified. The abdominal\naorta is normal in course and caliber. No retroperitoneal adenopathy. The\nstomach and duodenum appear normal. No free air or free fluid.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is normal. The colon is normal. The urinary bladder appears mildly\nthickened though mostly decompressed. Please correlate for cystitis. The\nuterus appears normal. There is a right adnexal cystic structure measuring\n2.7 x 3.1 cm, of doubtful significance in a reproductive age female. The left\novary is normal. No pelvic free fluid. No pelvic sidewall or inguinal\nadenopathy.\n\nBones: Sclerosis is noted at the SI joints bilaterally, which may reflect\ndegenerative disease. Otherwise, the imaged bony structures appear normal.", "output": "1. Thickened urinary bladder with mildly thickened and hyperemic ureters,\nplease correlate for infection.\n2. Normal appendix.\n3. SI joint DJD.\n4. Small right ovarian cyst, for which no additional follow-up is needed\nunless patient is postmenopausal.\n5. Mild hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits.\n\nIn the right lower quadrant, the appendix contains an appendicolith, is\nfluid-filled and dilated measuring up to 10 mm. There is mucosal hyperemia\nwith apparent mucosal disruption best seen on series 6b, image 22 (6b:24,\n6b:22). Findings consistent with micro perforation though there is no\npneumoperitoneum or drainable fluid collection. Stranding, fluid surrounding\nthe appendix is consistent with phlegmon. No signs of mesenteric venous\nthrombophlebitis. Adjacent lymph nodes are reactive.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, retroverted, fibroid uterus. No\nadnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute appendicitis complicated by microperforation with surrounding\nphlegmon.\n2. Fibroid uterus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. in person on ___ at 20:30 ___, 5 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: There is subsegmental atelectasis in the right worse than left\nlung bases.. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic z\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post appendectomy. Adjacent to the\npostoperative site, there is a small amount of fluid measuring 1.8 x 1.2 cm\nwith suggestion of rim enhancement (601b:25). This is between the cecum and\nadjacent small bowel loops. Mild adjacent fatty stranding in the right lower\nquadrant near the operative site is likely postoperative. There is mild wall\nthickening of small bowel loops adjacent to the postoperative site (601b:26)\nlikely representing focal mild inflammation.\n\nThe stomach is unremarkable. Small bowel loops otherwise normal in caliber\nwall thickness. The colon and rectum are within normal limits. The appendix\nis surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nmoderate amount of intermediat density fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is enlarged retroverted fibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post appendectomy with fluid measuring 1.2 x 1.8 cm with suggestion\nof rim enhancement. An abscess cannot be ruled out. Given the size, this is\nunlikely to be drainable. This is also located between the cecum and the\nsmall bowel in the right lower quadrant.\n2. Moderate amount of intermediate density fluid in the pelvis, could be\nproteinaceous versus hemorrhagic and likely postoperative.\n3. No evidence of bowel obstruction.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 9:01 am, 5 minutes after discovery of\nthe findings." }, { "input": "CHEST:\nMild dependent bibasilar atelectasis is noted. The partially visualized lung\nbases are otherwise clear without focal consolidation. No pleural effusion or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 2.5 cm simple cyst in the left hepatic lobe. Few additional\nsubcentimeter hypodensities are too small to characterize, though likely\ncompatible with simple cysts or biliary hamartomas. There is no evidence of\nconcerning focal lesion or laceration. Mild dilatation of the common bile\nduct and minimal intrahepatic biliary ductal dilatation. The gallbladder is\nnot visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right adrenal gland is normal in size and shape. Minimal\nthickening of the left adrenal gland.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nFew tiny cortical hypodensities are too small to characterize, though likely\ncompatible with simple renal cysts. There is no evidence of concerning focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Moderate fecal\nloading noted throughout the colon. The colon and rectum are otherwise within\nnormal limits. The appendix is not visualized, however no secondary signs of\ninflammation in the right lower quadrant. There is no evidence of mesenteric\ninjury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder is moderately distended, though otherwise within normal\nlimits. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Few central coarse calcifications are noted within the\nprostate. Central hypodensity within the prostate may reflect changes from\nprior TURP.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nMild to moderate atherosclerotic disease is noted. Extensive collateral\nvessels are noted in the anterior chest wall and anterior abdominal wall, of\nuncertain etiology.\n\nBONES: There is no evidence of acute fracture identified. No focal suspicious\nosseous abnormality. Few tiny sclerotic foci within the bilateral femoral\nheads and bilateral iliac bones are likely compatible with bone islands. \nExtensive degenerative change of the lumbar spine, including multi level disc\nnarrowing, endplate sclerosis, and anterior osteophytosis. Mild\nretrolisthesis of L5 on S1 and mild anterolisthesis of L3 on L4, age\nindeterminate though likely chronic and secondary to degenerative change. \nChronic changes involving the sternum likely secondary to median sternotomy.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of acute intra-abdominal or intrapelvic injury.\n2. No definite evidence of acute fracture identified.\n3. Extensive degenerative change of the lumbar spine as described above,\nincluding mild retrolisthesis of L5 on S1 and mild anterolisthesis of L3 on\nL4, age indeterminate though likely chronic and secondary to degenerative\nchange." }, { "input": "Lungs: There are partially visualized small bilateral pleural effusions,\nslightly greater on the right, with associated subsegmental atelectasis. This\nhas not significantly changed compared to most recent prior.\n\nLiver: Homogeneous appearance of the liver as before. There is no evidence of\nhepatic abscess on this noncontrast examination.\n\nBiliary: There has been interval placement of the common bile duct stent, in\nadequate position. There is pneumobilia, suggesting patency of the stent. The\ngallbladder has been surgically removed.\n\nSpleen: The spleen measures 10.7 cm and is normal in size.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation. There is no\nevidence of pancreatitis.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Several hypodensities are seen within both kidneys measuring up to\n4.2 cm in the midpole of the right kidney, consistent with cortical cysts.. \nThere is no hydronephrosis.\n\nPelvis: Limited examination of the pelvis due to artifact from the right total\nhip arthroplasty.\n\nThere is a small amount of ascites.\n\nGastrointestinal: There is a 5 cm segment of sigmoid colon, demonstrating new\ncircumferential wall thickening, with diverticula and surrounding fat\nstranding. The findings are consistent with of acute diverticulitis. No\nabscess is seen.\n\nThe small bowel appears within normal limits, although the evaluation is\nlimited due to lack of IV contrast administration.\n\nThere is no evidence of bowel dilatation or obstruction.\n\nThe previously described duodenal mural nodule is not well seen on today's\nexamination. There is no evidence of duodenal perforation.\n\nThere has been interval resolution of the dilatation of the esophagus.\n\nVascular: There are moderate to severe atherosclerotic calcifications of the\nabdominal aorta.\n\nLymph nodes: There is no lymphadenopathy.\n\nBone and soft tissues: There is no suspicious bone lesion. Mild multilevel\ndegenerative disc disease of the lumbar spine. Previous right total hip\narthroplasty. There is mild anasarca. There is a tiny fat-containing\numbilical hernia.", "output": "1. Uncomplicated acute diverticulitis of the sigmoid colon.\n\n2. Interval placement of a common bile duct stent, in adequate position.\nPneumobilia is seen suggesting patency of the stent. Recommend correlation\nwith the ERCP report. No evidence of hepatic abscess. Small amount of ascites,\nworse compared to previously.\n\n3. The small bowel appears within normal limits, although the evaluation is\nlimited due to lack of IV and oral contrast administration." }, { "input": "LOWER CHEST: There is scarring at the left lung base. There is no pericardial\nor pleural effusion. Relative low density of the blood pool likely secondary\nto anemia. Coronary artery calcifications are severe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is cholelithiasis without evidence\nof acute cholecystitis.\nPANCREAS: There is fatty atrophy of the pancreas.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: Kidneys are atrophic. There is no evidence of hydronephrosis. A\npunctate nonobstructing renal stone is noted in the of right kidney. 2\nnon-obstructing sub 3 mm stones are seen within the upper pole of the left\nkidney (series 300b image 33, 31). A lower pole hypodensity in the right\nkidney is compatible with a simple cyst. There is no perinephric abnormality.\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. The\nsmall bowel is normal in caliber without focal wall thickening. The large\nbowel is tortuous, but normal in caliber without wall thickening or dilation. \nThe appendix is well-visualized and normal. There is no intra-abdominal free\nfluid or free air. There is no mesenteric adenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The bladder is distended. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: A compression deformity of the T12 vertebral body is\nage indeterminate without prior studies for comparison. The bones are\ndiffusely demineralized with multilevel degenerative changes. Hemangiomas are\nseen at multiple levels. No definite pelvic fracture seen. The right hip is\ninternally rotated with a chronic trochanteric deformity, possibly from prior\ntrauma.\nAbdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Compression deformity of the T12 vertebral body, age indeterminate without\nprior studies for comparison.\n3. Right hip internally rotated with a chronic deformity, but no fracture\nseen.\n4. Cholelithiasis.\n5. Nonobstructing small bilateral renal calculi." }, { "input": "LOWER CHEST:\n\nMild atelectasis and scarring at the lung bases is similar to prior CT. \nCalcification is noted in the coronary arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver parenchyma is normal in attenuation. A radiopaque\ngallstone is again noted within the gallbladder without gallbladder wall\nthickening to suggest acute cholecystitis. There is no intra or extrahepatic\nbile duct dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout. The pancreatic duct\nis of normal caliber. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size without hydronephrosis. Punctate\nnonobstructive nephroliths in both kidneys are unchanged from prior CT (3:20,\n22).\n\nBOWEL AND MESENTERY: Small bowel loops are nondilated with normal wall\nthickness throughout. Colon and rectum are within normal limits. The\nappendix is normal in caliber and contains air.\n\nRETROPERITONEUM: There is a retroperitoneal stranding or hematoma. \nRetroperitoneal lymph nodes are not pathologically enlarged.\n\nVASCULAR: Atheromatous calcification in the abdominal aorta and major\nbranches is greatest at the aortoiliac bifurcation and in the splenic artery. \nThere is no abdominal aortic aneurysm.\n\nPELVIS:\n\nThe urinary bladder is fully distended with normal wall thickness. Uterus and\nadnexa have a normal appearance for age. There is no pelvic lymphadenopathy.\n\nNo free fluid, abscess, or free air is seen within the abdomen or pelvis.\n\nBONES:\n\nChronic compression deformity of T12 is unchanged from prior CT. The bones\nare diffusely demineralized.", "output": "1. No acute intra-abdominal process.\n2. Multiple chronic findings without significant change from prior CT,\nincluding cholelithiasis, punctate nonobstructive calculi in both kidneys,\nosteopenia, chronic T12 compression deformity, and diffuse atheromatous\ndisease." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nfocus of hyperdensity in hepatic segment 6 measures approximately 7 mm, and is\nmost likely a perfusion anomaly or small hemangioma (02:33). There is no\nevidence of suspicious lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. An accessory spleen is incidentally noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The appendix is dilated and fluid-filled, measuring up to 13\nmm (02:55), with thickened and hyperemic walls. There is no evidence of\nperforation or fluid collection. No free intra-abdominal air. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate, mildly complex free fluid in the pelvis, likely from the involuting\nleft corpus luteal cyst.\n\nREPRODUCTIVE ORGANS: The uterus contains an intrauterine device in standard\nposition. There is an involuting left corpus luteum. Dilated left gonadal\nveins are noted along with left-sided pelvic varices.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute uncomplicated appendicitis. No evidence of perforation or drainable\nfluid collection.\n2. Dilated left gonadal vein and left-sided pelvic varices, findings which can\nbe seen in pelvic congestion syndrome. Correlate with any history of chronic\npelvic pain." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nfew scattered hypodense lesions are seen in the liver, too small to fully\ncharacterize but likely representing hepatic cysts or biliary hamartomas. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is distended.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is slightly\nincreased enhancement and thickening of the colonic wall involving the sigmoid\nand descending colon, which can be seen in mild colitis. No evidence of\nperforation, obstruction, or abnormal fluid collection concerning for abscess\nformation. The appendix is not definitively seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is resected.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Slightly increased enhancement and thickening of the colonic wall involving\nthe sigmoid and descending colon may represent mild colitis." }, { "input": "CT of the abdomen: Please see formal chest CT. For chest findings common again\nnoted are bilateral pulmonary nodules at both lung bases.\n\nMetastatic disease involving the liver is again identified. The dominant\nlesion within segment ___ which measured 32 x 32 mm. On the study of ___, currently measures 24 x 24 mm (series 2, image 51). An additional lesion\nwithin segment ___. Which measured 2.8 x 3.1 cm, now measures 2.2 x 1.9 cm\n(series 2, image 54). The lucency within segment 8 shows no change in size\nhowever, there is less enhancement than on the prior exams. Overall, lesion\nshow a decrease in relative enhancement compared to prior studies. No new\nlesions are identified. The portal vein and hepatic veins remain patent. The\ngallbladder is unremarkable.\n\nThe spleen, pancreas, visualized loops of large and small bowel and right\nadrenal gland appear normal. There is no free fluid, no pathologically\nenlarged adenopathy.\n\nIll-defined hypodense area within the lower pole of the right kidney. This has\nbeen present on prior studies but more conspicuous and is currently not\nmass-like and somewhat wedge-shaped. Attention on followup is warranted . \nLeft kidney is surgically absent.\n\nCT of the pelvis. No free fluid, no adenopathy, prostatic enlargement,\nvisualized loops of large small bowel appear unremarkable. The bladder also\nappears unremarkable.\n\nBone windows demonstrate unchanged appearance of metastatic disease involving\nthe left iliac bone L3 and a mid thoracic vertebral body) as well as a small\nfocus involving the sternum).", "output": "1. Hepatic metastases either unchanged in size or decreased in size as\ndescribed above. However, all show a decrease in enhancement compared to the\nprior exams of ___ .\n2. Ill-defined hypodense region within the lower pole of the right kidney, not\ndefinitely mass like but more visible and on prior exams. Attention on\nfollow-up. Shape and extension to the renal capsule may suggest organizing\nsubacute infarction .\n3. No change in metastatic disease involving the bony structures as described\nabove.\n4. Pulmonary nodules at both lung bases, please see formal chest CT dictation\nfor complete chest findings." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hypodense and peripherally enhancing hepatic lesions\nare again seen, unchanged in number, but increased in size from ___. \nExamples include a lesion at the left hepatic dome measuring 3.9 x 3.8 cm\n(transverse by AP), previously 3.0 x 2.8 cm and a conglomerate of lesions\nwithin segment VIII measuring 4.9 x 4.7 cm (transverse by AP), previously 3.6\nx 2.9 cm. No new liver lesions are identified. The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right adrenal gland is normal in shape and size.\nURINARY: The right kidney is normal in size and contour. There is no\nhydronephrosis. The ureter is normal in caliber along its course to the\nbladder. A hypodense lesion in the lower pole of the right kidney measures 13\nmm, not significantly changed (series 8, image 30). The patient is status post\nleft nephrectomy and adrenalectomy. There is no evidence of local recurrence.\nGASTROINTESTINAL: Oral contrast is seen in a distended stomach and within the\ndistal esophagus. The small bowel is normal in caliber without focal wall\nthickening. The large bowel is also normal in caliber without wall thickening.\nThe appendix is not visualized but there are no secondary signs of\nappendicitis within the right lower quadrant.\nRETROPERITONEUM: There is no mesenteric adenopathy. There are no\npathologically enlarged retroperitoneal lymph nodes. There are multiple small\nscattered periaortic lymph nodes, not significantly changed.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nMild bladder wall thickening is likely secondary to chronic outlet\nobstruction.. There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.5 x 5.5 cm.\n\nBONES AND SOFT TISSUES:\n\nMixed lytic and sclerotic lesions of L3 and left iliac bone are unchanged. \nThere is a new sacral fracture with a suggestion of a probable mildly\nexpansile lucent lesion in its vicinity (series 10, image 36). The superficial\nsoft tissues are unremarkable.", "output": "1. Multiple hepatic hypodense lesions, all increased in size compared to\nprior, consistent with progression of metastatic disease. No new lesions\nidentified.\n2. 1.3 cm right lower pole hypodense lesion, unchanged from the prior study.\nIf further characterization is needed MRI can be obtained.\n3. New sacral fracture, likely pathologic, with a probable lytic lesion in\nthis location. Other bony metastases appear stable.\n4. Please see separate dictation for dedicated chest CT for details on\nintrathoracic findings.\n\nNOTIFICATION: Findings were discussed with Dr. ___ by Dr. ___\nthe telephone on ___ at 10:55, 10 min after they were made." }, { "input": "LOWER CHEST: Postsurgical sternotomy changes and intracardiac device leads are\nnoted. There is suggestion of a stent in the LAD. A 4 mm pulmonary nodule is\nnoted in the right middle lobe, stable since ___. Visualized lung bases are\notherwise clear. There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation, lower than the\nspleen, consistent with hepatic steatosis. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Note is made of focal atrophy\nof the pancreatic neck. There is no peripancreatic stranding or fluid\ncollection.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. In the interpolar region of the left\nkidney, there is a 1.3 x 1.1 cm simple renal cyst. Bilateral subcentimeter\nhypodense lesions are noted which are too small to characterize, however\nlikely represent additional simple cysts. Bilateral extrarenal pelves are\nnoted. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia with gastric fundus in the\nthorax. The stomach is otherwise unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is mild prostatomegaly. The bladder is moderately\nwell distended with possible circumferential bladder wall thickening which\ncould suggest chronic outflow obstruction.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: The bones are demineralized. There is moderate to severe multilevel\ndegenerative changes of the lumbar spine as well as lumbar levoscoliosis. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No pancreatic mass or CT findings of acute pancreatitis.\n2. Hepatic steatosis.\n3. Moderate hiatal hernia.\n4. Mild prostatomegaly." }, { "input": "LOWER CHEST:\nThe non-calcified nodule at the lung base is overall stable since ___\n(Series 11, Image 3). The previously described right lung nodule is not\nincluded in the scanning plane. Bilateral subpleural nodules also appear\nstable since ___. No new suspicious nodules or masses.The heart size is\nnormal without coronary vascular calcification. There is no pericardial or\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout, but\nsurface macronodularity in areas suggesting cirrhotic change. , new since\n___. Compared to ___, there is significant contour change in the\nposteroinferior right lobe of the liver with adjacent calcification and\ninterposition of the colon, which may suggest a prior resection or local\ntreatment, although not clear from the history. There is no concerning or\nhyper-enhancing focal hepatic lesion. There is no intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent. There is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without focal\nlesions, pancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is of normal size and attenuation throughout without focal\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric in size with normal\nnephrograms. There is a 1.4-cm simple cyst in the cortex of the lower pole of\nthe right kidney (Series 11, Image 33). There is a multi-loculated or group of\ncysts in the cortex of the right upper pole that appears unchanged since ___\n(Series 11, Image 21; Series 12, Image 59). Several tiny cortical\nhypodensities in the left kidney that are too small to characterize are also\nprobably renal cysts. There is no obstructing stone, concerning focal renal\nlesion, hydronephrosis, hydroureter, or perinephric abnormality. The urinary\nbladder is under-filled but appears unremarkable.\n\nGASTROINTESTINAL: The stomach is markedly distended and filled with oral\ncontrast and food contents, consistent with delayed gastric emptying on a\nrecent study. There is no hiatal hernia. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is not definitely seen, but no secondary\nsigns of appendicitis are noted. There is no bowel obstruction,\npneumoperitoneum, pneumatosis coli, or intra-abdominal fluid collection.\n\nRETROPERITONEUM: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: The portal vein, SMV, and splenic veins are patent. The IVC is\npatent. Again demonstrated is a retroaortic left renal vein. There is no\nabdominal aortic aneurysm or calcium burden in the abdominal aorta or its main\nbranches.\n\nPELVIS: There is no evidence of pelvic or inguinal lymphadenopathy. There is\nno free fluid in the pelvis. Multiple small cysts are demonstrated in the\ncervix and likely nabothian cysts. The endometrium is homogeneous and at the\nupper limit of normal in thickness. The adnexa are unremarkable.\n\nBONES AND SOFT TISSUES: There is no suspicious lytic or sclerotic bony lesion\nor degenerative change. The abdominal and pelvic walls are unremarkable other\nthan a tiny fat-containing umbilical hernia without evidence of complication.", "output": "1. Markedly distended stomach.\n\n2. Otherwise, no specific acute CT finding to explain the patient's abdominal\npain, including no obstructing urinary stone, no diverticulitis, or evidence\nof appendicitis.\n\n3. New hepatic macronodularity suggesting cirrhotic change, with superimposed\nnew large contour abnormality to right lobe of liver--question interval\ntreatment? No focal concerning hepatic lesion.\n\n4. Incidental probable grouped nabothian cysts, but clinical correlation with\nphysical exam and/or pelvic ultrasound could be performed for further\nevaluation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "The appendix is not visualized. There is trace free fluid in the pelvis,\npossibly physiologic. Please note that no pelvic ultrasound was performed." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\nSubcentimeter hypodensity in segment 6 is too small to characterize, but\nlikely represents a simple cyst or biliary hamartoma. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of hydronephrosis. There is no perinephric abnormality. \nThere is a 2.1 cm cyst in the interpolar region of the left kidney. Multiple\nadditional subcentimeter hypodensities bilaterally too small to characterize,\nbut also likely represent simple cysts.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon without evidence of diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications are noted the prostate which is\nnormal in size. Seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nare slightly prominent right external iliac nodes measuring up to 1.4 cm\n(3:72, 3:74). A prominent right inguinal node measures up to 1.5 cm (3:100). \nNo other pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Veins are well opacified without evidence of thrombus. The\nbilateral external iliac, common femoral, and superficial femoral veins are\nwell opacified without evidence thrombus. Infrarenal IVC filter is noted.\n\nBONES: There is a comminuted, angulated, and displaced fracture of the right\ndistal femur with surrounding callus formation indicating that this is\nsubacute or chronic in age. The distal fracture fragment is displaced\ndorsally and laterally with angulation of the fracture apex medially. There\nis subcutaneous edema seen around the distal right thigh. There is a\nperipherally enhancing fluid collection around the proximal fracture fragment\nin the anterior thigh measuring 7.6 x 3.2 x 5.4 cm, likely representing an old\nor evolving hematoma. Right-sided rib deformities likely reflect chronic\nfractures. Patient is status post ORIF of a right femoral neck fracture\ntransfixed with a dynamic compression screw, without hardware complications.\n\nSOFT TISSUES: Fatty atrophy of the right-sided psoas muscle, pelvic\nmusculature, gluteal musculature and thigh musculature is demonstrated. Small\nfat containing umbilical and left inguinal hernias are noted.", "output": "1. No acute intra-abdominal process. No evidence of venous thrombosis or\nanomaly.\n2. Subacute to chronic comminuted, angulated, displaced distal right femur\nfracture with an associated peripherally enhancing 7.6 x 3.2 x 5.4 cm fluid\ncollection within the anterior right thigh which may represent an old or\nevolving hematoma. Superinfection within this collection cannot be excluded on\nthe basis of this exam.\n3. Prominent right external iliac and right inguinal lymph nodes are likely\nreactive.\n4. Cholelithiasis." }, { "input": "The lung bases demonstrate a moderate to large right pleural effusion,\nincreased from prior, and small left pleural effusion, new since prior, with\ncompressive atelectasis of the right lower lobe. Limited imaging of the heart\nreveals no pericardial effusion or cardiomegaly. Numerous large esophageal\nvarices are demonstrated along the distal esophagus.\n\nCT ABDOMEN: The liver is shrunken and nodular with multiple well circumscribed\nhypodensities, the largest of which can be accurately characterized as hepatic\ncysts, and that the smallest of which are too small to fully characterize.\nThese lesions are grossly unchanged from the prior CT and were previously\ncharacterized as cysts by prior MRI. The portal veins are dilated but patent.\nThere is a splenorenal shunt. A patent paraumbilical vein is noted and\nparaesophageal varices are also noted. The hepatic veins are patent. There is\nno intra or extrahepatic biliary dilatation. The gallbladder is distended and\ncontains gallstones. Gallbladder wall thickening, edema and pericholecystic\nfluid is not significantly changed from the outside study of ___,\nlikely related to chronic liver disease. The pancreas enhances homogeneously\nwith hypodensity at the tail (02:26) as on prior MRI. The spleen is enlarged,\nmeasuring 19.2 cm. 1.3 cm cystic lesion in the spleen is unchanged. Incidental\nnote is made of an accessory spleen. The adrenal glands are normal. The\nkidneys enhance and excrete contrast promptly. There are no concerning renal\nlesions.\n\nThere are multiple prominent periportal lymph nodes, measuring up to 2.3 x 1.4\ncm (02:22). No free air is present. There is small volume ascites. The aorta\nand its major branches are patent and not dilated. The stomach demonstrates\nmultiple perigastric varices. There are several loops of small bowel in the\nlower abdomen with bowel wall thickening, edema and hyperenhancement\n(601b:24). The appendix is visualized in the right lower quadrant measuring 5\nmm in diameter with surrounding ascites but otherwise normal in appearance.\n\nAbdominal aorta is normal in caliber. Major branches including the celiac\naxis, SMA and ___ are patent.\n\nCT PELVIS: The remainder of the bowel is normal. The bladder is normal. There\nis contiguous pelvic ascites. Uterus is not seen. There is no inguinal or\npelvic adenopathy.\n\nOSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesion\nidentified.", "output": "1. Loops of small bowel in the lower abdomen with bowel wall thickening,\nedema and hyper enhancement could represent enteritis. The etiology may be\ninfectious, inflammatory, ischemic or related to third spacing of fluid.\nSuperimposed infection of intra-abdominal ascites is not excluded.\n2. Cirrhotic appearing liver with multiple hypodensities previously\ncharacterized as cysts by MRI.\n3. Evidence of portal hypertension including splenomegaly, ascites, patent\nparaumbilical vein, splenorenal shunt and multiple perigastric and\nparaesophageal varices.\n4. Cholelithiasis with gallbladder wall thickening and edema is not\nsignificantly changed from the outside CT of ___, likely related\nto underlying systemic causes such as chronic liver disease or\nhypoalbuminemia." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular with multiple\nwell-circumscribed hypodensities, the largest of which can be accurately\ncharacterized as benign hepatic cysts and the smallest of which are too small\nto fully characterize. These lesions are grossly unchanged from the prior CT\nand were previously characterized as cysts by MRI. The portal veins\nredemonstrate chronic partial thrombosis of the main and left portal veins as\nseen on the abdominal ultrasound of ___. There is interval partial\nthrombosis of the right portal vein with near complete occlusion of its\nanterior branch. There is a large splenorenal shunt. A previously patent\nparaumbilical vein is now diminutive in caliber. There are multiple\nparaesophageal and perigastric varices consistent with underlying cirrhosis\nand portal hypertension. There is no intra or extrahepatic biliary dilation. \nThe gallbladder is distended with gallstones. The gallbladder is nondistended\nwith gallbladder wall thickening and edema similar to prior cyst, likely\nrelated to chronic liver disease.\n\nPANCREAS: There is a hypoenhancing lesion in the pancreatic head measuring 1.9\nx 1.9 x 1.6 cm (2:56), which may be new or more conspicuous on today's exam. \nIn the neck of the pancreas, again seen is a cystic lesion measuring 2.3 x 2.2\nx 1.4 cm (previously 2.6 x 1.5 cm on MRCP of ___. Additional\nsmaller cystic lesions in the body of the pancreas measure up to 9 mm. There\nis no pancreatic ductal dilatation or peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged, measuring 18 cm. An 11 mm hypodensity in the\nspleen (2:42) is unchanged. An accessory spleen is noted in the splenic hilum\n(2:54).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The duodenum and a few loops\nof proximal small bowel demonstrate mild bowel wall thickening/edema, similar\nto prior CT and likely related to third spacing. The colon and rectum are\nwithin normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: Several prominent periportal lymph nodes are unchanged. There is\nno lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable dominant cystic lesion in the pancreatic neck, unchanged from MRCP\nof ___, which may represent a serous cystadenoma or IPMN. \nSmaller cystic lesions in the pancreas likely represent side branch IPMNs. \nThe patient is due for follow-up MRI in ___.\n2. 1.9 cm hypodense lesion in the pancreatic head is new or more conspicuous. \nThis can be further evaluated at the time of follow-up MRI, which should be\nperformed with contrast.\n3. Cirrhotic appearing liver with multiple grossly stable hypodensities\npreviously characterized as hepatic cysts on MRI.\n4. Nonocclusive portal venous thrombosis involving the main, left and right\nportal veins as detailed above.\n5. Evidence of portal hypertension including splenomegaly, splenorenal shunt\nand multiple perigastric and paraesophageal varices.\n6. Cholelithiasis with stable gallbladder wall thickening and edema, not\nsignificantly changed from prior studies and likely related to chronic liver\ndisease.\n7. Bowel wall thickening/edema of the duodenum and a few loops of proximal\nsmall bowel is nonspecific and may reflect inflammation or third spacing of\nfluid." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nFluid collections: Previously seen fluid collection in the in right\nhemipelvis has resolved. However there is a new collection in the left lower\nquadrant/left hemipelvis lying just to the left of the uterus measuring 5.5 x\n3.2 cm. Additional 5.0 x 4.4 collection noted in the right upper quadrant\nlying just anterior to the transverse colon and in between the liver in the\nstomach. The tip of the VP shunt tubing terminates in this collection, on the\nprevious study tubing extended down to the right hemipelvis. A third\ncollection is noted in the right upper abdominal wall subcutaneous tissues and\nmeasures 8.7 x 5.5 cm in the axial plane. The shunt tubing forms a loop\nwithin this superficial subcutaneous fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 3 new collections/CSF pockets, left hemipelvis, right upper quadrant\nbetween the liver in the stomach and in the subcutaneous right anterior\nabdominal wall. Infection cannot be excluded. Previously seen right\nhemipelvis collection has resolved.\n2. The VP shunt tubing which previously had its tip lying in the right lower\nquadrant normal forms a loop within the subcutaneous fluid pocket and the tip\nlies in the right upper quadrant collection." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is small volume perihepatic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. High-density material posterior to the spleen is\nof unknown significance.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. In the mid abdomen and mid pelvis\nthere are several borderline dilated and edematous loops of distal small\nbowel. There is small amount of associated mesenteric free-fluid. There is\nsuggestion of two adjacent transition points in the low mid abdomen (601:16). \nFew relatively hypoenhancing loops of bowel are also concerning for possible\nischemia (e.g. a loop in the midline low abdomen (2:61)). The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. IUD is noted. Adnexa are normal\nfor age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Dilated edematous loops of distal small bowel in the low mid abdomen and\npelvis with suggestion of adjacent transition points raises concern for closed\nloop obstruction and/or internal hernia. Relative ___ of a few of\nthese small-bowel loops also raises concern for associated ischemia. There is\nsmall volume associated mesenteric free-fluid. Recommend surgical\nconsultation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The native spleen is surgically absent. There is a 4.2 x 3.7 cm\nprobable accessory spleen (601b:20), less likely a splenosis nodule.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n8 x 7 mm simple cyst within the interpolar aspect of the right kidney is\nunchanged (2:32). No concerning focal renal lesion identified. No\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastrectomy. There is no evidence of\nrecurrence within the surgical bed. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal. No bowel obstruction. No\nascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Mild degenerative changes of the visualized thoracolumbar spine, most\nnotable at L5-S1. 5 mm sclerotic focus within the left ischial tuberosity is\nunchanged since prior study most consistent with a bone island (601b:35). \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT findings to explain patient's symptoms.\n2. Status post gastrectomy without evidence of local recurrence or metastatic\ndisease within the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Unchanged surgical material in\nthe anterior epicardial fat and adjacent to the sternum.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is subtle nodular contour of the liver compatible with known cirrhosis. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Splenule at the pancreatic\ntail (02:18) was better characterized on prior MRI. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\nscattered diverticula in the sigmoid and descending colon without surrounding\ninflammation to suggest diverticulitis. There is fluid throughout the extent\nof the colon is nonspecific and can be seen in a diarrheal illness. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is an unchanged nonobstructing moderately sized right\ninguinal hernia which contains nondilated small bowel.", "output": "1. No etiology identified for right upper quadrant pain. Normal gallbladder. \nNo intra-abdominal collection.\n2. Unchanged moderately size right inguinal hernia containing nondilated loops\nof small bowel.\n3. Diverticulosis without surrounding inflammation to suggest diverticulitis.\n4. Fluid throughout the extent of the colon is nonspecific and can be seen in\ndiarrheal illness." }, { "input": "Lung bases: Motion artifact limits evaluation through the lung bases which\nappear grossly unremarkable. The imaged portion of the heart is unremarkable.\nThere is a small hiatal hernia.\n\nAbdomen: The liver, gallbladder, spleen, adrenals and pancreas are\nunremarkable. No hydronephrosis or renal/ureteral stone. The abdominal aorta\nis normal in course and caliber with mild to moderate atherosclerotic\ncalcifications. No retroperitoneal adenopathy. The stomach and duodenum\nappear normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is normal. The colon contains numerous fluid levels though there is\nno wall thickening or signs of pericolonic inflammation. Diverticulosis is\nnoted without evidence of diverticulitis. There is a fat containing right\ninguinal hernia containing nonobstructed small bowel loops. The urinary\nbladder appears normal. Prostate appears normal in size. No pelvic free\nfluid. No pelvic sidewall or inguinal adenopathy.\n\nBones: There is no worrisome lytic or blastic osseous lesion.", "output": "1. No evidence of colitis.\n2. Normal appendix.\n3. Small bowel containing right inguinal hernia without evidence of\ncomplication.\n4. Mild to moderate atherosclerotic calcification.\n5. Small hiatal hernia." }, { "input": "LOWER CHEST: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal. As before, surgical material is seen in the anterior\nepicardial fat and adjacent to the sternum.\n\nHEPATOBILIARY: The liver is normal in size and attenuation. No focal hepatic\nlesions are identified. The portal vein is patent. There is no intra or\nextrahepatic biliary duct dilatation. The gallbladder is normal-appearing.\n\nSPLEEN: The spleen is normal in size and enhancement.\n\nPANCREAS: The pancreas shows normal enhancement. There is no pancreatic duct\ndilatation or peripancreatic fat stranding.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys display symmetric nephrograms with no evidence of\nhydronephrosis or mass lesion in either kidney. The ureters are symmetrical\nin their course to the bladder.\n\nGASTROINTESTINAL: The stomach is within normal limits. Small bowel loops are\nnormal in caliber. There is moderate to large fecal loading throughout the\ncolon however there is no evidence colonic wall thickening. The appendix is\nnormal. There is mild diverticulosis of the sigmoid colon without evidence of\ndiverticulitis\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nVASCULAR: The abdominal aorta is normal in caliber and shows moderate to\nsevere calcified atherosclerosis.\n\nPELVIS: The bladder is within normal limits. There is no inguinal or pelvic\nsidewall lymphadenopathy. The rectum is within normal limits. As before,\nthere is a moderate to large right inguinal hernia which contains multiple\nloops of small bowel however there is no evidence of small bowel obstruction. \nProstate and seminal vesicles are unremarkable.\n\nBONES AND SOFT TISSUES: No suspicious osseous lesions are seen.", "output": "Moderate to large fecal loading throughout the colon. No evidence of colitis\nor obstruction. Unchanged appearance of a right inguinal hernia containing\nloops of small bowel with no evidence of obstruction or ischemia." }, { "input": "LOWER CHEST: The imaged lung bases are clear aside from mild dependent\natelectasis. The imaged portion of the heart is unremarkable. Mild\nthickening of the distal esophagus may reflect esophagitis.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hypodense liver lesions are compatible with metastasis\nas seen on prior imaging studies. The largest lesion is seen within segment 8\nmeasuring approximately 4.7 x 4.7 cm. The main portal vein is patent. There\nis stable mild prominence of the common bile duct measuring up to 8 mm. The\ngallbladder appears normal.\n\nPANCREAS: The pancreas enhances normally without ductal dilation or discrete\nfocal lesion. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Duplicated right renal collecting system is noted with stable mild\nfullness of the lower pole moiety and ureter without discrete distal\nobstruction. No worrisome renal lesion is seen. Bilateral perinephric\nstranding is seen, unchanged from prior and nonspecific.\n\nGASTROINTESTINAL: The stomach is distended containing contrast and ingested\nmaterial. There is mild narrowing at the level of the gastric antrum though\ncontrast is seen passing through this level into small bowel. The duodenum\nappears normal. There is progressive dilation of small bowel loops which can\nbe traced to a point of abrupt caliber transition in the right mid abdomen\nwhere there is a 360 degree \"whirl\" of the mesentery and small bowel. There\nare 2 discrete transition point both centered at the mesenteric whirl, best\nseen on series 2 image 59. Findings are concerning for a closed loop\nobstruction. Mesenteric free fluid is small to moderate in volume. No\nevidence of hypoenhancing small bowel to suggest ischemia. Distal small bowel\nis entirely decompressed. The appendix is normal. The colon is unremarkable\nand contains a mild fecal load. An end colostomy is seen in the left mid\nabdominal wall. No definite evidence for malignant obstruction or mesenteric\nmass.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder appears moderately distended and normal. The\nuterus and adnexal structures appear unremarkable. There is a ___ pouch\nat the distal colon/rectum. Presacral soft tissue thickening may reflect\ntreatment related changes. No free fluid tracks into the lower pelvis. No\npelvic sidewall adenopathy is seen. No inguinal hernia or adenopathy.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.", "output": "1. Findings concerning for closed loop small bowel obstruction with \"whirl\"\nsign in the right mid abdomen. Moderate volume abdominal ascites noted. \nDifficult to exclude early bowel ischemia.\n2. Gastric distention with possible stricture at the level of the pylorus.\n3. Multiple liver lesions compatible with known sites of metastasis.\n4. Postsurgical changes including end colostomy, ___ pouch.\n5. Duplicated right renal collecting system with mild fullness of the lower\npole moiety, unchanged.\n6. Mild thickening of the distal esophagus could reflect esophagitis.\n\nNOTIFICATION: Findings were discussed in person with Dr. ___." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple hypodense lesions throughout the liver, most\nof which have increased in size since CT abdomen/pelvis dated ___. \nThe largest lesion measures 4.8 x 5.1 cm, previously for 4.0 x 4.4 cm, in\nsegment VIII. There are no definite new lesions. The intervening hepatic\nparenchyma is homogeneous in attenuation. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Incidental note is made of a duplicated right renal\ncollecting system.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is fecalization\nthroughout much of the distal ileum. Small bowel loops otherwise demonstrate\nnormal caliber, wall thickness, and enhancement throughout without any\nadjacent fat stranding. A diverting colostomy protrudes through the left\nabdominal wall. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Incidental note is made of duplicated right renal veins.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Presacral soft tissue thickening is stable. Again seen are\nbilateral injection site granulomatous of the buttocks.", "output": "1. Most of the previously identified hepatic metastases have increased in size\nas described above.\n2. Please refer to separate report for same-day CT chest for complete\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: Numerous large hepatic hypodensities are re- demonstrated and\nare increased in size from the prior examination. The largest measures 6.1 x\n5.3 cm in segment 5 (previously 5.1 x 4.6 cm. Additionally, multiple poorly\nseen an ill-defined hypodensities on the prior examination are more\nconspicuous and enlarged on the current examination for example a 1.7 x 1.3 cm\nhypodense lesion in segment 6 (05:53). There is no biliary ductal dilatation.\nThe portal vein is patent. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. As before a\ndiverting colostomy protrudes through the left abdominal wall in similar\nposition to the prior exam.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Duplicated right renal veins are re- demonstrated.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple hepatic metastases are increased in size from the prior\nexamination. No additional metastatic disease identified in the abdomen or\npelvis.\n2. Chest report dictated separately." }, { "input": "LOWER CHEST: No focal pneumonia in the imaged lower lungs. No evidence of a\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: 10 mm and 5 mm hypodensities in the liver are unchanged from at\nleast ___ (series 5, image 7). Wedge-shaped, peripheral hypoenhancement in\nthe right hepatic lobe along the falciform ligament is probably a transient\nhepatic attenuation difference, not clearly seen as focal fat on prior\nunenhanced exam (series 5, image 16). The liver otherwise demonstrates\nhomogenous attenuation throughout. No evidence of concerning focal lesions. \nNo evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality\n\nGASTROINTESTINAL: The stomach is unremarkable. A proximal duodenal\ndiverticulum is moderate (series 5, image 33). Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. No bowel obstruction. No free air. No\nfluid collections. The appendix is not definitely seen but no secondary signs\nof appendicitis are demonstrated.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is bulky with a 4 x 3.8 cm enhancing lesion\nposteriorly, likely a fibroid; this lesion is not FDG avid the recent PET-CT\n(series 5, image 266). A 10 mm similar lesion is probably also fibroid\n(series 5, image 63). No evidence of adnexal masses.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild-to-moderate atherosclerotic\ndisease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Multilevel\ndegenerative changes are mild. Mild broad-based disc bulges at L4-L5 and\nL5-S1 indenting anterior thecal sac.\n\nSOFT TISSUES: A fat containing umbilical hernia is tiny.", "output": "1. No acute intra-abdominal or pelvic process.\n2. Moderate duodenal diverticulum.\n3. Bulky fibroid uterus." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic otherwise unremarkable this noncontrast\nexam. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Extensive calcifications splenic artery are noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. Punctate nonobstructing stones and/or vascular\ncalcifications are noted in the bilateral kidneys. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis is seen\nthroughout the colon, most prominent in the sigmoid, without evidence of\ndiverticulitis. The appendix is normal. The rectum demonstrates 5.3 cm\nrounded area of feces. There is tricompartmental pelvic floor laxity/descent,\nwith the rectum in a very low or prolapsed position.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The suprarenal aorta is mildly ectatic measuring 3.5 x 3.3 cm,\nunchanged from prior exam. The infrarenal aorta is mildly ectatic measuring\n2.3 x 2.1 cm, unchanged from prior exam. Moderate to severe atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are again noted in the L-spine with anterolisthesis of L4\nover L5, unchanged from prior exam. Degenerative changes are seen in the\nbilateral hips.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diverticulosis throughout the colon, most prominent in the sigmoid,\nwithout evidence of diverticulitis.\n\n2. Tricompartmental pelvic floor laxity/descent, with the rectum in a very\nlow or prolapsed position.\n\n3. Mildly ectatic aorta, similar to prior exam.\n\n4. Moderate degenerative changes in the lumbar spine with anterolisthesis of\nL4 over L5, similar to prior exam. Moderate degenerative changes in the\nbilateral hips.\n\nNOTIFICATION: Updated findings from original wet read were communicated to\nDr. ___ at 1:37 p.m. on ___ by phone." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNote is made of a subcentimeter hypodensity in the upper pole of the left\nkidney which is too small to characterize but likely represents a cysts\nmeasuring 0.6 cm (series 2, image 60).\n\nGASTROINTESTINAL: A nasoenteric tube ends in the stomach. Oral contrast\nextends to the distal small bowel. There is no small-bowel or colonic wall\nthickening. There is no evidence of obstruction. The appendix is normal. \nNote is made of moderate fecal loading in the colon. There is no\nintra-abdominal free fluid or free air.\n\nPELVIS: The bladder is decompressed with a Foley catheter. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There are multiple scattered retroperitoneal lymph nodes but none\nthat are pathologically enlarged. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abdominopelvic process." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Incidental note is made of a circumaortic left renal\nvein.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Moderate degenerative changes within the thoracolumbar spine. There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Nonvisualization of the cecal mass on today's examination.\n2. No evidence of local, regional, or metastatic disease." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The small or large bowel obstruction. Postsurgical changes\nfrom prior right colonic resection and ileocolic anastomosis are again noted. \nThere are surgical clips in the region of the soft tissue recurrence located\nadjacent to the neoterminal ileum. No residual soft tissue is seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.", "output": "No evidence of new recurrence or metastatic disease in the abdomen and pelvis." }, { "input": "The study is limited due to lack of oral contrast and a paucity of\nintra-abdominal fat.\n\nLOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Candidate for normal appendix is identified\nthough not with absolute certainty.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid dependently in the pelvis. Fluid density in the paracolic gutters\ninferiorly seen bilaterally. This fluid density is relatively well delineated\nraising the possibility of postoperative changes of prior bilateral inguinal\nherniorrhaphies, to be correlated clinically. No underlying cause identified\nfor this finding otherwise.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process to explain the patient's symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. There is no proper hepatic artery. A replaced left hepatic artery\narises from the left gastric artery. A replaced right hepatic artery arises\nfrom the SMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No findings of acute or chronic pancreatitis." }, { "input": "LOWER CHEST:\n\nCoronary artery calcifications are partially imaged. Included portions the\nlower lungs are grossly clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is decreased in attenuation relative to the spleen\nindicative of steatosis. No focal hepatic lesion is identified. There is no\nintra or extrahepatic biliary dilatation. The gallbladder is unremarkable\nwithout radiopaque stones or wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout without focal lesion\nor duct dilatation.\n\nSPLEEN: The spleen is normal in size. A 1.7 cm splenule is incidentally noted\nnear the splenic hilum.\n\nADRENALS: The adrenal glands are normal bilaterally.\n\nURINARY: There is no hydronephrosis. Two nonenhancing thin walled cysts\narising from the left kidney, 4.2 cm at the upper pole and 4.6 cm at the lower\npole, both have characteristics of simple cysts. No concerning enhancing\nlesion is seen in either kidney. A 2 mm nonobstructive nephrolith is\nidentified in the interpolar left kidney on the pre contrast images. A small\ncortical scar is noted at the upper pole of the right kidney. There is no\nevidence of urothelial lesion in the kidneys or ureters.\n\nGASTROINTESTINAL: Small bowel loops are of normal caliber. A few colonic\ndiverticula are noted along the descending colon and sigmoid colon without\nassociated findings of diverticulitis. The colon and rectum are otherwise\nwithin normal limits.\n\nLYMPH NODES: There are no pathologically enlarged mesenteric or\nretroperitoneal lymph nodes.\n\nVASCULAR: The abdominal aorta is somewhat tortuous but maintains normal\ncaliber through the bifurcation. Variant vascular anatomy is noted, with the\nceliac axis and SMA sharing a common origin from the aorta.\n\nPELVIS:\n\nEnlarged prostate gland protrudes into the neck of the urinary bladder. The\nurinary bladder wall appears diffusely thickened and trabeculated, even\nallowing for incomplete distention.\n\nBONES AND SOFT TISSUES:\n\nNo aggressive osseous lesion is identified. Chronic degenerative changes are\nnoted at L5-S1 and in the hips bilaterally.", "output": "1. Nonobstructive nephrolith in the interpolar left kidney.\n2. Thickened urinary bladder wall with enlarged prostate gland suggestive of\nchronic outlet obstruction.\n3. Hepatic steatosis.\n4. Atherosclerotic disease including coronary artery calcification.\n5. Colonic diverticulosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates ill-defined hypodensities throughout the\nright lobe (series 2 images 11 to 33) of unknown etiology. The largest\nhypodensity in the right lobe is located in segment 8 and measures up to 4.0\ncm, (series 2, image 21). There is hypodensity along the portal vein\ncompatible with portal edema which can be seen in congestive heart failure. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple well-circumscribed hypodense lesions in bilateral kidneys,\nsome too small to characterize on CT. The largest is located in the upper\npole of the left kidney and measures of up to 4.6 cm compatible with a simple\nrenal cyst. The renal cyst is unchanged when compared to prior CT abdomen\npelvis dated ___ there is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\npandiverticulosis without evidence of wall thickening, hyperemia or adjacent\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.5 x 3.4 by 4.2 cm,\n(series 2, image 72), (602 image 39). The seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine. There are no\nworrisome osseous lesion.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Ill-defined hypodensity throughout the right lobe are of unknown etiology\nas described above.\n2. There is periportal edema, which is compatible with the patient's previous\ndiagnosis of congestive heart failure.\n3. Unchanged 4.6 cm simple renal cyst in the upper pole of the left kidney.\n4. There is small amount of free fluid in the pelvis.\n\nRECOMMENDATION(S): Liver MRI with contrast is recommended to further\ncharacterize the ill-defined hypodense regions in the right hepatic lobe.\n\nNOTIFICATION: The patient's findings were discussed with Dr ___ via\nphone by Dr ___ on ___ at 18:04." }, { "input": "LOWER CHEST: A small right pleural effusion is substantially decreased in size\nsince ___ status-post pleural drainage catheter placement. Mild\ndependent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is diffuse wall\nthickening of the transverse and descending colon with adjacent fat stranding.\nNo free fluid or fluid collection. No pneumoperitoneum or pneumatosis. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable for patient age.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade ___ anterolisthesis of L4 on L5 with moderate to severe spinal canal\nnarrowing. Otherwise mild lumbar spine degenerative changes.\n\nSOFT TISSUES: Small, fat containing umbilical hernia.", "output": "1. Colitis of the transverse and descending colon. No pneumatosis,\npneumoperitoneum, free fluid, or evidence of abscess formation.\n2. Significant interval decrease in size of a now small right pleural effusion\nstatus-post pleural drainage catheter placement.\n3. Grade ___ anterolisthesis of L4 on L5 with severe spinal canal narrowing." }, { "input": "LOWER CHEST: There is a subpleural nodule in the right lower lobe measuring\n1.4 cm (series 2:8), similar to prior. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a 6 mm hypoattenuated focus in the left lobe (series 2:17) which is\ntoo small to characterize. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is extensive sigmoid\ncolonic diverticulosis. There is focal wall thickening and stranding\nsurrounding a diverticulum in the sigmoid colon (601:29) compatible with acute\ndiverticulitis. No extraluminal air nor drainable collection. The appendix\nis not visualized but there is no secondary sign of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a calcified fibroid uterus.\n\nLYMPH NODES: Scattered mesenteric lymph nodes are not pathologically enlarged\nby CT size criteria. There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute uncomplicated sigmoid diverticulitis.\n2. Subpleural nodule in the right lower lobe measuring 1.4 cm is unchanged as\ncompared to CT chest ___.\n\nNOTIFICATION: The updated findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 4:56 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensity in the liver is too small to characterize but likely\nrepresents a biliary hamartoma or cyst. There is a 3.9 x 4.8 cm hemangioma in\nsegment ___. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. In the right\nlower quadrant, there is a rim enhancing 3.4 x 5.4 x 3.7 cm fluid collection\nwith ___ of 28 concerning for an abscess, without evidence of extraluminal air\n(6; 15). The cecum drapes anterior to the abscess and demonstrates wall\nthickening and inflammation. There is also associated wall thickening of the\nascending colon. The appendix appears dilated measuring up to 1.0 cm and\nlocated posterior to the abscess (7; 26). The terminal ileum is inflamed in\nappearance to the medial wall of the fluid collection (6; 13). This process\nmay either be related to acute appendicitis or Crohn's disease.\n\nThere is mild stranding within the omentum (4; 40).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There are multiple prominent right lower quadrant mesenteric\nnodes measuring up to 1.0 cm in short axis (4; 1), which may be reactive. \nThere is no retroperitoneal lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are noted at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 5.4 cm rim enhancing fluid collection in the right lower quadrant\nconsistent with an abscess. This process may either be related to acute\nappendicitis or Crohn's disease. The cecum drapes anterior to the abscess and\nan inflamed terminal ileum is adherent to the medial aspect of the abscess. \nThe appendix is dilated and located posteriorly.\n2. Prominent right lower quadrant mesenteric lymph nodes likely reactive. \nMild stranding also noted in the omentum.\n3. 4.8 cm liver hemangioma incidentally noted.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 3:03 pm, 5 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Visualized lung fields are notable for minimal right lower lobe\natelectasis. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is present. The stomach is\ndecompressed. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Along an approximately 6.4 cm segment of sigmoid\ncolon there is diffuse wall thickening with adjacent fat stranding and\nhyperemia surrounding multiple sigmoid diverticula consistent with acute\ndiverticulitis. No extraluminal air. No focal fluid collection. The\nremaining colon is unremarkable. The rectum within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No large adnexal mass seen. \nThere is mild inflammation adjacent to the left ovary secondary to the sigmoid\ndiverticulitis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is mild fat stranding adjacent to the left external iliac\nartery.\n\nBONES: Healed bilateral inferior pubic rami fractures as well as a right\nsuperior pubic ramus fracture are noted. No acute fracture. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small fat containing umbilical hernia is noted. The\nabdominal and pelvic wall is otherwise within normal limits.", "output": "Acute diverticulitis of the sigmoid colon with wall thickening, adjacent fat\nstranding and hyperemia. No focal fluid collection. No extraluminal air.\n\nRECOMMENDATION(S): Consider dedicated colonoscopy or follow-up imaging to\nexclude an underlying lesion once clinically resolved." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is extensive diffuse\ncolonic diverticulosis, without evidence of acute diverticulitis. Mild\nrelative thickening of the colonic wall between diverticula is consistent with\nmuscular hypertrophy from chronic diverticular changes. The appendix is not\nvisualized. No ascites or pneumoperitoneum.\n\nPELVIS: The urinary bladder is collapsed around a Foley balloon. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: No suspicious osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diverticulosis without evidence of diverticulitis. No evidence for\ncolitis..\n2. No gastrointestinal obstruction." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 7 mm hypodensity in segment 6, incompletely characterized but\nunchanged from previous and statistically benign. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal gland is normal in size and shape. A 2.7 x 3.4 cm\nsolid lesion is noted arising from the right adrenal gland, nonspecific. It\nis unchanged in size and appearance dating back to ___, an may represent an\nadenoma. Its long-term stability is reassuring.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is focal prominence of a few distal ileal bowel loops,\nwith possible gradual transition identified at the right lower quadrant\n(02:57). No abrupt transition is noted, and there is a large quantity of air\nnoted in the colon. The etiology of this finding is not apparent, although a\nlow grade partial obstruction is not excluded.\n\nExtensive colonic diverticulosis without complication.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Focal prominence of a few distal ileal bowel loops, with possible gradual\ntransition area at the right lower quadrant (02:57). No abrupt transition\npoint is seen, however a very low grade or partial obstruction at this level\nis not excluded.\n2. Stable 2.7 x 3.4 cm right adrenal gland nodule, unchanged since ___. \nAlthough it remains indeterminate, its long-term stability is reassuring.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 5:01 ___, 30 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Mild bibasilar dependent atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A small punctate hypodensity in segment ___ measures up to 11\nx 9 mm, incompletely characterized on this single-phase study, likely a simple\ncyst or biliary hamartoma, unchanged. Otherwise, the liver demonstrates\nhomogeneous attenuation throughout. No focal concerning liver lesions\nidentified. There is no evidence of intrahepatic or extrahepatic biliary\nductal dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 2.7 x 2.4 cm heterogeneous right adrenal lesion is again seen,\nunchanged from ___. The left adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are multiple\nfluid-filled, dilated loops of small bowel measuring up to 3.6 cm, more\ndilated on the left compared to right, with associated mesenteric edema\n(60___:26), consistent with a small bowel obstruction. While a discrete\ntransition point is difficult to identify, a decompressed distal ileum\nindicates a transition point is likely within the distal ileum in the mid\npelvis (2:59). There is no evidence of bowel perforation, ischemia or\ninfarction. No ascites. No free intraperitoneal air. Extensive colonic\ndiverticulosis is demonstrated without diverticulitis. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. No adnexal\nabnormalities are detected.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Anterior abdominal wall subcutaneous stranding may be related\nto prior injections. Otherwise, the abdominal and pelvic wall is\nunremarkable.", "output": "1. Small bowel obstruction with likely transition point in the distal ileum. \nNo evidence of bowel ischemia or perforation.\n2. Stable 2.7 x 2.3 cm right adrenal nodule, unchanged since ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 7\nmm hypodensity within hepatic segment 6 likely represents a cyst or biliary\nhamartoma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Again seen 3.3 cm heterogeneous right adrenal lesion, unchanged\nsince ___. The left adrenal gland is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is an enteric tube with the tip in the gastric body.\nThe stomach is unremarkable. There are multiple loops of prominent small bowel\nloops in the left hemiabdomen measuring up to 3.1cm. There are collapsed,\nopacified loops of small bowel in the right lower pelvis concerning for\npartial small bowel obstruction. No definitive transition point identified. \nThere is no free intraperitoneal air or free fluid in the pelvis. There is\npancolonic diverticulosis without evidence of diverticulitis. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes of the visualized spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Findings compatible with partial small bowel obstruction. No\nintraperitoneal free air.\n2. Pancolonic diverticulosis, without evidence of diverticulitis.\n3. Stable right adrenal lesion measuring up to 2.7 cm.\n\nNOTIFICATION: The findings were communicated to ___ via telephone\nat 4:04 pm on ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodense lesion in the liver is too small to characterize but\nlikely represents a cyst or biliary hematoma. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Stable heterogeneous right adrenal lesion measuring 2.7 x 3.7 cm (2;\n23). The left adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach appears unremarkable. There are multiple mildly\ndilated small bowel loops with possible transition point in the mid abdomen\n(2; 48) with decompressed small bowel loops more distally. Extensive\ndiverticulosis throughout the colon is again noted. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple mildly dilated loops of small bowel in the abdomen with possible\ntransition point in the mid abdomen and more decompressed distal loops of\nbowel. Stool remains within the colon and rectum. While there is no definite\nhigh grade bowel obstruction, findings may represent early or partial small\nbowel obstruction.\n2. Pancolonic diverticulosis similar to prior.\n3. Unchanged right adrenal lesion measuring up to 3.7 cm." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent with clips in the\ngallbladder fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. A small amount of\nfeces in the terminal ileum just proximal to the ileocecal valve suggest\nileocecal valve incontinence (series 9B, image 28). The descending colon is\ncollapsed. The proximal appendix is dilated up to 11 mm (series 9b, image 37)\nwith air seen all the way to the tip which is normal in caliber. There is no\nadjacent fat stranding or fluid collection to suggest acute appendicitis. \nAscending colonic stool burden is moderate. No bowel obstruction or\npneumatosis. The rectum is within normal limits. No free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is mildly enlarged.\n\nLYMPH NODES: A few periportal lymph nodes measure up to 8 mm short axis and\nare nonspecific active. No retroperitoneal or mesenteric lymphadenopathy. No\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Calcified and noncalcified\natherosclerotic plaque throughout the abdominal aorta and iliac arteries are\ndiffuse and moderate to severe. There are small penetrating atherosclerotic\nulcers in the infrarenal abdominal aorta at the level of the origin of the ___\n(series 6, image 71). There are focal short segments of predominantly\nnoncalcified plaque in the right common iliac artery resulting in areas of\nsevere, near-complete occlusion (series 6, image 85, 79, 80).\n\nBONES: A well-circumscribed sclerotic lesion in the left sacrum measures up to\n9 mm, likely a bone island (series 9b, image 51). A tiny well-circumscribed\nsclerotic lesion in the left iliac may be a bone island (series 6, image 90). \nA lucent lesion in the left iliac measures up to 1.5 cm without evidence of\ncortical erosion (series 9B, image 51). Deformity of the of bilateral\nsuperior pubic rami and near fusion of the pubic symphysis indicates sequelae\nof prior trauma (series 9B, image 37). Multilevel degenerative changes in the\nlumbosacral spine are moderate. No spondylolisthesis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence of malignancy in the abdomen or pelvis.\n2. Moderate calcified and noncalcified atherosclerotic disease with focal\nareas of severe, near-complete narrowing of the right common iliac artery.\n3. Nonspecific sclerotic lesions in the left sacrum and iliac, likely bone\nislands.\n4. Mild prostatomegaly.\n This preliminary report was reviewed with Dr. ___\nradiologist." }, { "input": "LUNG BASES: Imaged lung bases are clear. The imaged portion of the heart is\nunremarkable. No pleural or pericardial effusions seen.\n\nABDOMEN: A nodular contour of the liver is re-demonstrated consistent with\ncirrhosis with relative atrophy of the right lobe and hypertrophy of the left\nlobe. Patient is status post cholecystectomy. An umbilical vein is noted. \nThe spleen appears mildly enlarged at 13 cm in maximal length. There is trace\nfluid abutting the liver. The pancreas appears unremarkable. The adrenal\nglands are normal bilaterally. The kidneys appear normal without\nhydronephrosis or stone. No worrisome renal lesion on this unenhanced exam. \nThe abdominal aorta is normal in course and caliber. No significant\natherosclerosis is seen. No adenopathy. No free air. The stomach and\nduodenum appear normal.\n\nPelvis: Small bowel appears fluid distended without evidence of obstruction. \nThe appendix is normal. Fluid levels are seen within the proximal colon. The\ncolon appears thin walled and contains a mild fecal load. No convincing\nevidence for ulcerative colitis flare. No free pelvic fluid. Uterus and\nadnexal regions appear normal. Urinary bladder is well distended appearing\nnormal. No pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion. Degenerative changes in\nthe spine appear most pronounced at L1-2 level.", "output": "1. Fluid distended small bowel loops without evidence of obstruction,\ncorrelate for enteritis.\n2. Cirrhotic liver with mild splenic enlargement.\n3. Status post cholecystectomy.\n4. No evidence of bowel obstruction." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. No retroperitoneal hematoma.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (601:22).\n\nPELVIS: The urinary bladder is decompressed. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A fibroid is noted within the uterus, which is otherwise\nunremarkable. The left adnexa is unremarkable. There is a 4.3 x 4.1 x 6.0 cm\nright adnexal cystic structure measuring intermediate density (2:65, 601:27),\nbetter assessed on same day pelvic ultrasound. A smaller peripherally\nenhancing adjacent cystic structure likely represents a corpus luteal cyst.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute findings in the abdomen or pelvis.\n2. Re-demonstration of a 6 cm right adnexal cystic structure, described as a\nhemorrhagic cyst or endometrioma on same day pelvic ultrasound. Per\nrecommendation from that study, recommend follow-up pelvic ultrasound in ___\nweeks for re-evaluation.\n\nRECOMMENDATION(S): Follow-up pelvic ultrasound in ___ weeks to re-evaluate\nresolution of the right adnexal, likely hemorrhagic cyst/endometrioma." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 3 mm hypoattenuating lesion hepatic segment 2, too small to\ncompletely characterize, statistically most likely to represent a biliary\nhamartoma or cyst. No additional focal liver lesions. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence for intra-abdominal metastatic disease." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of hepatic mass within limitations of a noncontrast\nstudy. There is no intrahepatic biliary ductal dilatation. There is mild\ndilatation of the common bile duct, measuring up to 9 mm, within expected\nlimits post cholecystectomy. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is normal in bulk and homogeneous in attenuation. \nThere is no main ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\na 4 mm obstructing right distal ureteral stone with moderate upstream right\nhydroureteronephrosis, likely migration of the right lower pole renal stone\nseen on prior CTU from ___. Multiple additional punctate\nnonobstructing stones in the right kidney are similar prior. No stones in the\nleft kidney. No left hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are normal\nin caliber. There is sigmoid diverticulosis. The colon and rectum are\notherwise unremarkable. The appendix is unremarkable.\n\nPELVIS: The urinary bladder is decompressed. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent. No adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild loss of height of the T7 and T8 vertebral bodies.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 4 mm obstructing right distal ureteral stone with moderate upstream\nhydroureteronephrosis. Multiple punctate nonobstructing stones in the right\nkidney. No left nephrolithiasis or hydronephrosis." }, { "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by the lack of\nintravenous contrast.\nHEPATOBILIARY: The liver is normal in size and attenuation with no\nintrahepatic biliary dilatation. The gallbladder is nondistended with no\nstones.\nPANCREAS: The pancreas is normal in attenuation with no surrounding stranding.\nSPLEEN: The spleen is normal in size and attenuation.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are normal in size with no hydronephrosis or stones.\nGASTROINTESTINAL: The small bowel is normal in caliber with no surrounding\ninflammation. Diverticulosis of the sigmoid colon is noted, without evidence\nof wall thickening and fat stranding. Appendix contains air, has normal\ncaliber without evidence of fat stranding.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is mild retrolisthesis of L5 on S1 with vacuum disc phenomenon. No\nconcerning osseous lesions are seen.", "output": "1. Sigmoid diverticulosis without diverticulitis.\n2. No renal or ureteral stones.\n3. Mild retrolisthesis of L5 on S1." }, { "input": "LOWER CHEST: There is a trace left pleural effusion. Visualized lung fields\nare within normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. The celiac axis, SMA, ___, renal and iliac arteries and their major\nbranches are patent with no signs of occlusive or aneurysmal disease. The\nportal system including SMV, splenic and portal veins is patent. The renal\nveins, iliac veins and IVC are patent and demonstrate normal caliber.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abdominopelvic findings.\n2. Patent abdominopelvic vasculature.\n3. Trace left pleural effusion." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Mild coronary artery\ncalcification.\n\nABDOMEN:\n\nHEPATOBILIARY: Again demonstrated is abnormal enhancing soft tissue within the\nleft hepatic duct (06:43, 10:46). There has been interval placement of a\ncommon bile duct stent which terminates in the duodenum. An irregular\nsatellite lesion which is hypodense on portal venous imaging is unchanged in\nsize compared to ___ currently measuring 2.7 x 2.1 cm (10:32). An\nadditional satellite lesion straddling segments II/IV is also unchanged in\nsize currently measuring 3.8 x 2.8 cm (10:33). The left hepatic lobe\ncontinues to demonstrate heterogeneous enhancement with stable moderate\nleft-sided intrahepatic biliary ductal dilatation. Several peripheral\narterial enhancing foci in segment 6 and 8 are unchanged compared to prior\nexam and do not demonstrate washout or pseudo capsule formation on portal\nvenous or delayed images. The gallbladder contains gallstones without wall\nthickening or surrounding inflammation. The total liver volume is 1729 cc,\npreviously 1754 cc. The right lobe volume is 1479 cc, previously 1484 cc and\nthe left lobe volume is 258 cc, previously 260 cc.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.7 x 1.8 cm right inferior pole hypodense lesion was characterized as a\nsimple cyst on prior MRCP (10:70). There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nRETROPERITONEUM AND MESENTERY: Multiple borderline periportal, celiac,\naortocaval lymph nodes are again seen (10:44, 46). The largest aortocaval\nlymph node measures up to 9 mm (10:62). There is no pelvic or inguinal\nlymphadenopathy. There is no abdominal aortic aneurysm. Mild atherosclerotic\ndisease is noted. The left portal vein is chronically occluded. The liver\narterial anatomy is conventional.\n\nBONES: Moderate to severe multilevel degenerative changes of the lower\nthoracic and lumbar spine are again seen with stable retrolisthesis of L5 on\nS1. Changes are worst at L1-L 2, L2-L3, and L5-S1\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Grossly stable exam compared to ___. Stable appearance of likely\ntumor involvement in the left hepatic duct and left lobe of the liver. \nInterval placement of a biliary duct stent with persistent moderate left-sided\nintrahepatic biliary ductal dilatation.\n2. Distal left portal vein is chronically occluded.\n3. Total liver volume is 1729 cc. Right lobe volume measures 1479 cc and left\nlobe volume measures 258 cc.\n4. Conventional hepatic arterial anatomy.\n5. Stable appearance of borderline retroperitoneal lymph nodes." }, { "input": "LUNG BASES: Mild bronchial wall thickening is noted in the lower lungs without\nsignificant mucous plugging. Minimal platelike right lower lung atelectasis. \nPort-A-Cath tip resides within the right atrium. The imaged portion of the\nheart is unremarkable.\n\nAbdomen:\nHEPATOBILIARY: A metal stent is noted within the CBD and there is a plastic\nstent traversing this metal stent which extends from the level of the common\nhepatic duct to the level of the duodenum. Despite both stents in place,\nthere is intrahepatic biliary ductal dilation which is moderate in extent. \nThere is malignant obstruction of the biliary tree due to known\ncholangiocarcinoma at the hepatic hilum. Mass best seen on series 5, image 25\nmeasures 2.8 x 3.8 x 3.7 cm. Given persistent intrahepatic biliary ductal\ndilation despite the presence of a metallic and plastic stent, the positioning\nof the plastic stent likely does not fully bypass the level of obstruction. \nUnchanged atrophic appearance of the left hepatic lobe. Gallbladder contains\na gallstone and appears mildly distended. Main portal vein and central\nbranches are patent.\nSPLEEN: 13.7 cm in length.\nADRENALS: Normal.\nPANCREAS: Normal.\nGI: The stomach is decompressed. The duodenum appears normal. Small bowel\nloops demonstrate no signs of ileus or obstruction. There is ascites which is\nmoderate in volume. The appendix is somewhat prominent best seen on series 5,\nimage 53 measuring 13-14 mm in diameter. Mild surrounding inflammation is\nalso noted. Please correlate clinically. The colon is decompressed.\nLYMPH NODES: No change in mildly prominent porta hepatis lymph nodes.\nVascular: The abdominal aorta is mildly calcified though normal in caliber.\n\nPELVIS: Urinary bladder is mostly decompressed. Pelvis free-fluid is moderate\nin volume. No pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion. Multilevel degenerative\nchanges within the imaged portion of the spine.", "output": "1. Persistent intrahepatic biliary ductal dilation despite the presence of a\nmetal and plastic stent. The central portion of the plastic stent at the\nporta hepatis likely does not bypass the site of malignant obstruction. \nRepositioning should be considered.\n2. Increased ascites, now moderate in volume.\n3. Increased size of the appendix, measuring up to 14 mm with mild adjacent\nstranding, correlate for associated symptoms of acute appendicitis.\n\nNOTIFICATION: D/w Dr. ___ at 19:08 on ___" }, { "input": "LOWER THORAX: The lung bases are clear.\n\nHEPATOBILIARY: There is abnormal enhancing soft tissue within the left hepatic\nduct, in keeping (axial series 8, image 89). Intraparenchymal satellite\nlesion is again noted within segment 2, measuring 28 mm (axial series 8, image\n78) with an additional 31 mm lesion straddling segments ___ (axial series 8,\nimage 82). Heterogeneous enhancement is noted extending throughout the left\nhepatic lobe which is atrophic with moderate left-sided intrahepatic biliary\nductal dilatation. The left portal vein is attenuate at the level of the\nhilum with distal occlusion intraparenchymally. Hepatic arterial anatomy is\nconventional.\n\nThere are several peripheral arterially hyperenhancing foci within segments 6\nand 8 without washout or pseudo capsule which are inconspicuous on the portal\nvenous and delayed phases, likely perfusional, unchanged from the prior MRI. \nLiver volume of 1754 cc. Uncomplicated cholelithiasis.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: 19 mm cyst within the lower pole of the right kidney. No\nhydronephrosis. The kidneys are otherwise unremarkable.\n\nGASTROINTESTINAL: No bowel obstruction or ascites.\n\nLYMPH NODES: There are multiple borderline periportal, celiac, and aortocaval\nlymph nodes, the largest aortocaval measuring 10 mm. No pelvic or inguinal\nadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. arterial anatomy is conventional.\n\nBONES: Degenerative changes of the lower lumbar spine with mild retrolisthesis\nof L5 on S1. Degenerative changes are worst at L1-L2, L2-L3, and L5-S1, with\nposterior osteophytes resulting in moderate narrowing of the bony spinal\ncanal.", "output": "1. Redemonstration of likely tumor involvement in the left hepatic duct and\nleft lobe of the liver in with left lobe atrophy, moderate left-sided\nintrahepatic biliary ductal dilatation, and marked attenuation of the left\nportal vein, which is occluded distally. Findings remain highly concerning\nfor cholangiocarcinoma.\n2. Conventional hepatic arterial anatomy.\n3. Borderline retroperitoneal lymph nodes." }, { "input": "LOWER CHEST: There are calcified pleural plaques at the lung bases. There is\nsevere centrilobular emphysema. There is no pleural or pericardial effusion. \nThere is left basilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains multiple stones\nwhich are fatty in density.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nSmall bowel is normal in caliber without focal wall thickening. The large\nbowel is also normal in caliber without focal wall thickening. A metallic\nforeign body is seen within the cecum, consistent with the capsule. There is\ndiverticulosis of the sigmoid colon without evidence of diverticulitis. The\nappendix is not visualized but there are no secondary signs of appendicitis in\nthe right lower quadrant. There is no intra-abdominal free air or free fluid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains coarse calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. An IVC filter is in place.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process. Specifically, no evidence of\ndiverticulitis.\n2. Capsule in the cecum, no evidence of bowel obstruction.\n3. Cholelithiasis.\n4. Calcified pleural plaques, consistent with prior asbestos exposure.\n5. Severe emphysema." }, { "input": "LOWER CHEST: There is mild basal dependent atelectasis. No worrisome nodule,\nmass, or consolidation in the imaged lower lungs. The imaged portion of the\nheart is within normal limits of size with trace pericardial effusion noted.\n\nABDOMEN: The liver enhances normally without focal concerning lesion. There\nis mild intrahepatic biliary ductal dilation which is similar in overall\nappearance to prior CT exam. The main portal vein is patent. The gallbladder\nis surgically absent. The spleen is within normal limits of size. Adrenal\nglands appear normal bilaterally. The pancreas appears normal.\n\nThere is persistent bilateral hydronephrosis and hydroureter,\nright greater than left, with increased urothelial thickening noted on the\nright. There is no evidence of nephritis though there is thinning of the\nright renal cortex. No perinephric abnormality is seen. No ureteral stone. \nBoth ureters are dilated and thickened through the level of the urinary\nbladder.\n\nThe abdominal aorta is normal in course and caliber with minimal\natherosclerotic calcification. The stomach is decompressed. The duodenum\nappears normal. There is no free air in the abdomen. No significant free\nfluid.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. A\ncandidate for the appendix is suggested on series 2, image 45 and 48 which is\ngas-filled and appears normal. The colon contains a mild fecal load. The\nurinary bladder is thickened with hyper enhancing walls in this patient with\nreported colovesical fistula. No air is seen within the urinary bladder or\nbilateral renal collecting systems. The uterus is poorly visualized. There\nis pelvic floor descent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Thickened hyperemic urinary bladder which may reflect infection in the setting\nof reported colovesical fistula. Thickened hyperemic bilateral urinary tract,\nright greater than left with hydronephrosis progressive on the right. \nPercutaneous nephrostomy drains can be considered." }, { "input": "LOWER CHEST: Mild dependent bibasilar atelectasis. No pericardial or pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild intrahepatic biliary ductal\ndilatation is similar compared to prior studies. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is persistent bilateral hydroureteronephrosis, marked on the\nright and mild on the left, with an interval increase in the degree of\nurothelial thickening on the right and enhancement. There are new\nwedge-shaped cortical areas of hypoenhancement in the right kidney concerning\nfor pyelonephritis. No stones are seen. Both ureters are dilated and\nthickened through the level of the urinary bladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. Enteric contrast reaches the\nmid small bowel loops. There is mucosal hyper enhancement of loops of distal\nsmall bowel as well as the ascending colon. The remainder of the colon\ndemonstrates a massive stool burden with an 8.4 x 8.0 cm stool ball in the\nrectum with stercoral colitis.\n\nPELVIS: There is a small focus of nondependent gas in the bladder as well as\ncircumferential bladder wall thickening. There may be some trace free fluid\nin the pelvis versus mesenteric stranding.\n\nREPRODUCTIVE ORGANS: The uterus and vagina are now fluid-filled which was not\nseen on prior studies and is concerning for fistulization.\n\nLYMPH NODES: There are some prominent mesenteric and retroperitoneal lymph\nnodes which are likely reactive. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Findings are compatible with enterocolitis of the distal small bowel and\nascending colon. There is no free air.\n2. Persistent marked right and mild left hydroureteronephrosis with interval\nincrease in the degree of urothelial thickening and enhancement on the right\nwith new wedge-shaped cortical areas of hypoenhancement in the right kidney,\ncompatible with pyelonephritis. No stones are seen.\n3. Small focus of nondependent gas within the bladder and circumferential\nbladder wall thickening is compatible with the patient's history of\ncolovesicular fistula. The uterus and vagina are now fluid-filled which was\nnot seen on prior studies and is concerning for fistulization.\n4. Massive stool burden in the remainder of the colon including an 8.4 x 8.0\ncm stool ball in the rectum with stercoral colitis.\n5. Prominent mesenteric and retroperitoneal lymph nodes are not enlarged by CT\nsize criteria and are likely reactive." }, { "input": "LOWER CHEST: Dependent consolidation of the left lung base likely represents\natelectasis. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is chronic appearing right-sided hydronephrosis with associated\ncortical thinning though the degree of hydronephrosis is improved since the\nprior. Hydroureter and ureteral hyperenhancement and surrounding stranding\nextends to the level of the bladder, an appearance also seen on multiple\npriors. There is an 6 mm stone seen in the distal right ureter (02:56), not\nseen on prior exam. Previously seen mild left hydronephrosis has resolved. \nThere is no evidence of focal renal lesions or left hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness. There is mild mucosal hyperenhancement of\nthe colon and small bowel loops in the pelvis. Colon is predominantly\nfluid-filled. Appendix is not definitively visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The vagina is fluid-filled as on prior exam. Small\namount of fluid appears to extend into the endometrial canal (602:33).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild compression deformity of the L4 vertebral body appears new compared to\nprior though without CT evidence of acuity such as discrete fracture line or\nprevertebral stranding.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.Cachexia\nand mild diffuse subcutaneous edema is noted.", "output": "1. Fluid-filled colon and hyperenhancement of small and large bowel loops\nsuggestive of enterocolitis.\n2. Interval improvement of severe, chronic appearing right-sided\nhydronephrosis and hydroureter with a new 6 mm stone seen in the distal right\nureter. Interval resolution of left-sided hydronephrosis. Chronic wall\nthickening and hyper enhancement of the right renal collecting system and\nureter, to be correlated clinically with urinalysis as infection is not\nexcluded\n3. Fluid-filled vagina and uterus as seen on prior exam concerning for\npossible fistula given patient's history of previous colovesicular fistula.\n4. Mild compression deformity of the L4 vertebral body which is new since\nprior though without CT evidence to suggest acuity, to be correlated\nclinically." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post lap band removal. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Patient is status post supraumbilical hernia repair, with mesh\nin place. There is soft tissue stranding in the anterior abdominal wall\nsuperficial to the hernia repair site, without a focal fluid collection\n(602b:42).", "output": "1. Post surgical soft tissue stranding in the anterior abdominal wall at prior\nhernia repair site, with no focal fluid collection.\n2. No abnormality in the abdomen or pelvis to explain patient's pain.\n\nNOTIFICATION: During this exam, patient was evaluated for swelling at a prior\nantecubital IV site, separate from the IV site used for intravenous contrast\ninjection. The ED physician was notified and the patient has received\ninstructions verbally." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 9 mm right adrenal nodule, which is incompletely\ncharacterized. The left adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. The urinary bladder and distal ureters are\nunremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nOTHER: There is no free fluid or air in the abdomen or pelvis.\n\nREPRODUCTIVE ORGANS: There is a 12 mm subserosal fibroid arising from the\nright fundus. The uterus and bilateral adnexae are otherwise within normal\nlimits.\n\nLYMPH NODES: There is no lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There are minimal degenerative changes in upper lumbar spine. A 6 mm\nsclerotic lesion in the left ischial tuberosity is most likely represents a\nbone island.\n\nSOFT TISSUES: There is mild fat stranding in the subcutaneous fat of the\nanterior abdominal wall, which may be related to subcutaneous injections.", "output": "1. No evidence of primary malignancy in the abdomen or pelvis.\n2. A 9 mm adrenal nodule is indeterminate. Further evaluation is recommended\nwith MRI abdomen with contrast." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\nThere is uniform liver parenchymal attenuation without evidence of hepatic\nmass. There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent. Spleen is enlarged measuring 15.0 cm.\n\nThere are postsurgical changes consistent with Whipple procedure. The residual\npancreas is unremarkable without evidence of pancreatic mass or pancreatic\nductal dilatation.\n\nAdrenal glands are within normal limits. There is symmetric renal enhancement\nand excretion of intravenous contrast. There is no renal cyst, calculus, or\nmass. There is no evidence of hydronephrosis or hydroureter. Urinary bladder\nis mildly distended without gross abnormality.\n\nThere are no dilated or distended loops of bowel. There is no bowel wall\nthickening. There is no intraperitoneal free air or free fluid. Suture\nmaterial in a right lower quadrant likely relates to history of appendectomy.\nThere are no enlarged inguinal, iliac chain, mesenteric, or retroperitoneal\nlymph nodes. The abdominal aorta has a normal course and caliber with mild\ndistal atherosclerotic calcification. There is no suspicious osseous lesion.\nThere is unchanged lipoma in the left posterior chest wall musculature.", "output": "1. No evidence of recurrence within the abdomen or pelvis.\n2. Postsurgical changes consistent with Whipple procedure.\n3. Mild splenomegaly.\n4. Please see separate dictation for dedicated CT chest report." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Moderate cardiac enlargement is\nnoted as well as a prosthetic mitral valve.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous subcentimeter hypodensities throughout the liver are\ntoo small to characterize, but likely represent simple cysts or biliary\nhamartomas. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There are no adnexal\nabnormalitys seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild degenerative changes of the thoracic and lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process." }, { "input": "LOWER CHEST: Small bilateral pleural effusions with overlying compressive\natelectasis are new compared to ___. Small pericardial effusion is\nunchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: New scattered areas of rounded hepatic parenchymal hyper\nenhancement, are predominantly seen in the periphery of the liver and likely\nreflect sequela of microabscesses related to cholangitis. No discrete or\ndrainable fluid collections. Again demonstrated is a subcentimeter\nhypoattenuating lesion in the right lobe of the liver which is too small to\nfully characterize (05:28). Stable cholelithiasis. Interval placement of an\nintra biliary stent terminating in the duodenum is associated with mild\npredominantly left hepatic pneumobilia.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is top-normal in size measuring up to 12.8 cm, stable\ncompared to prior and otherwise unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: Bilateral renal cortical hypodensities are unchanged compared to the\nprior and are too small fully characterize but statistically represent simple\nrenal cysts. Left-sided parapelvic cyst is unchanged.\n\nGASTROINTESTINAL: No evidence of bowel obstruction. No evidence of free\nintraperitoneal air or ascites.\n\nLYMPH NODES: No enlarged lymph nodes in the abdomen.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES AND SOFT TISSUES: No evidence of aggressive osseous lesions.", "output": "1. New regions of hyper enhancement in the periphery of the liver are\nworrisome for microabscesses related to cholangitis. No discrete or drainable\nhepatic fluid collection.\n2. Expected pneumobilia status post CBD stent placement.\n3. New small bilateral pleural effusions.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:12 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The known gastric adenocarcinoma is not well evaluated on\nthis study. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Known gastric malignancy is not well evaluated. No evidence of metastatic\ndisease." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. The portal veins are patent. No evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of concerning renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: The known primary gastric malignancy is not well assessed by\nCT. Small bowel loops are unremarkable. No bowel obstruction. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged. The seminal vesicles are\nsymmetric.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease.\n\nBONES/SOFT TISSUES: There is no aggressive osseous lesion or acute fracture.\nSmall, fat containing umbilical hernia.", "output": "Examination somewhat limited by poor contrast bolus timing. The known primary\ngastric malignancy is not well assessed by CT. No evidence of regional\nlymphadenopathy or abdominopelvic metastases." }, { "input": "LOWER THORAX: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation. The\ngallbladder is contracted.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis. Unremarkable\nbladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient's known gastric\nadenocarcinoma is not visualized. The small and large bowel are normal in\ncaliber. Normal appendix.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric adenopathy. No pelvic or\ninguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Unremarkable.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic calcification.\n\nBONES: No suspicious osseous lesion.\n\nSOFT TISSUES: Unremarkable.", "output": "1. Primary gastric adenocarcinoma is not visualized on the current\nexamination.\n2. No evidence of abdominopelvic metastases.\n3. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is cholelithiasis. Luminal hyperdensity within the\ngallbladder may be due to vicarious excretion of contrast or sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Multiple calcified granulomas are compatible with\nprior granulomatous exposure.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is no nephrolithiasis or hydronephrosis. Mild persistent\nnephrograms suggests renal failure.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Other than diverticulosis, the\ncolon and rectum are unremarkable.\n\nPERITONEUM: No pneumoperitoneum. No retroperitoneal hematoma.\n\nPELVIS: There is contrast within the bladder from prior administration.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a left inguinal hematoma measuring 4.3 x 4.3 cm, just\ndeep to the recent femoral access site, with trace amount of fluid tracking\nsuperiorly along the left pelvic sidewall (2:109). This results in mass\neffect on the proximal left common femoral artery (2:116, 117). Locules of\nair within the common femoral artery is in keeping with recent endarterectomy.\nMild body wall edema is most pronounced along the left groin and proximal\nthigh.", "output": "1. 4.3 cm left inguinal hematoma near the recent femoral access site, with\ntrace fluid tracking along the left pelvic sidewall, resulting in mass effect\non the proximal left common femoral artery. This noncontrast examination does\nnot allow assessment for active extravasation. US could be considered if\nthere is any clincial suspicion for an underlying pseudoaneurysm.\n2. No retroperitoneal hematoma.\n3. Mild persistent nephrograms suggest renal failure.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 7:20 am, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Incidental note is made of a 2.5 cm lipoma in the gastric\nantrum. Otherwise, the stomach is unremarkable. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted in the internal iliac arteries.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abdominopelvic process. No evidence of perforation or\npneumoperitoneum.\n2. Sigmoid diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in both lower lobes. There\nare two nodules in the right lower lobe measuring 0.4 and 0.5 cm, respectively\n(11:3 and 2) which are unchanged dating back to CT chest ___. \nThere is moderate calcification of the aortic valve and coronary arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains small gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo renal or ureteral stones are detected. A 2 mm hypodensity in the lower\npole the right kidney (07:53) is too small to characterize. There are no\nconcerning renal lesions. There is no hydronephrosis or perinephric\nabnormality. There is no evidence of urothelial lesions.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is sigmoid\ndiverticulosis without evidence of diverticulitis. The appendix is not\nvisualized\n\nPELVIS: The urinary bladder is unremarkable. The median lobe of enlarged\nprostate protrudes into the base of the bladder. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are severe degenerative changes of the lower lumbar spine. There is\nosseous fusion of the L4 and L5 vertebral bodies.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No nephrolithiasis, concerning renal lesions, or evidence of urothelial\nlesions.\n2. Enlarged prostate with median lobe of the prostate protruding into the\nbladder.\n3. Two pulmonary nodules in the right lower lobe are stable dating back to CT\nchest from ___." }, { "input": "LOWER CHEST: Bilateral tiny pleural effusions are present. Compressive\natelectasis in the lower lungs also present. Contrast is seen within the\ndistal esophagus with note of a small hiatal hernia.\n\nABDOMEN: There is a massive volume of abdominal ascites. The liver, spleen,\npancreas, adrenals are grossly unremarkable on this noncontrast exam. There\nis a left renal cyst measuring approximately 3.7 x 3.4 cm. No hydronephrosis\nseen. The abdominal aorta is minimally calcified and normal in course and\ncaliber. The stomach appears normal as does the duodenum.\n\nPELVIS: There is a large predominantly cystic pelvic mass measuring 2.2 x 2.5\nx 2.3 cm. There are nodular and cystic components along the periphery of this\nlesion which is highly concerning for a primary ovarian malignancy. There is\nalso a cystic right adnexal lesion which appears separate from the dominant\naforementioned lesion on series 4, image 179 measuring 6.6 x 5.6 cm,\nindeterminate. Small large bowel appear unremarkable. The appendix is\nvisualized in the right lower quadrant and is contrast filled. Uterus appears\natrophic a contains a dystrophic calcification possibly reflecting a\ndegenerated fibroid.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse body wall edema is present.", "output": "Large pelvic mass with cystic and solid components concerning for primary\novarian malignancy with massive volume of abdominal ascites. \nContrast-enhanced abdominopelvic CT is recommended to further assess." }, { "input": "LOWER CHEST: The partially imaged lower lungs are clear other than minimal\nbasilar atelectasis. No evidence of a pericardial or pleural effusion. \nCalcified mediastinal lymph node is consistent with prior granulomatous\ndisease exposure (series 2, image 2).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver has a slightly nodular contour compatible with\nprovided history of cirrhosis. The lateral segment of the left hepatic lobe\nremains shrunken, compatible with known chronic left portal vein thrombus. No\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen remains mildly enlarged measuring up to 13.6 cm. Coarse\ncalcifications/granulomas in the spleen indicate sequelae of prior\ngranulomatous disease exposure.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: A hiatal hernia is small. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The transverse\ncolon and loops of small bowel are part of a large ventral midline hernia. \nIngested enteric contrast reaches the distal small bowel. No evidence of\nbowel obstruction.\n\nSigmoid diverticulosis is extensive. Chronic inflammatory changes adjacent to\nthe sigmoid colon with contained perforation is overall similar in\nconfiguration. The area of contained perforation has a thin track with air\nand moderate inflammatory change extending to the anterior rectal fascia along\nthe left aspect of the large ventral hernia, unchanged (e.g., series 2, image\n59-70). The tract does not extend to the skin surface. No soft tissue gas. \nNo drainable intra-abdominal fluid collections.\n\nPELVIS: The urinary bladder is moderately distended. The distal ureters are\nunremarkable. There is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus has an intrauterine device which appears\nappropriately positioned. The right ovary is normal. An 8.5 x 5.7-cm left\nadnexal cystic structure is similar in size and configuration to multiple\nprior exams (series 2, image 55).\n\nLYMPH NODES: No mesenteric lymphadenopathy. A left periaortic lymph node\nmeasures 10 mm in short axis, slightly prominent but unchanged (series 2,\nimage 35). No pelvic lymphadenopathy. A left inguinal lymph node is\nenlarged, measuring 12 mm in short axis (series 2, image 79), increased in\nsize since the prior exam, likely reactive. Right inguinal lymph nodes are\nprominent but not enlarged by size criteria.\n\nVASCULAR: No abdominal aortic aneurysm. No calcified atherosclerotic disease\nis noted. There is an accessory and/or replaced left hepatic artery (series\n2, image 17). The main portal vein is patent. The SMV and splenic veins are\npatent. Bilateral renal arteries and veins are patent.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A ventral hernia containing the transverse colon as well as\nloops of small bowel is large. There is asymmetric enlargement and hyperemia\nof the inferior aspect of the left rectus muscle (measuring up to 3.6 x 3.3\ncm) with thickening of the rectus fascia at the area of prior drain placement\n(series 2, image 68). These findings given the provided clinical history are\nconcerning for infection/phlegmon. However, no drainable fluid\ncollection/abscess is identified. No soft tissue gas. No definite connection\nof bowel to this area of the abdominal wall.", "output": "1. No drainable fluid collection.\n\n2. Asymmetric enlargement and hyperemia of the inferior aspect of the left\nrectus muscle at the site of prior drain placement along with left inguinal\nlymphadenopathy are concerning for phlegmon and/or infection given the\nprovided history. No definite defect or fistula is identified in the\nabdominal wall at this site. No soft tissue gas.\n\n3. Severe sigmoid diverticulosis with chronic sequelae of prior complicated\ndiverticulitis including persistent inflammatory changes and contained\nperforation with track extending to the anterior abdominal wall rectus fascia\non the left lower aspect of the large ventral hernia, overall unchanged.\n\n4. Unchanged large left adnexal cystic structure.\n\n5. Cirrhotic-appearing liver compatible with history of autoimmune hepatic.\n\nNOTIFICATION: The findings and impression were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at\n1:38 pm, 15 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate mild subsegmental atelectasis\nat the bases. Large calcified nodes in the left hilum and tiny calcified\nnodes in the right hilum. A there is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation with nodular\ncontours consistent with the given history of cirrhosis. Stable atrophic\nchanges involving the left lobe. There are no discrete focal lesions within\nthe limitations of an unenhanced scan. There is evidence of pneumobilia. Air\nis also within the CBD and the gallbladder lumen. No evidence of intrahepatic\nor extrahepatic biliary dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nductal dilatation.\n\nSPLEEN: The spleen is normal in size measuring 11.3 cm in the craniocaudal\ndimension.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Stable small hiatus hernia, the stomach is otherwise\nunremarkable. Status post sigmoidectomy with colorectal anastomosis and\ndiverting ileostomy in the right lower quadrant with ventral hernia repair. \nMultiple air locules and fat stranding seen involving the anterior abdominal\nwall. A surgical drain is seen terminating in lower abdominal wall (series 3,\nimage 91). Rectal contrast is seen opacifying the entire colon, the\nanastomosis at the sigmoid appears patent. No extraluminal oral contrast\nseen. Multiple locules of gas and free fluid are seen within the abdomen and\npelvis extending into the retroperitoneum. No discrete walled-off collection\nis identified in the abdomen or pelvis. Few scattered metallic clips are\nagain seen in the peritoneal cavity.\n\nPELVIS: The urinary bladder shows a small amount of intraluminal air, likely\nrelated to recent instrumentation. A radiopaque intrauterine device is seen\nin situ. The reproductive organs are otherwise within normal limits of an\nunenhanced study. The previously seen cystic mass in the left adnexa is no\nlonger visualized.\n\nLYMPH NODES: Stable 9 mm left para-aortic lymph node (series 3, image 44. Few\nprominent mesenteric and inguinal nodes are again seen, likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: S/p sigmoid resection, diverting ileostomy and hernia repair\nwith expected postoperative changes in the subcutaneous tissues.", "output": "1. Status post sigmoidectomy with colorectal anastomosis, diverting right\nlower quadrant ileostomy and hernia repair. Multiple locules of air in the\nperitoneal cavity and free fluid are within limits of postoperative day 2\nappearance. No evidence of anastomotic leak identified.\n2. Interval appearance of pneumobilia. Surgical drain tip seen lying within\nthe soft tissues of the lower abdominal wall, clinical correlation\nrecommended.\n3. The previously seen large cystic left adnexal structure is no longer\nvisualized.\n\nNOTIFICATION: The discrepant findings were discussed with Dr ___ MD and\nthe nurse practitioner by Dr. ___, M.D. on the telephone on\n___ at 11:00 am, 10 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Trace right pleural effusion. Re-demonstrated left greater than\nright hilar calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular configuration of the liver consistent with known\ncirrhosis. Small amount of pneumobilia is again seen, decreased. Chronic\nocclusion of the left portal vein is again noted. Trace perihepatic ascites.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: A few calcified granulomas again seen. Spleen is otherwise\nunremarkable\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable. There is no hydronephrosis.\n\nGASTROINTESTINAL: There is a small amount of pneumoperitoneum. Post diverting\nright lower quadrant ileostomy and sigmoid sutures from sigmoid resection are\npresent. There is a leak from the sigmoid anastomosis suggestive of\ndehiscence. The site of leakage is seen on the coronal images on series 6,\nimages 39 through 27 ending in a 6.5 cm pocket of oral contrast in the pelvis.\nThere are mildly dilated loops of small bowel with a transition point at the\nileostomy site. The oral contrast has not reached the distal ileal loops.\n\nPELVIS: IUD noted. There are multiple pockets of fluid and gas in the deep\npelvis from the sigmoid leak and the fluid with diluted oral contrast tracks\nalong the anterior pelvic wall into the subcutaneous soft tissues on series 4\nimages 81 through 83. Multiple pockets of loculated fluid are also seen\ntracking along the left paracolic gutter, right adnexal up to the pelvic\ninlet. A surgical drain is seen in the subcutaneous soft tissues of the\nabdominal wall.\n\nPERITONEUM/RETROPERITONEUM: Small amount of ascites adjacent to the liver. \nAdditional findings of the peritoneum and retroperitoneum are described in the\ngastrointestinal section.\n\nLYMPH NODES: Prominent peripancreatic, periportal and 1.2 cm left periaortic\nlymph node are stable. No enlarged pelvic lymph nodes.\n\nBONES: No suspicious osseous lesions.\n\nSOFT TISSUES: Ventral hernia repair changes are seen. Please note that there\nis discontinuity in the anterior pelvic wall on series 4, image 81.", "output": "1. Large extraluminal contrast within the pelvis with loculated gas in the\npelvis and a 6.5 cm pocket of contained contrast, compatible with the leak\nfrom the sigmoid anastomosis. There are additional fluid collections with\ncontrast in the pelvis and along the left pericolic gutter, also tracking into\nthe anterior pelvic wall.\n2. Small-bowel obstruction up to the diverting right lower quadrant ileostomy.\n3. Surgical drain in the subcutaneous anterior abdominal wall from hernia\nrepair.\n4. Additional findings as above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:00 am, during\nthe discovery of the findings. The updated findings were also discussed with\nDr. ___ at 930 am by Dr. ___ planning for percutaneous\ndrainage placement." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Multiple\nscattered granulomas are unchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the lower pole right kidney is too small to\ncharacterize, but statistically likely to be a simple cyst. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There has been significant interval improvement in\npneumoperitoneum, with only trace amounts remaining in the pelvis. The\npatient is status post sigmoid resection with a diverting right lower quadrant\nileostomy. There has been significant interval decrease in size in the pocket\nof oral contrast in the pelvis, measuring approximately 1.3 x 1.0 cm,\npreviously 5.3 x 4.3 cm. The abdominal drain is appropriately placed and is\nextraluminal, terminating within the pelvis adjacent to the small residual\npool of contrast. The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There are\nmultiple pockets of fluid in the deep pelvis, similar in appearance to prior.\n\nREPRODUCTIVE ORGANS: An IUD is again noted in the uterus. There is a 1.3 x\n1.4 cm partially collapsed cystic lesion in the right adnexa, likely a corpus\nluteum cyst.\n\nLYMPH NODES: There are multiple prominent nodes within the pelvis, likely\nreactive. There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Re-demonstrated is a parastomal, fat containing abdominal hernia\nwith a fascial defect measuring approximately 2.1 cm.", "output": "1. Continued interval improvement in pelvic free fluid and pneumoperitoneum. \nThe residual pocket of oral contrast has significantly decreased in size\ncompared to ___ and the abdominal drain is in appropriate\nposition with tip terminating adjacent to the area of residual oral contrast\nwithin the pelvis.\n2. Partially collapsed right adnexal cystic lesion is likely a corpus luteum\ncyst.\n3. Fat containing parastomal abdominal wall hernia, unchanged." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Partially imaged calcified left\nhilar adenopathy is again noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. The\nleft hepatic lobe is atrophic. There is no evidence of focal lesions. There\nis no clear, patent left portal vein, unchanged and consistent with chronic\nportal vein thrombosis. The hepatic veins and portal veins are otherwise\npatent. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Multiple splenic calcifications are again noted. The spleen is normal\nin size with no focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypoattenuating lesions are too small to completely characterize,\nstatistically likely simple cysts. No suspicious lesion. No hydronephrosis\nor perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status-post sigmoidectomy and diverting ileostomy\nin the right lower quadrant. A percutaneous drainage catheter remains coiled\nin the left hemipelvis. A small fluid collection not in continuity with the\ndrainage catheter measures 2.2 x 1.7 cm, previously 2.3 x 1.5 cm, unchanged. \nA small amount of fluid previously containing enteric contrast which continues\nto communicate with the catheter on the prior examination has nearly resolved.\nWith the administration of rectal contrast, there is no evidence ___\ncolonic anastomotic leak. No pneumoperitoneum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted. An intrauterine device is\nnoted.\n\nLYMPH NODES: A 1 cm left periaortic lymph node is unchanged (series 8, image\n35). Otherwise, no evidence of retroperitoneal or mesenteric lymphadenopathy.\nInguinal lymph nodes are prominent, likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A subcutaneous anterior abdominal/pelvic wall drain has\nintervally been removed. In the drain's prior location in the anterior\nabdominal wall, there is a new 7.7 x 1.4 x 9.2 cm rim enhancing fluid\ncollection (series 8, image 48; series 11, image 36). In the drains prior\nlocation in the anterior pelvic wall, there is a new 6.2 x 1.2 x 8.3 cm rim\nenhancing fluid collection (series 8, image 75; series 11, image 35).", "output": "1. Interval removal of a subcutaneous drainage catheter in the anterior\nabdominopelvic wall. There is a new 7.7 x 1.4 x 9.2 cm rim enhancing fluid\ncollection in the anterior abdominal wall. There is a new 6.2 x 1.2 x 8.3 cm\nrim enhancing fluid collection in the anterior pelvic wall.\n2. A 2.2 x 1.7 cm rim enhancing fluid collection in the anterior pelvis is\nessentially unchanged.\n3. Near complete resolution of a pelvic fluid collection previously containing\nextravasated enteric contrast material.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:15 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nHEPATOBILIARY: Hepatic enhancement is homogeneous with no suspicious mass\nlesions. Portal vein and hepatic veins are patent. Left hepatic lobe\ncontinues to be atrophic with mild caudate lobe hypertrophy. Gallbladder is\nunremarkable. There is no biliary ductal dilatation.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious mass lesions.\n\nSPLEEN: Splenic calcifications are likely reflective of chronic granulomatous\ndisease. There is no splenomegaly.\n\nADRENALS: Adrenal glands are unremarkable\n\nURINARY:There is no hydronephrosis. There is a right upper pole subcentimeter\nrenal cortical hypodensity, too small to characterize and appears to be\nstable.\n\nGASTROINTESTINAL: Stomach is unremarkable. There is no small bowel\nobstruction. There is a right lower quadrant ileostomy. Status post sigmoid\ncolonic resection and anastomosis. Contrast fills the anastomosis area with\nno evidence of leak. Contrast reaches the ileostomy. Large bowel is normal\nin caliber with no wall thickening.\n\nPERITONEUM: There has been interval removal of the left pelvic drain. There\nis trace of free fluid along the left pelvic sidewall. The previously\nidentified 2 rim enhancing collections in the left lower abdomen anteriorly\nare again noted. The anterior of the two collections is unchanged measuring up\nto 2 cm. The posterior collection is where the tip of the pigtail catheter\nused to be, is near completely resolved.\n\nLYMPH NODES: There are prominent mesenteric lymph nodes. Prominent inguinal\nand lymph nodes are unchanged.\n\nVASCULAR: Abdominal aorta is normal caliber with patent intra-abdominal\nbranches.\n\nPELVIS: There is a left ovarian cyst measuring 5 cm, likely functional. IUD\nis present and appears in good position. Right ovary is unremarkable. \nUrinary bladder is unremarkable.\n\nBONES:There is no acute osseous abnormality or suspicious osseous lesions.\n\nSOFT TISSUES: Interval decrease size subcutaneous soft tissue rim enhancing\ncollection, currently measures 2.8 x 0.9 cm compared to 6.2 x 1.2 cm. There\nis a focal area of fat that appears to be protruding from the subcutaneous\ntissues into the peritoneal cavity between the 2 rectus abdominus muscles in\nthe lower abdomen. This is unchanged.", "output": "1. Post drainage catheter removal with trace of free fluid along the left\npelvic sidewall. Stable or improved residual rim enhancing collections within\nthe anterior left pelvis.\n2. Colorectal anastomosis is intact with no evidence of leak.\n3. Improved subcutaneous soft tissue fluid collection.\n4. Left ovarian cyst measuring 5 cm likely physiologic. Consider short-term\nfollow-up in 6 weeks by ultrasound to ensure resolution." }, { "input": "LOWER CHEST: There is atelectasis at the lung bases.\n\nABDOMEN:\n\nThe liver enhances homogeneously. The gallbladder is normal without\nradiopaque stones. The portal vein is patent. The spleen, adrenal glands,\nand pancreas are unremarkable.\n\nThe distal esophagus is normal without a hiatal hernia. The small and large\nbowel are normal in caliber without focal wall thickening. The appendix is\nwell-visualized and normal. There is diverticulosis of the sigmoid colon\nwithout evidence of diverticulitis.\n\nA 17 mm hypodensity in the lower pole of the left kidney is most consistent\nwith a simple cyst although is incompletely characterized due to streak\nartifact in this location. There is no left-sided hydronephrosis. There are\nno left-sided renal stones. There is severe hydronephrosis of the right\nkidney which still enhances. There is delayed excretion of contrast with\nrelatively diluted contrast only seen within the renal pelvis. There are\nmultiple right renal stones including the largest in the right lower pole that\nmeasures 22 x 11 mm Hounsfield units 671. There are no ureteral stones seen. \nThere is mild dilation of the right ureter with surrounding stranding,\nurothelial thickening, and hyperenhancement of the ureteral wall. In\naddition, stranding is seen surrounding the right kidney.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThere is no abdominal aortic aneurysm. The celiac axis, SMA, and ___ are\npatent.\n\nPELVIS: The bladder is well distended. A stone in the region of the left UVJ\nis likely within the bladder as the left distal ureter is normal in\nappearance. There is no pelvic free fluid. There are no pelvic sidewall or\ninguinal adenopathy. Reproductive organs grossly unremarkable.\n\nBONES AND SOFT TISSUES: There is severe deformity and scoliosis of the lumbar\nspine. Partially image spinal fusion hardware is present. There is no acute\nfracture. There is no soft tissue abnormality.", "output": "1. Severe right hydronephrosis with delayed excretion of contrast from the\nright kidney, mild urothelial thickening enhancement, stranding and dilation. \nNo obstructing stones seen, differentials include a recently passed stone\nversus infection.\n2. Multiple right renal stones measuring up to 22 mm in the lower pole.\n3. Stone in the region of the left UVJ, most likely within the bladder as\nthere is no evidence of left renal obstruction. This could be a recently\npassed right ureteral calculus." }, { "input": "Heart is mildly enlarged without significant pericardial fluid. There is mild\nbibasilar atelectasis.\n\nCT abdomen without contrast: Liver, gallbladder, spleen, pancreas and adrenal\nglands are grossly unremarkable in the context of a noncontrast examination.\n\nThere is a large 1.8 cm nonobstructing stone in a right extrarenal pelvis,\npreviously seen by ultrasound. There are additional multiple scattered\nnonobstructing renal calculi throughout the right kidney measuring up to 6 mm\nin the right lower pole kidney. There are no left renal calculi. There is no\nhydronephrosis.\n\nStomach is grossly unremarkable. Duodenum and small bowel loops are normal\ncaliber without evidence of obstruction. There is trace sigmoid and\ndescending colon diverticulosis without evidence of diverticulitis. Large\nbowel is otherwise thin-walled and unremarkable without pericolonic fat\nstranding or fluid collection. A normal appendix is noted in the mid pelvis.\n\nAbdominal aorta is normal caliber. There is no mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria. There is no ascites or pneumoperitoneum.\nThere is a small fat containing umbilical hernia.\n\nCT pelvis without contrast: Bladder, uterus, adnexa and rectum are\nunremarkable. There is no free pelvic fluid or air. There is no inguinal or\npelvic sidewall lymphadenopathy by CT size criteria. Bilateral ___ rod\nspinal fixation hardware is partially imaged. There is severe lumbar\nlevoscoliosis and chronic spinal deformity. There is no suspicious focal bone\nlesion.", "output": "1. Several nonobstructing right renal calculi measuring up to a 1.8 cm in a\nright extrarenal pelvis. The largest of these was seen on prior ultrasound. \nNo hydronephrosis.\n2. Otherwise no acute findings in the abdomen or pelvis." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis without focal consolidation. Mild\ncardiomegaly is present. . There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a mildly atrophic right pelvic kidney with multiple\nnonobstructing renal calculi, the largest measuring 2.2 cm within the\nextrarenal pelvis, similar in size and appearance to the prior study. The\nother renal calculi are somewhat obscured by the presence of contrast within\nthe collecting system. There is no evidence of right-sided hydronephrosis or\nhydroureter. Small sub cm hypodensities in the right kidney are too small to\nfully characterize, likely cysts. The left kidney is normal size with\nmultiple hypodensities, the largest in the upper pole measuring 1.5 x 1.5 cm,\nlikely simple cysts. There is no left-sided hydronephrosis. No focal\nconcerning lesion is identified in either kidney, and there is no evidence for\nrenal injury. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Scattered colonic\ndiverticula are present without evidence for diverticulitis. The colon and\nrectum are otherwise within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Marked shape rotary thoracolumbar scoliosis is re- demonstrated with\nbilateral ___ rods in place, these superior aspects of which are not\ncompletely imaged on this exam. Irregularity of the right acetabulum is\nunchanged from prior examination. No acute fracture. No suspicious osseous\nlesions identified.\n\nSOFT TISSUES: There is a small fat-containing umbilical hernia. The abdominal\nand pelvic wall is within normal limits.", "output": "1. No acute abnormality identified to account for the patient's right lower\nquadrant pain. Specifically, no evidence of renal injury. Normal appendix.\n2. 2.2 cm nonobstructing stone within the right extrarenal pelvis, unchanged\nin size and position from prior CT on ___. Other additional\nnonobstructing right renal calculi are somewhat obscured by the presence of\ncontrast within the collecting system." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is normal in size and location. The right kidney is\nlocated within the right side of the pelvis. A large 2.5 cm right renal stone\nis unchanged in size and has moved from the ureteropelvic junction into the\nlower pole of the right kidney. There are additional multiple unchanged\nnonobstructing right renal stones, measuring up to 1.2 cm within the anterior\nand superior aspect of the right kidney. There has been interval removal of\nprevious stones in the right right ureterovesical with near complete\nresolution of moderate right-sided hydronephrosis. Right extrarenal pelvis is\nredemonstrated. There is no evidence of focal renal lesions within the\nlimitations of an unenhanced scan. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is colonic diverticulosis\nthroughout the on large colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: Again noted is marked levoscoliosis with fixation hardware in the\nthoracolumbar spine. Similar appearance of the deformity of the right hip.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Congenital right pelvic kidney is redemonstrated. Interval removal of\nright UVJ stones with near complete resolution of right-sided hydronephrosis.\n2. Large 2.5 cm right renal stone is unchanged in size and has migrated from\nthe ureteropelvic junction to the inferior pole the right kidney. Otherwise\nthere are multiple unchanged nonobstructing right renal stones measuring up to\n1.2 cm." }, { "input": "Heart is mildly enlarged. Visualized lung bases appear clear.\n\nWithin the limitations of a non-contrast examination, no focal liver lesions\nare identified. There is no biliary dilatation. Gallbladder appears normal. \nPancreas is unremarkable. Spleen is normal in size. Adrenals are\nunremarkable. No kidney is found on the right. The left kidney shows no\nevidence for stones or hydronephrosis, unchanged. The left kidney is\notherwise difficult to assess without intravenous contrast administration.\n\nThere are few scattered colonic diverticula. Stomach and small bowel appear\nwithin normal limits.\n\nPatient is status post nephrectomy, since the prior CT, of a pelvic kidney\nwith removal of stones. The proximal edge of the right ureteral remnant is\nmildly tortuous and dilated up to 18 mm in diameter. An oblong calcification\nmeasuring up to 7 mm in length possibly lies in the remnant along its margin\nversus immediately adjacent calcification, of which the images are more\nsuggestive. Uterus is unremarkable. No adnexal masses are found. Bladder\nappears normal. There is no lymphadenopathy or free fluid.\n\nSimilar bony hypertrophy along the right acetabulum with shallow acetabulum on\neach side. There is severe S shaped curvature with unchanged partly imaged\nthoracolumbar fusion hardware. Bones appear demineralized.", "output": "Status post nephrectomy of right pelvic kidney. Mildly dilated ureteral\nremnant with associated calcification, possibly a stone within the remnant\nureter versus, more likely, immediately adjacent calcification. Unremarkable\nremaining left kidney." }, { "input": "VASCULAR:\n\nMild poststenotic dilatation of the celiac trunk is again noted. The celiac\naxis and its major branches are patent. The superior mesenteric, bilateral\nrenal, inferior mesenteric, bilateral common iliac arteries, and their major\nbranches are patent. There is no abdominal aortic aneurysm. There is severe\nbackground atherosclerotic disease.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple irregular hypoattenuated masses in the\nliver, all of which are decreased in size from ___. Some\nrepresentative lesions as below:\n\n1.6 x 1.8 cm lesion in segment VIII (6:76), previously 2.9 x 2.1 cm\n2.1 x 1.5 cm lesion in segment III (6:89), previously 3.0 x 2.2 cm\n2.2 x 1.7 cm lesion in segment VII (6:85), previously 2.4 x 2.2 cm\n\nThere is cholelithiasis. A small hypoattenuating focus along the gallbladder\nwall inferiorly (6:104) likely represents adenomyomatosis, unchanged from ___.\n\nPANCREAS:\nRedemonstrated is an irregular hypoattenuating mass in the pancreatic\nbody/neck which measures 1.1 x 1.5 x 1.6 cm (AP by TV by CC, 6:90 and 9:28),\ndecreased in size from CTA abdomen and pelvis ___, previously\nmeasuring 2.1 x 1.2 x 2.3 cm. This mass extends superiorly to the\ngastrohepatic ligament, measuring up to 0.6 cm across maximal diameter (6:88),\ndecreased in size from CTA ___, previously measuring up to 1.9 cm. \nThis mass abuts the portal splenic confluence, the proximal common hepatic\nartery, and the proximal splenic artery, unchanged from ___. This\nmass encases the proximal gastroduodenal artery, best appreciated on coronal\nview (09:27), unchanged. There is upstream main ductal dilatation measuring\nup to 0.9 cm (6:92) and parenchymal atrophy of the body and tail.\n\nThere is a hypoattenuating focus in the pancreatic head measuring 1.7 x 1.3 cm\n(6: 98), decreased in size from ___, previously measuring 2.1 x 1.2\ncm, which could represent a IPMN.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is cortical thinning of the upper pole of the right kidney\nlikely rim reflecting atrophy. There is a simple cyst in the lower pole the\nright kidney measuring up to 1.7 cm (6:90). There is a 4 mm nonobstructive\ncalculus in the lower pole left kidney (6:97). Multiple subcentimeter\nhypodensities in both kidneys are too small to characterize. There is no\nhydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. The\nappendix is not visualized.\n\nLYMPH NODES: A omental soft tissue nodule measuring up to 0.4 cm (6:114) is\nnot pathologically enlarged by CT size criteria and unchanged. A lymph node\nat the porta hepatis measuring 0.7 cm in short axis is not pathologically\nenlarged and unchanged. There is no mesenteric, retroperitoneal, pelvic, or\ninguinal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nBONES: There are sclerotic foci in the L1, L2, and L5 vertebral bodies (6:\n92:104: 136: 104) and in the left sacrum (6:139). Bilateral sacroiliitis is\nnoted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval size of pancreatic mass which now measures up to 1.6 cm,\npreviously measuring up to 2.3 cm on CTA abdomen and pelvis ___.\n2. Multiple metastatic lesions in the liver are decreased in size since ___.\n3. Sclerotic foci in the L1, L2, and L5 vertebral bodies and in the left\nsacrum are new as compared to CTA abdomen pelvis ___ and could be\nsecondary due to treatment effects. Attention on follow-up imaging is\nrecommended." }, { "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver density is decreased, suggestive of steatosis. Again seen are\nmultiple ill-defined hypodense liver lesions throughout all segments,\ncompatible with metastases. Many of these lesions have demonstrated interval\ndecrease in size since the ___ examination. For example, a 1.9 x\n1.5 cm lesion along the periphery of segment VI previously measured 2.2 x 1.7\ncm (series 7 image 76). A 1.2 x 1.1 cm lesion within segment III previously\nmeasured 2.1 x 1.5 cm. However, other lesions appear slightly enlarged. For\nexample, a 1.6 x 1.2 cm segment VII lesion previously measured 1.1 x 1.1 cm\n(series 7, image 59). No definite new lesions are seen. There is no intra or\nextrahepatic bile duct dilation.\n\nCholelithiasis is again demonstrated. There is no CT evidence for acute\ncholecystitis. No radiopaque ductal stones are detected.\n\nA known 1.5 x 1.1 cm mass at the junction of the pancreatic head and neck\nappears unchanged (series 7, image 81). There is moderate upstream pancreatic\nduct dilation with severe parenchymal atrophy, also unchanged. A 1.3 x 1.3 cm\ncystic lesion at the pancreatic head, either side branch IPMN or focally\ndilated duct, appears unchanged (series 7, image 88).\n\nThere is continued contact of the pancreatic mass with the GDA and common\nhepatic artery (series 7, image 78, 80). The SMV and main portal vein remain\npatent. The SMA remain separate from the lesion. Intrahepatic portal and\nhepatic veins remain patent.\n\nThe spleen size is within normal limits. A 5 mm hypodensity along the medial\nanterior aspect of the spleen is unchanged over multiple prior examinations\n(series 7, image 70). No new splenic lesion is identified.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis. Multiple bilateral subcentimeter hypodense lesions, likely\nrenal cysts, remain too small to completely characterize, but are unchanged. \nNo concerning renal lesion is identified.\n\nA small hiatal hernia is present. The stomach and proximal duodenum are\nmildly distended with food and fluid (series 7 image 100, 85), without frank\ndilation. Intra-abdominal and intrapelvic loops of small and large bowel are\nnormal in caliber. The appendix is normal. There is moderate colonic\ndiverticulosis, without diverticulitis.\n\nThe bladder is decompressed, and appears normal. The uterus is normal in\nsize, in mid position. No concerning adnexal lesions are detected.\n\nThere is no retroperitoneal, inguinal, or intrapelvic lymphadenopathy, and no\nascites. No mesenteric lymphadenopathy is seen.\n\nSubcentimeter sclerotic foci within the left hemi sacrum (series 7, image\n134), L5 (series 7, image 130), L2, and L1 (series 11, image 53, 52) appear\nunchanged since the ___ study. A 7 mm hypodense lesion along the\nanterior aspect of T12 is unchanged, possibly a tiny hemangioma (series 11,\nimage 55, series 7, image 77). No new osseous lesion is identified within the\nabdomen or pelvis.", "output": "1. Multiple hepatic metastases, many demonstrating slight interval decrease in\nsize since the ___, however, a few lesions appear slightly\nenlarged, as described above. No new liver metastases.\n2. Multiple sclerotic lesions throughout the spine and sacrum are unchanged\nsince ___ examination. No new osseous lesion.\n3. Unchanged 1.5 x 1.1 cm mass at the junction of the pancreatic head and\nneck, with moderate upstream duct dilation and severe parenchymal atrophy. \nThere is continued contact of the mass with the GDA and common hepatic artery.\n4. Mild distension of the stomach and proximal duodenum. This could reflect a\nrecent meal, however, correlate with any early signs for gastric outlet\nobstruction. Small hiatal hernia.\n5. Cholelithiasis.\n6. Moderate colonic diverticulosis.\n7. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:\n\nNumerous intrahepatic metastases demonstrate interval increase in size. For\nexample, a 1.9 cm lesion in segment 4 B (series 2, image 92) was previously\n1.0 cm, a 1.3 cm lesion in segment 6 (series 2, image 83) was previously 0.7\ncm. Some of the lesions are stable in size. There are multiple new lesions,\nfor example a 1.0 cm lesion at the liver dome in segment 8 (series 2, image\n63) and a 1.1 cm lesion in segment 5 (series 2, image 84).\n\nThere is mild but slightly increased intrahepatic biliary dilation in the\nright lobe, suspected to be related to obstruction by a 1.5 cm lesion in\nsegment 8 (series 2, image 79). There is no extrahepatic biliary dilation.\n\nPANCREAS: The pancreatic head/neck mass appears stable in size at 1.8 x 1.3\ncm. There is stable upstream duct dilation and atrophy. A cystic lesion in\nthe pancreatic head is similar to prior at 2.2 x 1.4 cm, likely an IPMN.\n\nVASCULAR:\n\nThe pancreatic mass again contacts the common hepatic and gastroduodenal\narteries, with associated kinking and narrowing of the common hepatic artery. \nThe SMA and SMV are not contacted by the mass. There is focal contact with\nthe portal vein but no narrowing or thrombosis. There is extensive\natherosclerotic plaque in the abdominal aorta with no aneurysm.\n\nSPLEEN: Hypoattenuating foci in the spleen measuring 1.0 and 0.6 cm were\npreviously 0.5 and 0.4 cm. Multiple focal hypodensities have been seen\nvariably in the spleen on prior studies in this could be related to contrast\ntiming and/or chronic benign lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is chronic scarring in the right kidney. Both kidneys contain\nmultiple cortical hypodensities, corresponding with cysts on MRI from ___. There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach and bowel are grossly unremarkable. There is\nincreased diffuse retroperitoneal and mesenteric stranding with multiple\nprominent subcentimeter lymph nodes, nonspecific but possibly related to\nlymphatic obstruction. This is unlikely to represent metastatic disease. \nThere is no concentration of inflammatory change around the pancreas to\nsuggest active pancreatitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is a small amount of\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: Diffuse sclerotic osseous lesions are stable. No new lesions are\ndemonstrated.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval progression of liver metastases. Increased, mild intrahepatic\nbiliary dilation in the right lobe is likely due to obstruction by a\nmetastasis.\n2. Slight increase in hypoattenuating splenic foci, indeterminate. These\ncould be re-evaluated at next follow-up.\n3. Increase in numerous small mesenteric and retroperitoneal lymph nodes with\nassociated fat stranding is favored to be obstructive/inflammatory.\n4. Stable osseous metastases.\n5. Please refer to the separate report for the CT chest." }, { "input": "Small amount of pleural effusion is demonstrated bilaterally. Bibasilar\natelectasis are seen.\nSmall hiatal hernia is present.\nLarge amount of ascites is present.\nThe liver is shrunken and nodular in contour, consistent with cirrhosis. The\ndensity of liver parenchyma is heterogeneous. The spleen is enlarged\nmeasuring 17 cm in craniocaudal dimension. Multiple epigastric varices are\ndemonstrated.\nThe gallbladder is normal. The biliary tree is not deviated.\nThe pancreas is grossly normal.\nA hyperdense left cortical renal lesion 1.2 cm in size is demonstrated,\nindeterminate, probably a hemorrhagic cyst.\nThere is no hydronephrosis.\nThe adrenals are unremarkable.\nRight scrotal hernia containing fluid is seen. The appendix and tip of the\ncecum is seen within the right inguinal canal (Amyand hernia).\nArthrosclerotic calcifications are present in the abdominal aorta and the\ncommon iliac arteries. Intrarenal abdominal aortic aneurysm 3.5 cm in diameter\nis present.\nFoley catheter is present in the urinary bladder.\nNo osseous lesions are seen", "output": "1. Cirrhotic liver with portal hypertension, splenomegaly and a\nintra-abdominal varices.\n2. Large amount of ascitics.\n3. Ascites containing right scrotal hernia.\n4. Amyand hernia of the appendix .\n5. Abdominal aortic aneurysm 3.5 cm in diameter.\n6. Indeterminate hyperdense left cortical lesion can be further evaluated with\nMRI." }, { "input": "LOWER CHEST: Subsegmental linear atelectasis is identified in the right lower\nlung lobe. See chest CT report for full evaluation.\n\nABDOMEN:\nThe liver is normal in size. There is slight decrease attenuation suggestive\nfor fatty change. There is decreased conspicuity of the previously described\nmultiple focal hepatic lesions which are most consistent with hepatic\nmetastases. The more visible lesions are decreased in size. For example the\nlesion in segment 6 measures on the current study 1.7 cm in maximum dimension\nwhile it measured 2.6 cm previously. As mentioned above, the lesion in\nsegment 1 and the lesions in segment 8 and 7 are less conspicuous and\nprominent on the current exam. The gallbladder is unremarkable. There is no\nevidence for intra or extra hepatic bile duct dilation. Stable slightly\nenlarged lymph nodes are seen again in the porta hepatis measuring up to 1.9\ncm. These are most likely reactive in nature. The spleen is normal in size. \nThere is interval decrease in size of the previously described focal splenic\nlesion which on the current study measures 3 mm while it previously measured\n8.3 mm. The decrease in size is highly suggestive for another metastatic\nfocus. The pancreas is unremarkable. Both adrenals are normal in size. \nThere is no evidence for hydronephrosis. No suspicious focal renal lesions\nare present. There is no retroperitoneal or mesenteric lymphadenopathy.\n\nPelvis: The small bowel normal in caliber and no focal abnormalities are\npresent. The appendix is normal. There is decreased conspicuity in the\nappearance of the previously described rectal mass. There is stable\nmesorectal vein dilation which most likely represents extramural vascular\ninvasion. There is decreased size of the left mesial rectal lymph node which\non the current study only measures few mm. There is no inguinal or iliac\nlymphadenopathy. The urinary bladder is well distended and does not show any\ngross abnormalities. A small bladder diverticulum is identified arising from\nthe right lateral bladder wall.\n\nReview of the images in bone window does not show any suspicious bony lesions.", "output": "1. Decreased size and conspicuity of the focal hepatic lesions most consistent\nwith hepatic metastases. 2. Decreased size of the focal splenic lesion, also\nsuggestive for metastatic lesion. 3. Decreased conspicuity of the rectal\nmass with stable appearance of the dilated veins within the mesorectal fat. \nSlight decrease size of the left mesorectal lymph node." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:\nSeveral metastatic liver lesions, previously FDG avid, are again seen but have\nthey have decreased in size compared to the baseline exam of ___:\n1. Caudate lobe of (image 2; 51) measures 12.7 mm (compared to 17.5 mm)\n2. Segment VIII (image 2; 54) is sub 5 mm (compared to 5 mm)\n3. Segment VII (image 2; 53) is very faint and measures 7.9 mm (compared to\n10.8 mm)\n4. Segment VI (image 2; 78) measures 14.7 mm (compared to 22.5 mm)\nNo new liver lesions are identified. The liver parenchyma is otherwise\nhomogeneous and enhance appropriately. There are 2 small, sub cm lymph nodes\nin the porta hepatis unchanged since previous studies.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. The previously seen small focal splenic lesion is\nnot identified today.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The appendix is\nnormal.\nThe colon and rectum are within normal limits. No rectal mass identified on\nthe scan. Only 1 minutes mesorectal lymph node is identified, measuring 4.1\nmm\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size and contains 2\nsmallcalcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Continued decrease to the size of metastatic liver lesions\n2. Resolution of for mesorectal lymph node prominence." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion. Mild coronary artery calcifications are\nseen.\n\nABDOMEN:\n\nHEPATOBILIARY: Compared with ___, there has been significant\ninterval increase size and number of hepatic metastases. For reference, two\nsegment VII/VIII lesions measure 5.9 x 4.9 cm compared with 5.0 x 4.6 cm\npreviously, and 7.8 x 4.6 cm compared with 5.2 x 4.0 cm previously (2:12, 16).\nA caudate lobe lesion measures 6.3 x 4.2 cm, compared with 5.5 x 4.4 cm\npreviously (2:16). A segment VI lesion measures 7.7 x 5.6 cm compared with\n6.5 x 6.1 cm previously (2:38). There has thinned and increase in number of\ninnumerable small hepatic hypodensities throughout both lobes the liver. Mild\ncentral intrahepatic biliary dilatation is stable. The common bile duct is\nstably dilated up to 8 mm, however tapers appropriately to the ampulla. The\ngallbladder is within normal limits. There is no ascites. The main portal\nvein, splenic vein, and SMV are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\nwithin normal limits. There has been interval increase in size of a focal\nenhancing area at the anal rectal junction, corresponding to known anorectal\nmass, which currently measures 2.3 x 1.7 cm in the axial plane, compared with\n2.1 x 1.6 cm previously (2:90). The mass now spans approximately 5.2 cm in\nthe coronal plane, compared with 4.9 cm previously (601b:49). Again seen are\nmultiple areas of extramural extension, including left anterior lateral\n(2:82), posterior lateral (2:79). The appendix is not visualized.\n\nPELVIS: There is a right posterior bladder diverticulum (601b:45). The\ndistal ureters are unremarkable. There is trace presacral edema, similar to\nprior.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There has been interval increase in size of hypodense porta\nhepatis node, which measures 1.9 x 1.5 cm, compared with 1.4 x 0.9 cm\npreviously (2:23). A 1.3 cm hypodense periportal node is not significantly\nchanged (2:25). A superior rectal node measures 2.8 x 1.2 cm, compared with\n2.5 x 1.2 cm previously (602b:44). A 6 mm right mesorectal lymph node is not\nsignificantly changed (2:75). A 1.1 cm enhancing left obturator lymph node is\nnot significantly charged (2:72).\n\nVASCULAR: The abdominal aorta is ectatic, measuring up to 2.8 cm, unchanged. \nThere is no abdominal aortic aneurysm. Moderate atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval progression of disease with increase in size and number of\ninnumerable hepatic metastases, increased size of lymphadenopathy, and\nprobable increase size of primary anorectal mass.\n2. No additional acute intra- abdominopelvic process to explain patient's\npain." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. Appendix is not visualized.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries. Incidentally noted is a\nretroaortic left renal vein.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits. \nIntrauterine device is noted in unchanged position.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis." }, { "input": "Lung bases: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusions seen.\n\nAbdomen: The liver and spleen are intact without focal concerning lesion. \nGallbladder is unremarkable. No biliary ductal dilation. The main portal\nvein is patent. The pancreas and both adrenal glands appear normal. No signs\nof renal injury or worrisome mass. No hydronephrosis. Ureters appear normal.\nNo perinephric abnormality. The abdominal aorta is moderately calcified and\nslightly tortuous though without aneurysm. There is mild atherosclerosis\nalong the proximal segment of the SMA without critical stenosis. Otherwise\nthe imaged aortic branches appear widely patent. There is no retroperitoneal\nhematoma or adenopathy. No free air or free fluid. The stomach and duodenum\nappear normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. No\nnormal appendix visualized. No signs of bowel or mesenteric injury. \nDiverticulosis of the colon is noted without evidence of diverticulitis. \nUrinary bladder is partially distended appearing normal. Prostate is mildly\nprominent. Seminal vesicles appear normal. No pelvic free fluid. No pelvic\nsidewall or inguinal adenopathy.\n\nBones: No fracture is seen. No worrisome lytic or blastic osseous lesion.", "output": "No findings to account for hematuria. Nonemergent findings as above." }, { "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\nThere is moderate motion artifacts degrading quality of scan.\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 1 cm hypodensity in the right lobe (2a;6), too small to\ncharacterize. no evidence of other focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or upper ureters. There is no\nperinephric abnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Visualized part of colon is within\nnormal limits.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy. No bleed or other abnormal fluid collection. In particular\nthere is no abnormality in the region of the celiac plexus.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries. In particular, the upper\naorta, the celiac axis and primal SMA are normal.\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions. Abdominal\nwall and back are within normal limits.", "output": "Despite motion artifacts no abnormality seen in the abdomen and particularly\nin the region of the celiac plexus." }, { "input": "Lung bases are clear. There is no pleural or pericardial effusion.\n\nCT of the abdomen: The liver enhances homogeneously with no focal hepatic\nlesions identified. There is redemonstration of fundal adenomyomatosis. The\ngallbladder is otherwise normal with no pericholecystic fluid or gallbladder\nwall thickening. There is no intrahepatic biliary ductal dilatation. The\nadrenal glands, pancreas and spleen are normal. The kidneys enhance\nsymmetrically and excrete contrast without evidence of hydronephrosis or renal\nmasses.\n\nThe stomach is fluid-filled. There is no evidence of small bowel obstruction. \nEvaluation of the terminal ileum, distal transverse colon, descending and\nsigmoid colon is somewhat limited secondary to under distension. A mild\ncolitis cannot be excluded within these segments. There may be minimal\nhyperenhancement of the wall of the terminal ileum, although assessment is\nagain limited by the lack of luminal distension. There is suggestion of\nintramural fat within the ascending and transverse colon (series 2, image 45)\nwhich can be seen with chronic inflammatory bowel disease. No significant\nstranding is seen about the bowel loops. There is no extraluminal air or fluid\ncollections. There are scattered small mesenteric lymph nodes, none of which\nare pathologically enlarged. The appendix is not clearly visualized, however\nthere are no secondary signs of appendicitis.\n\nCT of the pelvis: The urinary bladder and terminal ureters are normal. An\nintrauterine device is seen within the endometrial cavity. There is no pelvic\nfree fluid. Simple bilateral ovarian cysts are likely physiologic.\n\nOsseous structures: No blastic or lytic lesion concerning for malignancy.", "output": "1. Terminal ileum may be minimally hyperemic and suggestive of a mild ileitis,\nalthough assessment is limited secondary to lack of luminal distension. No\nstranding is seen about the small bowel and there is no evidence of\nobstruction.\n\n2. Limited examination of the transverse colon, descending and sigmoid colon\nsecondary to underdistention. A mild colitis within the segments cannot be\nentirely excluded.\n\n3. Probable intramural fat within the wall of the ascending and transverse\ncolon, which can seen with chronic inflammation.\n\nFurther assessment with MR enterography with oral contrast is recommended to\nbetter evaluate the terminal ileum and colon.\n\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 6:45 ___, 10 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in the bilateral lower lobes.\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nGeographic area of lower attenuation adjacent the falciform ligament likely\nrepresents focal fatty infiltration (series 2:28). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Splenule is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are several subcentimeter hypoattenuated rounded foci in the bilateral\nkidneys measuring up to 0.7 cm in the lower pole the right kidney (series\n2:36), previously characterized on ___ ___ as simple cysts. \nThere is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is fluid-filled dilated\nhyperemic measuring 1.2 cm across maximal diameter (series 601: Image 20) with\nmild fatty stranding. There is no adjacent fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The appendix is fluid-filled, dilated, and hyperemic measuring 1.2 cm\nacross maximal diameter (series 601: image 20) with mild fatty stranding.\nThere is no adjacent fluid collection. These findings are compatible with\nuncomplicated acute appendicitis.\n2. No evidence of colitis." }, { "input": "Detailed evaluation of solid organs, soft tissues, and vessels is limited\nwithout the use of intravenous contrast.\n\nLOWER CHEST:\nExtensive bronchial impaction, peribronchiolar thickening and bronchiectasis\nin the lower lobes, worse on the left, are overall similar to ___, but could be seen with aspiration. No pleural effusion. Bilateral\ncalcified pleural plaques are overall unchanged, indicating prior history of\nasbestos exposure. Coronary vascular calcifications are re-demonstrated. A\nsmall pericardial effusion is unchanged from ___ (series 3, image 10).\n\nABDOMEN:\n\nHEPATOBILIARY: A few scattered tiny hypodensities are too small to accurately\ncharacterize on CT but may reflect cysts and/or hemangiomas as better\nappreciated on the MR in ___. The liver demonstrates homogeneous attenuation\nthroughout otherwise. No evidence of concerning focal lesions within the\nlimitations of an unenhanced scan. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent with clips in the\nsurgical bed. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. No pancreatic\nductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A complex cystic\nstructure within the the left kidney demonstrates mass effect with associated\nmarked thinning of the cortex in the upper and mid poles appears overall\nsimilar to to the MR in ___. This could reflect hydronephrosis, parapelvic\nor intrarenal cyst, and a or cystic tumor. No focal right renal lesion or\nhydronephrosis is identified. No nephrolithiasis or perinephric abnormality.\n\nGASTROINTESTINAL: A hiatal hernia is small. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis, most severe in\nthe sigmoid colon is again demonstrated. No diverticulitis. The rectum is\nwithin normal limits. No bowel obstruction. No free air. No mesenteric or\nperitoneal masses are identified.\n\nPELVIS: The partially distended urinary bladder demonstrates possible focal\nwall thickening along the right lateral aspect (series 3, image 71; series 5,\nimage 28). A tiny posterior outpouching of the bladder wall with can activity\nto the bladder lumen is consistent with a diverticulum (series 3, image 70;\nseries 5, image 27).\n\nREPRODUCTIVE ORGANS: The prostate gland is markedly enlarged and\nheterogeneous. The estimated prostate size is 6.4 x 5.4 x 7.2 cm.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: Extensive, diffuse atherosclerotic disease is again noted. The\ndescending thoracic aorta is tortuous. An infrarenal abdominal aortic\naneurysm, measuring 3.7 cm in maximum dimension is overall similar in\nappearance in size compared to the MR in ___ when accounting for differences\nin modality. The probable infrarenal intramural thrombus displacing the\natherosclerotic calcifications is demonstrated (series 3, image 38, 35).\n\nBONES:\nNumerous densely sclerotic osseous lesions are most suspicious for \nmetastatic disease:\n5-mm left posterior rib (series 3, image 1)\n1.6-cm left anterior lesion and 6-mm left posterior lesion in the L1 vertebral\nbody (series 3, image 20; series 6, image 29)\n1.1-cm lesion in the left L4 vertebral body (series 3, image 41)\n\nOther smaller, tiny sclerotic lesions throughout the visualized bones could\nalso represent metastases versus bone islands.\n\nNo evidence of a pathologic fracture. A Schmorl's node is noted in the\ninferior endplate of L2 (series 6, image 32) in the setting of degenerative\nchanges in the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Numerous sclerotic osseous lesions most consistent with metastatic disease\nwith the largest measuring 1.6 cm in the L1 vertebral body. No pathologic\nfracture.\n\n2. Complex cystic structure in the left kidney is incompletely assessed\nwithout intravenous contrast and while appears somewhat similar to prior MR\nand ultrasound, this has been previously characterised as a complex parapelvic\ncyst. Further evaluation with MR is recommended.\n\n3. Minimal focal bladder wall thickening along the right sided bladder wall.\nRecommend direct visualization via cystoscopy to rule out an underlying\nurothelial abnormality.\n\n4. Markedly enlarged prostate. This could be further evaluated by MRI as\nclinically warranted, in the setting of multiple osseous metastases.\n\n5. Infrarenal abdominal aortic aneurysm measuring up to 3.7 cm with an\neccentric intramural thrombus as described above.\n\n6. Bilateral lower lobe bronchial impaction and bronchiectasis as before;\ncould be seen with aspiration.\n\n7. Small pericardial effusion, unchanged from ___.\n\n8. Calcified pleural plaques likely related to asbestosis.\n\nRECOMMENDATION(S): Cystoscopy to evaluate bladder.\nMRI to evaluate prostate and left complex cystic lesion.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 18:37 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A 7\nmm hypodensity at the hepatic dome is incompletely characterized, but\nstatistically most likely represents a cyst or hemangioma (02:17). There is\nno evidence of suspicious lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 5 mm obstructing stone at the left UPJ with mild left\nhydronephrosis (2:64). There is associated left perinephric stranding. A\npunctate nonobstructing stone is present in the right renal inferior pole\n(2:76).\n\nGASTROINTESTINAL: The stomach is relatively collapsed. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSome degenerative change seen at L5/S1, with posterior disc bulge mildly\nnarrows the central canal..\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. 5 mm obstructing stone at the left UPJ with mild left hydronephrosis and\nleft perinephric stranding.\n2. Punctate right lower pole nonobstructing stone.\n\nNOTIFICATION: The findings were discussed with ___ urgent care by\n___, M.D. on the telephone on ___ at 9:22 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There is mild dependent atelectasis bilaterally. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 3.3 x 2.9 cm nodule of the lateral limb of the left\nadrenal gland. This nodule is of indeterminate Hounsfield units on enhanced\nCT but may represent a lipid poor adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Right-sided parapelvic cyst measures up to 5.7 cm.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild soft tissue induration, stranding, and\nsubcutaneous edema of the lateral proximal left thigh as well as the anterior\nleft pelvic wall particularly along the intertriginous region beneath the\nabdominal pannus. There are small adjacent lymph nodes, likely reactive. \nThere is no foci of air to suggest necrotizing fasciitis. Small fat\ncontaining umbilical hernia is noted.", "output": "1. Mild soft tissue induration, stranding, and subcutaneous edema along the\nproximal left thigh as well as the left anterior pelvic wall, particularly in\nthe intertriginous area beneath the abdominal pannus. Small lymph nodes in\nthis area are likely reactive. There are no foci of air to suggest\nnecrotizing fasciitis though this cannot be excluded on the basis of this\nexam.\n2. Indeterminate 3.3 cm left adrenal nodule likely represents a lipid poor\nadenoma. Consider further evaluation with adrenal CT protocol on a\nnonemergent basis." }, { "input": "LOWER CHEST: Mild dependent bibasilar atelectasis. Visualized lung fields are\notherwise within normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is diffusely atrophic. There are numerous cystic\nlesions throughout the pancreatic parenchyma with the largest in the distal\npancreatic body measuring up to 2.4 cm (3:66, 601:79). No main pancreatic\nductal dilatation identified. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple simple appearing bilateral renal cysts, with the largest in\nthe posterior left upper pole measuring up to 6.9 cm (3:70). There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The partially visualized distal thoracic esophagus is mildly\ndistended and fluid-filled. The stomach is moderately distended. Multiple\nmildly distended loops of small bowel with air-fluid levels and no definite\ntransition point. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder is mildly distended but otherwise within normal\nlimits. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. Coarse\ncentral calcifications are noted within the prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There are numerous minimally displaced posterolateral rib fractures\ninvolving the right sixth through eleventh ribs. Most notably, there is a\ncomminuted mildly displaced fracture involving the posterior right eighth rib\nand a mildly displaced fracture involving the posterior right eleventh rib. \nSubtle cortical irregularity involving the right inferior pubic ramus is\nsuggestive of a nondisplaced fracture (4:179). Multilevel compression\ndeformities involving the T12 through L4 vertebral body, with associated\nhyperdense vertebroplasty material, likely chronic though correlation with\nprior imaging is recommended.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "1. Numerous minimally displaced posterolateral rib fractures involving the\nright sixth through eleventh ribs, most notably including a comminuted mildly\ndisplaced fracture involving the posterior right eighth rib and a mildly\ndisplaced fracture involving the posterior right eleventh rib.\n2. No abdominopelvic hematoma. No solid organ laceration.\n3. Subtle cortical irregularity involving the right inferior pubic ramus,\nsuggestive of nondisplaced fracture.\n4. Multilevel compression deformities involving the T12 through L4 vertebral\nbodies with associated vertebroplasty changes, likely chronic though\ncorrelation with prior imaging is recommended.\n5. Numerous cystic lesions throughout the pancreas, with the largest in the\ndistal pancreatic body measuring up to 2.4 cm. Recommend correlation with\nprior imaging if available, otherwise recommend dedicated MRCP follow-up in 6\nmonths to assess for stability and further characterization.\n\nRECOMMENDATION(S): Correlation with prior imaging regarding the pancreatic\ncystic lesions. Otherwise MRCP follow-up in 6 months is recommended." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contracted, limiting\nevaluation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Small accessory spleen is noted at the splenic\nhilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. Cortically based hypodensities within both\nkidneys are too small to characterize, but statistically likely represent\ncysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\nextensive diverticula off scattered throughout the colon without definite\nsurrounding inflammation. The colon is collapsed throughout the majority of\nits course, limiting evaluation. The appendix is fluid-filled and enlarged\nmeasuring approximately 1.0 cm in diameter (series 602; image 33). There is\nwall hyperemia and mild surrounding fat stranding (series 601; images 28 and\n29, series 2; image 46). These findings are concerning for acute\nappendicitis. No phlebolith is seen. No phlegmon or underlying collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized uterus is within normal limits. There is\nno suggestion of adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Fluid filled enlarged appendix measuring 1.0 cm in diameter with wall\nhyperemia and mild surrounding fat stranding. No phleboliths seen. No\nphlegmon or underlying collection. These findings are concerning for\nuncomplicated acute appendicitis.\n2. Diverticulosis throughout the colon, which is collapse throughout its\ncourse, limiting evaluation, without surrounding inflammation to suggest\ndiverticulitis." }, { "input": "The visualized lung bases appear clear. There are no pleural effusions.\n\nIn segment segment VIII of the liver there is a hyperenhancing lesion\nmeasuring up to 21 x 18 mm in axial ___. More generally there is a\nreticular appearance to the hepatic parenchyma which may be due potentially to\ninflammation of the liver. The gallbladder appears normal. The pancreas,\nspleen, and adrenal glands are unremarkable. The kidneys also appear within\nnormal limits. There is no biliary dilatation.\n\nThe mid transverse colon shows a segment of mild wall thickening suggesting\ncolitis. There are more questionable inflammatory findings along the splenic\nflexure of the colon with equivocal mild wall thickening. The wall of the\nrectum shows mild surrounding fat stranding, which is additionally seen along\nother portions of the colon such as the ascending portion. The patient is\nstatus post appendectomy.\n\nThere is no lymphadenopathy. The major mesenteric arteries and veins appear\npatent. The uterus, adnexa, distal ureters and bladder appear within normal\nlimits.\n\nThere are no suspicious bone lesions. Bilaterally the sacroiliac joints show\nerosive changes anteriorly which could be seen with a history of sacroiliitis.\nJoint spaces appear preserved, however. The vertebral body heights and\ninterspaces appear preserved.", "output": "1. Findings consistent with colitis including possible skip lesions although\nthe most definitive area of inflammatory involvement is within the mid\ntransverse colon.\n\n2. Reticular appearance to the hepatic parenchyma, of uncertain significance,\nbut hepatic inflammation may potentially explain this appearance. Correlation\nwith liver function tests is recommended.\n\n3. Enhancing mass in the dome of the right lobe of the liver. Differential\nconsiderations include focal nodular hyperplasia or adenoma although the\nlesion is indeterminate. Evaluation with multiphasic CT or preferably MR is\nrecommended.\n\n4. Anterior sacroiliac erosions, which may indicate a history of inflammatory\nsacroiliitis, which may additionally support concern for underlying\ninflammatory bowel disease." }, { "input": "Lung bases: Mild lower lung atelectasis. The imaged portion of the heart is\nunremarkable. There is a small hiatal hernia.\n\nAbdomen: The stomach is mostly decompressed. 2 tiny locules of gas along the\ngastric margin on series 3, image 17 likely reside within the stomach. A\nsmall amount of fluid is seen within the gastrohepatic recess, likely related\nto recent surgery. No convincing evidence for gastric perforation. The\nduodenum is unremarkable. The unenhanced appearance of the liver,\ngallbladder, spleen, adrenals and kidneys is normal. The pancreas is grossly\nunremarkable. Please note, motion artifact limits assessment. The abdominal\naorta is mildly calcified though normal in caliber. No adenopathy. No free\nair.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. There\nis a small bowel containing supraumbilical hernia, representing a Richter's\ntype hernia, without evidence of complication. The appendix is not\nvisualized. Dense barium is seen within the cecal base. The colon contains a\nmild fecal load. No free air or free fluid. Urinary bladder is unremarkable.\nThe uterus is surgically absent. No adnexal mass. No pelvic sidewall or\ninguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion. Facet arthropathy is\nnoted in the lower lumbar spine with multilevel disc disease within the lumbar\nspine. A grade 1 anterolisthesis of L4 on L5 noted.\n\nBody wall: Supraumbilical bowel containing hernia is uncomplicated. Soft\nthere is a small subacute appearing hematoma in the mid anterior body wall\nbest seen on series 3, image 27 measuring approximately 4.8 x 5.1 cm, likely\nrelated to recent surgery.", "output": "1. Status post lap band removal without evidence of gastric perforation. 2. \nSmall amount of fluid in the region of the gastrohepatic recess.\n3. Small subacute appearing hematoma in the anterior body wall\n4. Supraumbilical small bowel containing hernia, uncomplicated, Richter's\ntype.\n\nNOTIFICATION: Findings were discussed with Dr. ___ at the time of this\ndictation." }, { "input": "LOWER THORAX: The lung bases are clear. No pleural or pericardial effusion. \nDual lead ICD in situ.\n\nHEPATOBILIARY: Morphologic features of cirrhosis. No suspicious liver lesion.\nNo biliary ductal dilatation. The gallbladder is unremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Splenomegaly, measuring 15.6 cm. 1.1 cm accessory splenic tissue\nposterior to the spleen.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: Markedly atrophic left kidney, similar to ___. The right kidney is\nunremarkable. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are\nnormal in caliber. Normal appendix.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly.\n\nLYMPH NODES: Multiple enlarged retroperitoneal and mesenteric lymph nodes,\nlargest periportal measuring up to 11 mm. No pelvic or inguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Mild diffuse stranding of the\nperitoneum. Trace ascites.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic calcification. \nThe portal and hepatic venous systems are patent.\n\nBONES: Fat density lesions within the bilaterally of bones adjacent to the SI\njoints, likely benign. No suspicious osseous lesion.\n\nSOFT TISSUES: Unremarkable.", "output": "1. Cirrhotic liver with splenomegaly. No lesions meeting OPTN 5 criteria for\nhepatocellular carcinoma.\n2. No evidence of portal or hepatic vein thrombosis.\n3. Prominent retroperitoneal and mesenteric lymph nodes may be reactive.\n4. Atrophic left kidney." }, { "input": "LOWER CHEST: There is mild bibasilar dependent atelectasis. There is trace\nright pleural effusion. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post right partial nephrectomy with postsurgical\nchanges noted in the surgical bed and mild to moderate perinephric stranding. \nFree air is noted surrounding the surgical bed, consistent with postsurgical\nchanges. No hydronephrosis bilaterally. The left kidney appears\nunremarkable. No focal lesions noted in the left kidney.\n\nGASTROINTESTINAL: The stomach is unremarkable.\n\nThere is a umbilical hernia containing a loop of small bowel which contains\noral contrast without evidence of extraluminal contrast. Air is noted outside\nof the bowel lumen in the umbilical hernia, likely surrounding the loop of\nsmall bowel and unlikely to be pneumatosis. There is also a right lower\nquadrant ventral hernia containing a loop of small bowel which also contains\noral contrast without evidence of extraluminal contrast extravasation. Free\nair adjacent to this loop of small bowel with extension into the right lateral\nsubcutaneous tissues may all be postsurgical. No evidence of small bowel\nperforation.\nOtherwise, small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. Patient is status post subtotal colectomy with\nmultiple clips noted in the pelvis and right upper quadrant again noted. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted. Large\namount of subcutaneous emphysema over the right lateral abdominal wall is\nlikely postsurgical.", "output": "1. Patient status post right partial nephrectomy with postsurgical changes\nnoted and the amount of free air within the peritoneal cavity with\npostsurgical changes.\n2. Loop of small bowel is noted within an umbilical hernia and a right lower\nquadrant ventral hernia and both loops contain oral contrast without evidence\nof extraluminal contrast to suggest perforation. The amount of free air\nsurrounding the loops of bowel within the hernia and the extensive\nsubcutaneous emphysema over the right lateral abdominal wall is likely\npostsurgical.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___,\nM.D. on the telephone on ___ at 6:19 pm, 20 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Two pulmonary nodules measure up to 2 mm at the right lung base\n(series 5, image 4, 2). Evaluation of the lung bases is mildly limited by\nrespiratory motion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a large hyperdense lesion near the dome, likely representing a\nhemangioma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post right partial nephrectomy with\npostsurgical changes involving the posterior aspect of the right kidney. No\nsuspicious renal lesion or hydronephrosis, bilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. A loop of small bowel again\nprotrudes through a small fat containing umbilical hernia without evidence of\ncomplication (series 5, image 46). The patient is status post partial colonic\nresection without evidence of complication at the lower pelvic rectosigmoid\nanastomosis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is moderately enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic lesions in the pelvis are compatible with bone islands.\n\nSOFT TISSUES: There are bilateral fat containing inguinal hernias.\n\nThere has been interval hernia repair involving a right lower spigelian\nhernia. There is extensive inflammation involving the superficial soft\ntissues and right lower abdominal wall musculature extending from the level\nthe umbilicus inferiorly to the level of the sacrum. There is no discrete\nfluid collection. No evidence of bowel leak or fistula.", "output": "1. Extensive edema and soft tissue stranding at the right lower quadrant\nsurgery site. No focal fluid collection. No evidence of bowel injury.\n2. Right partial nephrectomy changes.\n3. Tiny pulmonary nodules at the right lung base measure up to 2 mm. For\nincidentally detected multiple solid pulmonary nodules smaller than 6mm, no CT\nfollow-up is recommended in a low-risk patient, and an optional CT follow-up\nin 12 months is recommended in a high-risk patient. See the ___ ___\nSociety Guidelines for the Management of Pulmonary Nodules Incidentally\nDetected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: A punctate 1-2 mm nodule at the right lung base is unchanged from\n___ exam. Mild dependent basal atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas demonstrates mild fatty replacement, without evidence\nof focal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.Note is made of an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Mild right hydroureteronephrosis can be traced to the level of a\npunctate stone in the right distal ureter seen best on series 2, image 81. \nRight perinephric stranding and fluid is noted, possibly reflecting forniceal\nrupture. Cortical scarring involving the right kidney appear similar to the\nprior exam. Punctate nonobstructing bilateral kidney stones are present.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Patient is status post subtotal\ncolectomy. Appendix is surgically absent.\n\nPELVIS: The urinary bladder is mildly distended. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is rectus diastasis with a small bowel containing supraumbilical hernia,\nuncomplicated and unchanged in appearance. Small fat containing inguinal\nhernias are present.", "output": "1. Mild right hydroureteronephrosis secondary to a punctate right distal\nureteral stone. Right perinephric stranding and fluid may reflect forniceal\nrupture.\n2. Additional tiny nonobstructing kidney stones.\n3. Postsurgical changes related to prior subtotal colectomy.\n4. Diastasis of the rectus musculature with small bowel containing\nsupraumbilical hernia.\n5. Small fat containing inguinal hernias." }, { "input": "LOWER CHEST: 3 pulmonary nodules are seen within the left lower lobe measuring\nup to 3 mm (2:4, 8, 16). Visualized lung fields are otherwise clear. There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hepatic hypodensities measure up to 2.0 x 1.7 cm and\nlikely represent simple cysts. There is no evidence of focal lesions. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 5 mm nonobstructing stone in the upper pole of the left\nkidney. 5 mm angiomyolipomas noted within the lower pole the right kidney. \nBoth kidneys otherwise appear unremarkable without hydronephrosis or\nperinephric stranding. The ureters are normal in caliber without calculi.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are mild to moderate.\n\nSOFT TISSUES: There is a moderate size fat containing umbilical hernia.", "output": "1. 5 mm nonobstructing stone in the upper pole of the left kidney without\nevidence of hydronephrosis, hydroureter or perinephric stranding.\n2. Three sub-4 mm left lower lobe pulmonary nodules. If the patient has risk\nfactors for lung malignancy, a follow-up chest CT is recommended in ___ year. \nOtherwise no further follow-up is necessary.\n\nRECOMMENDATION(S):\n\n1. Three sub-4 mm left lower lobe pulmonary nodules. If the patient has risk\nfactors for lung malignancy, a follow-up chest CT is recommended in ___ year. \nOtherwise no further follow-up is necessary.\n\nNOTIFICATION: The recommendation above was emailed by Dr. ___ on\n___ at 20:03 to the ED QA nurses for followup with the referring\nprovider." }, { "input": "LUNG BASES: Evaluation limited given patient motion. Several tiny\n(<4mm)pulmonary nodules are noted in the imaged lower lungs for example in the\nright lower lobe on series 3 image 13, left lower lobe on series 3, image 5,\n11, 16. The imaged portion of the heart is unremarkable. There is a tiny\nhiatal hernia.\n\nABDOMEN: Again seen within the liver are several well-circumscribed\nhypodensities most likely representing cysts however not fully characterized\nin the absence of contrast. The gallbladder appears normal in overall\nmorphology without definite evidence for stones. The pancreas is unremarkable\naside from a parenchymal calcification noted within the distal body. The\nspleen is normal in size. The adrenal glands are normal bilaterally. There\nare no renal or ureteral stones. No hydro nephrosis or hydroureter. No\nperinephric stranding. No worrisome renal lesions seen on this unenhanced\nexam. The abdominal aorta is normal in course and caliber without significant\natherosclerotic calcification. There is no retroperitoneal lymphadenopathy. \nThe stomach is decompressed. The duodenum is normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThere is a fat containing supraumbilical hernia similar to prior without\nevidence of complication. The appendix is not definitively visualized though\nthere are no secondary signs of appendicitis in the right lower quadrant. The\ncolon contains a mild fecal load. No signs of colitis or pericolonic\ninflammation. The uterus appears unremarkable. There is no adnexal mass. \nUrinary bladder is only partially distended though appears grossly\nunremarkable. There is mild pelvic floor descent. No pelvic sidewall or\ninguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen. Facet\narthropathy is noted in the lower lumbar spine. Mild disc disease is noted in\nthe lumbar spine.", "output": "1. No renal or ureteral stone. No hydronephrosis.\n2. Supraumbilical fat containing hernia, uncomplicated.\n3. Several punctate micro nodules in the lower lungs, several new from prior,\nof doubtful clinical significance.\n4. Additional nonemergent findings as above.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: Partial compressive atelectasis of the right lower lobe. \nBilateral pleural effusions, small, right greater the left.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a hypodense lesion in hepatic segment 4B measuring\napproximately 2.0 cm, new since the abdominal CT of ___. (Series\n2, image 31). There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Previously seen pneumobilia in the left hepatic lobe has\nresolved. The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post Whipple surgery, with demonstration of\nmultiple surgical clips along the remaining pancreas and expected post\noperative appearance. The body and tail of the pancreas are unremarkable. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal glands is normal in size and shape. Diffuse\nthickening of the left adrenal gland.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no nephrolithiasis or ureterolithiasis. There is no hydronephrosis. \nThere is no perinephric abnormality. Simple cyst in the mid third of the\nright kidney measuring 1.1 cm (02:51). The bladder has an indwelling Foley\ncatheter but is otherwise unremarkable.\n\nGASTROINTESTINAL: Enteric tube with tip terminating in the stomach body. \nPostoperative changes of Whipple surgery with gastrojejunostomy. No evidence\nof bowel obstruction. Colonic diverticulosis without evidence of acute\ndiverticulitis.\n\nPELVIS: Mild-to-moderate free fluid in the anterior abdomen and pelvis,\nassociated with increased enhancement of the peritoneum. No free air within\nthe peritoneal cavity.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: Multiple subcentimeter gastrohepatic and retroperitoneal lymph\nnodes are again seen, nonspecific.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild dorsal spondylosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Hypodense lesion in the left hepatic lobe, new since at least ___, could represent biloma, infarct, or small abscess. Recommend attention\non follow up studies.\n2. Expected post operative changes of Whipple surgery.\n3. Ascites associated with probable peritonitis, in keeping with ___\nparacentesis results.\n\nNOTIFICATION: The findings were discussed with Dr ___, M.D. by\n___, M.D. on the telephone on ___ at 3:24 pm." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver appears diffusely hypodense most likely reflecting\nchemotherapy associated steatosis. No focal lesions identified. Normal\nappearances of a hepaticojejunostomy with expected pneumobilia in the left\nlobe of the liver. There is no intrahepatic biliary dilatation. Narrowing of\nthe portal vein at the confluence is stable.\n\nPANCREAS: Status post Whipple surgery. The appearance of the\npancreaticojejunostomy are unremarkable. No evidence of local recurrence. \nRetroperitoneal fat haziness posterior to the pancreaticojejunostomy is\nstable. The remnant pancreas has normal attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape. The\nleft adrenal gland appears nodular however, this is a longstanding appearance.\n\nURINARY: Known bilateral renal cysts are stable in size. The largest on the\nright is a 2 cm right midpole cyst while the cyst on the left are\nsubcentimeter in size . The kidneys are of normal and symmetric size with\nnormal nephrogram. There is no evidence of stones, solid renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Unremarkable appearances of the gastrojejunostomy. The\nstomach is otherwise unremarkable. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post Whipple surgery. No evidence of local disease recurrence.\n2. Diffusely hypodense liver likely representing chemotherapy associated\nsteatosis.\n3. No evidence of abdominopelvic metastasis.\n4. Please see the report of CT chest from same day for details of\nintrathoracic findings." }, { "input": "LOWER CHEST: There is a filling defect in a pulmonary artery on the\nsubsegmental level on the right side (7;19) consistent with pulmonary\nembolism. A 0.4 cm pulmonary nodule in left upper lobe is stable since ___ (7;13). There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is a 2.6 x 2.2 x 1.9 cm lesion hypodense peripheral ring enhancement in\nsegment 2 of the liver (7; 34) which is new since ___. The portal vein is\npatent. The gallbladder is surgically absent. A metal common bile duct stent\nis identified with mild intrahepatic biliary duct dilatation. Pneumobilia is\nexpected given stent patency. There is soft tissue thickening around stent\ncompatible with known carcinoma, not changed since prior imaging. Stranding\nsurrounding common hepatic artery may reflect tumor involvement or post\nCyberKnife changes (7; 50).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypodense lesions in the posterior interpolar region bilaterally measuring 5.1\nx 4.8 cm in the left kidney with Hounsfield units of 11 (11; 77) and measuring\n1.1 x 1.1 cm in the right kidney with Hounsfield units of 13 (11; 57)are\nconsistent with simple cysts. There is no evidence of hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nLYMPH NODES: There are multiple retroperitoneal lymph nodes, particularly\nperiaortic and aortocaval, which are subcentimeter in size and appear stable\nsince ___. A 1.4 x 0.9 cm periportal lymph node (11; 50) appears\nincreased in size compared to ___ when it measured 1.0 x 0.5 cm (2; 50\nfrom ___\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nExtensive degenerative changes throughout the visualized portions of the lower\nthoracic and upper lumbar spine are noted. Sclerotic focus in L3 vertebral\nbody may represent bone island (13; 54).\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Right pulmonary embolism at the subsegmental level.\n2. New 2.6 cm hypodense lesion in segment 2 of the liver with ring enhancement\nconcerning for metastasis.\n3. Soft tissue thickening around CBD stent compatible with known carcinoma.\nMild stranding around the common hepatic artery may reflect post CyberKnife\nchanges or tumor involvement.\n4. 1.4 cm periportal lymph node has slightly increased in size since ___.\n5. Stable 0.4 cm LUL nodule since ___\n6. Bilateral renal cysts\n\nNOTIFICATION: The findings of pulmonary embolism were discussed with Dr.\n___. by ___, M.D. on the telephone on ___ at 4:53 ___, 40\nminutes after discovery of the findings." }, { "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The gallbladder is distended measuring up to 6.5 cm in\ntransverse diameter. There is a focal outpouching of the gallbladder fundus\n(series 7, image 32) with an associated soft tissue mass extending to the\nliver parenchyma at the junction of segments IVB and V measuring 4.7 x 3.8 x\n6.7 cm (series 6, image 22 and series 3, image 50). There are other similar\nhypodense lesions adjacent to the main lesion. Findings are concerning for\ngallbladder carcinoma, with invasion of the right hepatic lobe. There is a 17\nmm cyst in segment VI. There is mild-to-moderate intrahepatic biliary\ndilatation secondary to a 2.2 x 1.7 obstructing tumor deposit located the\nhepatic duct bifurcation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, or hydronephrosis. Bilateral renal cysts with\nthe dominant ones measuring 2 cm at the inferior pole of the right kidney and\n18 mm at the upper pole of the left kidney, and subcentimeter hypodensities\ntoo small to characterize. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There are three peritoneal implants in the right\nhemi-abdomen, two located near the hepatic angle adjacent to the colon\nmeasuring 2.4 x 2.7 cm and 3 x 2.2 cm. The third is located lower in the\nright hemiabdomen, lateral to the ascending colon measuring 2.5 x 2.4 cm\n(series 3, image 87). There is also a peritoneal implant measuring 2.5 x 2.2\ncm (series 3, image 104) along the wall of a small bowel loop in the anterior\nleft pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate\natherosclerotic disease of the abdominal aorta.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains fiducial markers.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Findings concerning for a gallbladder carcinoma invading the right hepatic\nlobe, with a tumor deposit at the hepatic duct bifurcation, which causes\nmild-to-moderate intrahepatic biliary dilatation.\n2. Peritoneal implants in the right lateral abdomen and left anterior pelvis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:18 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. There is some bilateral\ndependent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Stable appearance of small hypodense foci scattered in the\nliver with the largest lesion measuring 1.3 x 1.9 cm, likely cysts or biliary\nhamartomas. The liver otherwise demonstrates homogeneous attenuation\nthroughout. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A large simple appearing pararenal cyst is seen in the left kidney\nmeasuring 3.4 x 3.0 cm and a second cyst is seen in the lower pole of the\nright kidney measuring 2.3 x 3.5 cm. The kidneys are of normal and symmetric\nsize. A tiny non-obstructing sub-millimeter stone is seen in the lower pole\nof the left kidney (series 601b, image 46). There is moderate amount of\nhydronephrosis extending into the proximal ureter with some narrowing seen at\nthe ureteropelvic junction. There is mild left perinephric fat stranding and\nthickening of Gerota's fascia, without evidence of abscess. These findings\ncould be concerning for pyelonephritis in the right clinical setting.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. There is evidence of diverticulosis in the sigmoid colon\nwithout signs of diverticulitis. No evidence of bowel ischemia on this\nnoncontrast study. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRedemonstrated Grade 1 anterolisthesis of L4 on L5 vertebrae.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild left perinephric fat stranding with moderate amount of hydronephrosis\nextending into the proximal ureter with some narrowing at the ureteropelvic\njunction. These findings could be concerning for pyelonephritis in the right\nclinically setting.\n2. A tiny non-obstructing sub-millimeter stone is seen in the lower pole of\nthe left kidney.\n3. Diverticulosis of the sigmoid colon without evidence of diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.Coronary artery calcifications are\npartially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. An\n8 mm hypodensity within segment 6 (02:54) is unchanged from prior and likely\nrepresents a cyst there is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post placement of double-J stent with the superior\nloop terminating within the left upper pole calyx and the inferior loop\nterminating appropriately within the bladder. Nonobstructing stones are\ndemonstrated in the lower pole left kidney measuring up to 9 mm (02:63) the\nkidneys are of normal and symmetric size. A right renal cystic lesion\nmeasures 1.6 cm and is unchanged from prior. There is no hydronephrosis and\nonly mild left renal pelvis dilation remains. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is re-demonstrated. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes visualized throughout the imaged\nportion of the thoracolumbar spine without evidence of worrisome osseous\nlesions or acute fracture..\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post placement of left-sided double-J stent with note of a proximal\nloop that terminates within a left upper pole calyx. Interval resolution\npreviously demonstrated hydronephrosis with only mildly dilated left renal\npelvis remaining.\n2. Nonobstructing left renal calculi measuring up to 9 mm, in the lower pole." }, { "input": "LOWER CHEST: Bibasilar dependent atelectasis is moderate in the partially\nimaged lower lungs. No pleural effusion or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: An 18 mm discontinuous nodular enhancing lesion in hepatic\nsegment 2 is consistent with a hemangioma, unchanged (series 2, image 17). \nThe remaining liver demonstrates homogenous attenuation throughout. No\nevidence of new focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Small amounts of\ncolonic diverticulosis is seen in the descending and sigmoid colon. No\nevidence of diverticulitis. The rectum is within normal limits. The appendix\nis normal. No bowel obstruction. No drainable intra-abdominal fluid\ncollections. No free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is not enlarged.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No calcified atherosclerotic disease\nis noted.\n\nBONES: Tiny sclerotic lesion in the right iliac is unchanged, likely bone\nisland (series 2, image 68). Areas of sclerosis in the left iliac are\nunchanged most in the most recent exam, but as noted on the prior exam, new\nfrom ___. A mild broad-based disc bulge at L4-L5 flattens the anterior\nthecal sac, unchanged (series 602, image 30; series 2, image 56). Bilateral\nL4-L5 neural foraminal narrowing is mild-to-moderate.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute process in the abdomen or pelvis to explain the patient's\nsymptoms.\n2. Unchanged hepatic hemangioma." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows mildly increased size, measuring 13 cm, and normal\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n1.5 x 1.1 cm exophytic lesion of the upper pole of the left kidney is of\nintermediate density, which could be further assessed on outpatient renal\nultrasound. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. 7.2 x 7.2 x 7.9 cm\nheterogeneous, soft tissue density mass appears to arise from mesentery in the\nlateral left mid abdomen. There is mild surrounding fat stranding. \nDifferential diagnosis includes desmoid tumor which is benign, versus other\nmesenteric tumors or even GIST.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small 2\nmoderate amount of simple appearing free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Hypoattenuation of the anterior portion of the uterus\nmeasuring 1.8 x 2.0 cm likely represents intramural fibroid. Follicular\nactivity is seen in the left ovary.\n\nLYMPH NODES: Multiple prominent subcentimeter mesenteric lymph nodes are not\npathologically enlarged. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 7.2 x 7.2 x 7.9 cm heterogeneous, soft tissue density mass appears to arise\nfrom the mesentery in the mid left abdomen. There is mild surrounding fat\nstranding. Finding is concerning for mesenteric neoplasia, including desmoid\ntumor, which is benign versus other mesenteric tumors or even GIST.. Small to\nmoderate amount of free fluid in the pelvis. Multiple prominent but not\npathologically enlarged mesenteric lymph nodes..\n2. 1.1 x 1.5 exophytic lesion in the upper pole left kidney of intermediate\ndensity. Nonurgent renal ultrasound would further assess..\n3. Mild splenomegaly.\n4. Fibroid uterus.\n\nRECOMMENDATION(S): Recommend considering MRI versus tissue sampling of left\nmid abdomen mass.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 5:20 pm, 5 minutes after discovery of\nthe findings." }, { "input": "CT OF THE ABDOMEN AND PELVIS WITHOUT IV CONTRAST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nNoncontrast enhanced views of the liver are within normal limits. No\nconcerning hepatic mass is detected. There is no intra or extrahepatic bile\nduct dilation. A sub-3-mm gallstone is again seen (series 2 image 64).\n\nThe spleen, adrenal glands, right kidney, pancreas, stomach, and\nintra-abdominal loops of small and large bowel remain within normal limits. \nThere is no mesenteric or retroperitoneal lymphadenopathy, and no ascites. \nThe appendix is normal (series 2 image 90).\n\nSevere left hydronephrosis with a markedly thin renal cortex is unchanged in\nconfiguration since the ___ CT, without left ureteral dilation,\nmost compatible with chronic left UPJ obstruction(series 2 image 73). The\nbladder is collapsed, limiting its evaluation, but appears within normal\nlimits. Tiny foci of dependent-layering calcifications are again seen within\ndilated calices (image 72, 76).\n\nThe rectum and intrapelvic loops of small and large bowel remain within normal\nlimits. The patient is post hysterectomy. No concerning adnexal masses are\ndetected.\n\nModerate atherosclerotic calcifications are again seen throughout the\nabdominal aorta branches, without aneurysm.\n\nThere are no osseous lesions concerning for malignancy or infection. Mild\nlevoscoliosis cenetered about the lumbar spine and moderate degenerative\nchanges are stable since ___. A midline fat-containing ventral hernia, 8.4\ncm superior to the umbilicus, measures approximately 3.8 x 1.7 cm axially\n(series 2 image 57), protruding through a 1.5 cm fascial defect.", "output": "1. Severe left hydronephrosis, reflecting chronic UPJ obstruction, remains\nunchanged since ___. The right kidney is normal. The bladder is\nunderdistended, limiting evaluation, but remains within normal limits.\n2. Cholelithiasis.\n3. Unchanged small fat-containing midline ventral hernia, approximately 8.4\ncm superior to the umbilicus, via a 1.5 cm fascial defect." }, { "input": "Overall evaluation partially limited by streak artifact from spinal hardware\nfor severe scoliosis. With this limitation:\n\nLOWER CHEST: Mild bibasilar atelectasis. There is no evidence of pericardial\neffusion. There is a small left pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.1 x 1.5 cm hypodense lesion in the left lower renal pole with ___\nof 14, likely a renal cyst (300; 28). No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Large hiatal hernia. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. There is a stool\nball in the rectum measuring up to 5.5 cm in diameter. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen. There is mild pelvic floor descent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Severe scoliosis of the thoracolumbar spine status post fusion with\nlaminectomy and bilateral rods and pedicle screws. No evidence of\nperihardware loosening or fracture. Small amount of fluid and stranding in\nthe posterior paraspinal muscles consistent with expected postoperative\nchanges.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process to explain patient's abdominal pain.\n2. Large hiatal hernia.\n3. Large stool ball in the rectum.\n4. Small left pleural effusion.\n5. Small amount of fluid and subcutaneous stranding in the paraspinal muscles\nconsistent with expected postoperative changes." }, { "input": "LOWER CHEST: Visualized lung fields are grossly within normal limits. There is\nno evidence of pleural or pericardial effusion.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder demonstrates cholelithiasis\nwithout evidence of acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. \nMultiple bilateral renal cysts are noted. There are no urothelial lesions in\nthe kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A large stomach-containing hiatal hernia is again noted,\nincreased in size from the prior examination. A potential gastric\ndiverticulum is noted within the hernia.\n\nThe patient is status post small bowel resection with side-to-side anastomosis\nwith severe dilation noted at the anastomotic site. Additionally, there is a\nsmall bowel obstruction seen distal to this anastomosis with a transition\npoint noted in the left mid abdomen (___:13, ___:48), with adjacent fat\ninduration seen in the mesentery. The small bowel proximal to this transition\npoint is dilated up to 3.5 cm, with a relatively collapsed large bowel seen\ndistally. There is no evidence of overt perforation.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The uterus contains fibroids. The urinary bladder and distal ureters\nare unremarkable. There is no evidence of pelvic or inguinal lymphadenopathy.\nThere is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:Degenerative changes are seen in the lumbar spine. No\nsuspicious osseous lesion is identified. A metallic surgical mesh overlies\nthe lower abdomen.", "output": "1. Small bowel obstruction distal to an enteric anastomotic site with a\nsingle transition point noted in the left mid abdomen. No evidence of\nperforation.\n2. Large, stomach-containing hiatal hernia.\n3. Cholelithiasis without evidence of acute cholecystitis.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ Dr. ___ telephone\nat 08:15 on ___." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder demonstrates a punctate\nstone.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. 11 mm left\nadrenal nodule in the medial limb is unchanged (04:50).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimple right upper pole renal cyst measures 2.0 cm. There is no evidence of\nfocal solid renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a small\njuxtapapillary duodenal diverticulum. A loop of bowel in the high right\npelvis demonstrates mild wall thickening (4:85), likely within the port of\nradiation. Remainder of the small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. There is trace diverticulosis\nwithout evidence of diverticulitis. The colon and rectum are otherwise within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Mild fat stranding and soft tissue prominence at\nthe residual vaginal cuff appears unchanged compared to the prior exam.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nPreviously identified enlarged right external iliac chain pelvic sidewall\nlymph node has resolved. There is no inguinal or pelvic sidewall\nlymphadenopathy by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval resolution of right pelvic sidewall lymphadenopathy.\n2. Unchanged, nonspecific fat stranding and soft tissue prominence at the\nresidual vaginal cuff which may represent posttreatment change.\n3. Mild wall thickening of a single loop of small bowel in the right\nhemipelvis, which may represent post radiation change.\n4. Otherwise no new focus of metastasis in the abdomen or pelvis.\n5. Stable 11 mm left adrenal nodule.\n6. Cholelithiasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Punctate calcification within the expected location of the distal\nright ureter (series 3, image 74). No hydronephrosis. Additional punctate\nnonobstructing stones within the kidneys bilaterally (series 3, image 36 and\nseries 602, image 56). The kidneys are of normal and symmetric size. There\nis no evidence of focal renal lesions within the limitations of an unenhanced\nscan. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. punctate (2mm) calcification within the expected location of the distal\nright ureter near the UVJ. No hydronephrosis.\n\n2. additional punctate non-obstructing stones within the kidneys bilaterally." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic with cortical thinning bilaterally. There\nis a 4 mm nonobstructive calculus within the right lower renal pole (02:48),\nunchanged in appearance since ___. There is no evidence of focal\nrenal lesions within the limitations of an unenhanced scan. There is a 2.9 cm\nexophytic simple cyst at the left upper renal pole (02:41). Additional\nsubcentimeter hypodensities in the left kidney are too small to characterize,\nhowever likely compatible with simple renal cysts. There is no hydronephrosis\nor hydroureteronephrosis. Minimal perinephric stranding bilaterally is\nunchanged appearance since ___.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. A duodenal diverticulum is\nunchanged. Extensive diverticulosis of the colon is noted, without evidence\nof wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild multilevel degenerative change of the thoracolumbar spine\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.", "output": "1. No evidence of hydronephrosis or obstructive renal calculus. 4 mm\nnonobstructive calculus in the right lower renal pole is unchanged in\nappearance since ___.\n2. Diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal at its mid to distal\nportion and tip though at its base appears prominent size measuring up to 1.0\ncm in diameter (2:62, 602:37. There is questionable adjacent stranding near\nits base. No extraluminal collection nor extraluminal air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. A 1.6 cm left adnexal cyst\nis likely physiologic given the patient's age. Multiple subcentimeter\nfollicles are seen in the right ovary.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. A retroaortic left renal vein is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "The base of the appendix and its proximal portion are prominent in size\nmeasuring up to 1 cm in diameter with questionable adjacent fat stranding. \nDistally and at its tip the appendix is normal. Findings are equivocal for\nmild or early acute appendicitis.\n\nNOTIFICATION: Change in wet read was discussed with doctor ___ by Dr.\n___ at 19:00 on the day of the exam." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Stable 2.2 x 2.5 cm hyperattenuating lesion in segment 8 of the\nliver, previously characterized as an area of focal nodular hyperplasia. \nStable 1.1 cm hemangioma in segment 7. There are no new liver lesions. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nuncomplicated diverticulosis of the sigmoid and descending colons. The\nappendix is unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias.", "output": "1. Stable focus of focal nodular hyperplasia in the liver, with a small\nadjacent hemangioma.\n2. No new lesions in the abdomen and pelvis. There is no mesenteric or\nretroperitoneal lymphadenopathy.\n3. Uncomplicated diverticulosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Patient is status post\ndual-chamber pacemaker placement. Similar-appearing 3 epicardial lymph nodes\nare again noted, measuring 1.6 x 1.3 cm, 6 mm, 6 mm (series 3b, image 130,\n123, 122).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is enlarged. There are multiple hypodensities in the\nliver, the largest measuring 0.8 cm in segment III. The heterogeneous mass in\nthe right lobe measures 14.4 x 10.7 x 14.3 cm, and appears more hypodense\ncompared to prior exam, consistent with treatment effect. There is a small\nfocus of air within the mass (series 6, image 17). Again noted are\npersistently hyperdense areas in segment II and IVb on portal venous and\ndelayed phase, likely representing a perfusion abnormality or flash filling\nhemangioma. There is mild intrahepatic biliary dilatation. Patient is status\npost cholecystectomy. There is small foci of air within the cystic duct which\nis most likely related to prior instrumentation. Common bile duct is mildly\ndilated at 15 mm (series 3b, image 170). Portal caval nodes are enlarged up\nto 1.5 cm (series 3b image 168). Portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout. Again seen is a 9\nmm hypodensity in the body of the pancreas, most likely representing IPMNs\nwhich is stable from previous exam (series 3b, image 173). Main pancreatic\nduct measures 3 mm. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There are multiple hypodensities in the spleen,\nthe largest measuring 1.1 cm (series 3 B, image 133), which are filled in\ndelayed phase, most likely representing hemangioma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAgain seen are the nonobstructing renal stone in the lower pole of the right\nkidney (series 2 image 40) and a smaller nonobstructing stone on the left\nkidney (series 2, image 42). There are multiple hypodensities in kidneys\nbilaterally that are too small to characterize by CT. There is no\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: A large paraesophageal hernia is again seen. Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout. \nThere is diverticulosis without evidence of diverticulitis in the sigmoid and\ndescending colon The appendix contains air and has normal caliber without\nevidence of fat stranding. There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries. Multiple venous collaterals\nare seen in the subcutaneous layer of the lower abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES Again seen are 2 soft tissue nodules in the posterior\nabdominal wall, measuring 11 and 15 mm (series 3, image 49 and 53) appears\nunchanged from prior exam and likley represent seeding.. Multiple metal clips\nare seen anterior to the pelvis.", "output": "1. Enlarged liver with heterogeneous mass measuring up to 14.4 x 10.7 x 14.3\ncm. The liver appears more necrotic compared to previous study, most likely\ntreatment related.\n2. Similar appearance of the portacaval and epicardial lymph nodes, and soft\ntissue nodules in the posterior right chest wall, representing metastasis.\n3. Stable appearing 9 mm pancreatic body hypodensity.\n4. 2 soft tissue nodules in the posterior abdominal wall, measuring 11 and 15\nmm (series 3, image 49 and 53) appears unchanged from prior exam and likley\nrepresent seeding. from a prior percutaneous procedure (these preceeded the\nrecent US-guided liver biopsy perfomed at tis institution)." }, { "input": "LOWER CHEST: The nodular appearance with scarring in the left lower lobe is\nstable.. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of solid focal lesions. Again seen are innumerable\nlow-attenuation lesions scattered throughout the level of which is stable in\nsize and appearance. The hepatic artery and portal veins are widely patent. \nThe hepatic veins have a normal appearance. The liver parenchyma appears\nnormal. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding. Calcifications are noted in the splenic artery.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Specifically there is no splenomegaly. A tiny\nsplenule is present in the splenic hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nExtensive degenerative changes noted in the lumbar spine disc spaces.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Stable low-attenuation lesions scattered throughout liver.\n2. No splenomegaly.\n3. Stable nodular scarring in left lower lobe of lung" }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings including left lower lobe pleural-based\nopacity.\n\nAbdomen/pelvis:\n\nScattered subcentimeter hypodensities in the liver hepatic parenchyma are\nunchanged compared CT ___ and likely represent cysts versus small\nhamartomas. There is no intrahepatic or extrahepatic biliary ductal\ndilatation. The gallbladder is within normal limits. The spleen is not\nenlarged. There is no evidence of pancreatic mass or pancreatic ductal\ndilatation.\n\nThe adrenal glands are unremarkable. There is symmetric renal enhancement and\nexcretion of intravenous contrast. There is no evidence of renal mass or\nhydronephrosis. Urinary bladder is moderately distended and without gross\nabnormality.\n\nThere are no dilated loops of bowel. Suture material at the rectosigmoid\njunction is unchanged in appearance. There are no dilated loops of bowel.\nThere are scattered descending and sigmoid colonic diverticula without\nevidence of diverticulitis. There is no evidence of bowel wall thickening.\n\nThere is mild atherosclerotic calcification of the abdominal aorta without\nevidence of aneurysmal dilatation. There are no enlarged inguinal, iliac\nchain, or retroperitoneal lymph nodes.\n\nThere is no suspicious osseous lesion. Anterior flowing osteophytes of the\nthoracic spine are suggestive of DISH.", "output": "1. No evidence of recurrent or metastatic disease in the abdomen or pelvis.\n2. Unchanged hepatic hypodensities, consistent with cysts.\n3. Please see same day CT chest dictation for dedicated thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: 3 hypodensities are noted within the liver, largest measuring 1\ncm in segment 8. These are unchanged from prior exams and had the appearance\nof simple cysts on MRI. No new or suspicious hepatic lesion.\n\nThe gallbladder and biliary tree are within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Surgical bowel sutures are noted within the distal\nsigmoid/rectum, otherwise the visualized small and large bowel loops are\nwithin normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of recurrent or metastatic disease within the abdomen or\npelvis. Please see seen the CT for details on thoracic findings. ." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered small hypoattenuating foci in the liver, for example a 1.1 cm lesion\nin segment VIII (series 5:47) and a 0.7 cm lesion in segment VI (series 5:59)\nare stable dating back to at least ___ and likely represent biliary\nhamartomas or cysts. There is no suspicious hepatic lesion. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are a few\nsigmoid colonic diverticula. Again noted is an anastomotic suture line in the\nrectum. The appendix is normal.\n\nPELVIS: There is circumferential wall thickening of the bladder with mild\nstranding anteriorly, suggestive of cystitis. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent. There is no adnexal\nmass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel spinal degenerative changes.\n\nSOFT TISSUES: There are incisional changes along the anterior midline pelvic\nwall.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Circumferential wall thickening of the bladder with mild stranding\nanteriorly, suggestive of cystitis. Correlation with clinical symptoms and\nurinalysis is recommended.\n3. Please refer to dedicated CT chest report on same day for intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple small scattered hypoattenuating foci in the liver,\nmeasuring up to 1.1 cm in the right hepatic lobe, are stable dating back to\n___, likely hepatic cysts or biliary hamartomas. Otherwise, the liver\ndemonstrates homogenous attenuation throughout. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Postsurgical\nchanges seen following sigmoid colectomy. A few scattered diverticula are\nseen throughout the colon without evidence of acute diverticulitis. The\nremaining colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are resected.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen along the visualized spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Postsurgical changes seen following sigmoid colectomy. No evidence of\nmetastatic disease in the abdomen or pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "Substantial atelectasis involving the basilar right lower lobe. More minor\natelectasis involving the right middle lobe, lingula and left lower lobe. \nSmall new right-sided pleural effusion since the prior CT.\n\nHypoattenuating liver suggests hepatic steatosis. No focal liver lesions are\nidentified. There is no biliary dilatation. Patient is status post\ncholecystectomy. Pancreas appears normal. Spleen is normal in size and\nappearance. Adrenals are unremarkable. Kidneys appear normal without\nevidence for stones, solid masses, perfusion defects or hydronephrosis.\n\nStomach is non-distended. Proximal through mid small bowel is mildly\ndistended, fluid-filled and dilated, measuring up to 34 mm in diameter. Bowel\nmakes an turn in the anterior upper pelvis (2:67 and 601:23) and after that is\ngenerally speaking almost fully collapsed. Colon is largely empty aside from\nsmall quantities of fluid in the cecum and rectum. Patient is status post\nrecent appendectomy.\n\nUterus and adnexa appear normal. Right hydrosalpinx is no longer found. \nThere is trace ascites in the pelvis. Known uterine fibroids are not entirely\ndelineated although a left uterine body fibroid appears intramural measuring\nabout 34 mm, similar to prior findings. There is no free fluid or organized\nfluid collection. No lymphadenopathy. Major vascular structures appear\nwidely patent.\n\nThere are no suspicious bone lesions. Mid through lower thoracic interspaces\nshow mild degenerative changes.", "output": "Dilated proximal through mid small bowel with the distension in fluid. \nRelative transition in caliber to collapsed distal small bowel. Largely empty\ncolon. Findings could be seen with some degree of small bowel obstruction\nalthough transition is not very abrupt. Ileus could also be considered\nparticularly noting the clinical context. Short-term follow-up radiographs\nmay be helpful in addition to correlation with clinical findings.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:30 pm." }, { "input": "LOWER CHEST: Compared with CT chest on ___, small bilateral\nnonhemorrhagic pleural effusions are decreased in size. There is bibasilar\natelectasis. Coronary artery and aortic valve calcifications are partially\nvisualized. There is no pericardial effusion. A central venous catheter is\npartially the visualized, terminating in the right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A\ncalcified granuloma is again noted in the right hepatic lobe. There is no\nevidence of focal lesions within the limitations of an unenhanced scan. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is not visualized.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions within\nthe limitations of an unenhanced scan. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post left iliac fossa renal transplant. There is\na new faint hyperdensity in transplanted kidney, may represent a 5 mm\nnonobstructing stone (2:57). A failed right lower quadrant renal transplant\nis again noted with calcification. The native kidneys are atrophic, with\nunchanged extensive vascular calcifications. There is no evidence of focal\nrenal lesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Surgical clips adjacent to the distal esophagus are likely\nrelated to prior hiatal hernia surgery. Patient is status post PEG tube\nplacement with expected trace amount of pneumoperitoneum. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon is within\nnormal limits. A rectal tube is present. The appendix is not visualized. \nThere is no intra-abdominal or pelvic hematoma.\n\nPELVIS: A Foley catheter is present in the bladder which contains a small\namount of air. The distal ureters are unremarkable. There is a small amount\nof presacral edema.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: The bones are diffusely heterogeneous in appearance, similar to priors\nand consistent with renal osteodystrophy. A superior endplate compression\ndeformity of the L5 vertebral body is similar to prior. Vertebral body height\nloss and fusion from T8- T10 is not significantly changed compared with\n___. There is no new fracture.\n\nSOFT TISSUES: There is diffuse subcutaneous edema.", "output": "1. A PEG tube appears appropriately positioned in the stomach, with trace\nexpected pneumoperitoneum. No evidence of intra-abdominal or pelvic hematoma.\n2. A new faint hyperdensity in the left iliac fossa transplanted kidney may\nrepresent a 5 mm nonobstructing renal stone.\n3. Interval decrease in size of small nonhemorrhagic bilateral pleural\neffusions and adjacent atelectasis.\n4. Diffuse anasarca." }, { "input": "LOWER CHEST: Atelectasis seen in the lung bases dependently. There is no\nevidence of pleural or pericardial effusion. Coronary artery and mitral\nannular calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is not visualized.\n\nPANCREAS: The pancreas appears atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The bilateral native kidneys appear atrophic, in keeping with\nend-stage renal disease. There are areas of relative ___ of the\nleft iliac fossa transplant kidney (7b:30 AP: 57. There is also urothelial\nwall thickening, involving the renal pelvis and the ureter throughout its\ncourse, particularly at its insertion on the bladder. There is no evidence of\nhydronephrosis or focal lesion. A right iliac fossa field transplant kidney\nis again seen with calcifications, unchanged from prior exam.\n\nGASTROINTESTINAL: Surgical clips are noted at the gastroesophageal junction. \nSmall hiatal hernia is also noted. A PEG tube is seen terminating in the\nstomach, appropriately placed. Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is normal. There has been interval removal of a\nrectal tube since ___.\n\nPELVIS: The urinary bladder and native distal ureters are unremarkable. \nDistal ureteral wall thickening of the left iliac fossa transplant kidney is\nagain seen with surrounding stranding. Wall thickening of the left\nposterolateral aspect of the bladder is also noted. There is no free fluid in\nthe pelvis. Surgical clips are seen in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Diffuse osseous heterogeneity is in keeping with renal osteodystrophy. \nMultiple compression deformities are seen in the vertebral bodies, unchanged\nsince the prior study in ___, notably worse at the T9 level.\n\nSOFT TISSUES: Multiple foci of edema are seen in the subcutaneous tissues of\nthe lower abdomen, compatible with injection sites.", "output": "1. Areas of ___ of the left iliac fossa renal transplant worrisome\nfor pyelonephritis. Wall thickening of the collecting system and ureter as\nwell as wall thickening of the left posterolateral aspect of the bladder\nsuggesting pyelitis/cystitis.\n2. No other acute CT findings in the abdomen or pelvis. Specifically, no\nevidence of obstruction or colitis.\n3. Unchanged appearance of diffuse osseous heterogeneity, in keeping with\nrenal osteodystrophy.\n\nNOTIFICATION: The updated findings were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 7:01 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are notable for bibasilar atelectasis. \nThere is 0.8 x 0.7 cm left lower lobe rounded opacity may represent an area of\natelectasis however pulmonary nodule would be similar in appearance (02:17). \nNo pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is not visualized.\n\nPANCREAS: There is fatty replacement of the pancreas. No focal lesions within\nthe limitations of a nonenhanced study. No pancreatic duct dilatation. No\nperipancreatic fat stranding. No pancreatic calcifications.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Native kidneys are atrophic. The left iliac transplant kidney is\nunchanged in morphology and appearance since prior examination. Again seen\nare few punctate nonobstructing stones within the left lower pole measuring up\nto 0.3 cm within the transplant kidney. There is a diminutive failed right\nrenal transplant which is unchanged in appearance (2:67). There is no\nevidence of focal renal lesions within the limitations of an unenhanced scan. \nThere is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Again seen are surgical clips at the gastroesophageal\njunction. There is a persistent small epiphrenic diverticulum. Stomach is\nunremarkable. A gastrostomy tube is again noted and unchanged in appearance\nsince prior examination. Small bowel loops demonstrate normal caliber and\nwall thickness throughout. The colon and rectum are within normal limits. \nRectal tube noted. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus not visualized. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted.\n\nBONES: Again seen is diffuse heterogeneity of the osseous structures\nconsistent with history of renal osteodystrophy. A nondisplaced chronic right\ninferior pubic rami fracture as well as a subacute right superior pubic rami\nfracture noted. No interval change in a 1 cm lucency within the left\nacetabulum. Previously described moderate compression deformity of the T9\nvertebral body is unchanged since prior. No retropulsion. No acute fracture.\n(2:85).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No fluid collection within the abdomen or pelvis.\n2. 0.8 cm left lower lobe opacity, likely round atelectasis.\n3. Chronic moderate T9 compression deformity. No retropulsion.\n4. Findings suggestive of renal osteodystrophy.\n5. Nonobstructing stones within left iliac fossa transplant kidney. No\nhydronephrosis." }, { "input": "LOWER CHEST: Small bilateral pleural effusions. Bibasal atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is not visualized.\n\nPANCREAS: The pancreas appears diffusely atrophic. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic bilaterally. Note is made of a left\nlower quadrant transplant kidney. Nonobstructing calculi are noted within the\ninterpolar region and lower pole of the transplant kidney. Calcified right\nlower quadrant renal transplant appears unchanged in comparison to previous. \nThere is no evidence of focal renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: There are surgical clips at the esophageal hiatus. Patient\nthere is a gastrostomy tube in situ. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is surgically absent. Small volume free\nfluid is noted adjacent to the splenic flexure.\n\nPELVIS: The bladder is nondistended with a Foley catheter in situ. Gas within\nthe bladder lumen is likely post catheterization. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes with bi concave multilevel compression\nfractures appear similar to previous.\n\nSOFT TISSUES: Mild subcutaneous edema involving the soft tissues of the lower\nabdominal wall.", "output": "1. No evidence of mechanical bowel obstruction. In particular, no evidence of\ncecal volvulus.\n2. Small bilateral pleural effusions and mild subcutaneous body wall edema,\nsuggestive of fluid third-spacing.\n3. Stable appearance of left lower quadrant transplant kidney, with\nnephrolithiasis. Calcified prior right lower quadrant transplant kidney\nappears unchanged." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis and trace bilateral pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is contracted with trace\npericholecystic fluid. No evidence to suggest cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged measuring up to 17 cm. There is no\nevidence of focal splenic lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSmall cortical hypodensity in the left kidney at the lower pole is too small\nto fully characterize but likely represents a simple renal cyst. No evidence\nof hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Trace free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Expected postpartum appearance of the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic process to account for patient's\nsymptoms.\n2. Splenomegaly measuring up to 17 cm." }, { "input": "Bilateral mild atelectasis, unchanged from previous.\n\nThe upper abdominal organs are unchanged. There is vicarious excretion of\ncontrast within the gallbladder. No significant change in a ventral hernia\nwith evidence of prior repair, which again is seen containing a non-obstructed\nloop of small bowel. There is no intestinal obstruction or free air.\n\nAgain seen is a small amount of pelvic hemorrhage, as seen in the presacral\nspace, with no significant change. There are no significant changes in\nmultiple displaced pelvic fractures. No new retroperitoneal hemorrhage.", "output": "Redemonstration of multiple pelvic fractures and small amount of pelvic\nhemorrhage. No new retroperitoneal hemorrhage." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas appears atrophic, without evidence of focal lesions\nwithin the limitations of an unenhanced scan. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Evaluation of the ureteral lumen is limited on this unenhanced exam. \nPatient is status post left nephroureteral stent placement which is seen\nterminating in the collapsed bladder, similar to the prior study from ___. Mild left hydroureteronephrosis is also unchanged. However, there is\nnew right mild-to-moderate hydroureteronephrosis which extends along the\nproximal to mid right ureter, to the level of the right iliac bifurcation\n(3:102). Increased soft tissue attenuation and mild fat stranding at this\nlevel may represent enlarging lymph nodes with resultant compression of the\nmid-ureter. The insertion site of the right ureterovesical junction is\ndifficult to assess due to streak artifact. Fat stranding is seen along the\ncourse of both ureters, mild on the right and moderate on the left. A 6 mm\nnonobstructive renal stone is unchanged in the right lower renal calyx\n(05:58).\n\nGASTROINTESTINAL: The stomach is unremarkable. A surgical anastomosis is\nseen in the right lower quadrant. The remaining small bowel loops, colon, and\nrectum are within normal limits. The appendix is not visualized likely\nsurgically resected.\n\nPELVIS: The urinary bladder appears decompressed. There are a few associated\nprominent lymph nodes adjacent to the bladder, measuring up to 13 mm (3:123). \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is obscured by streak artifact.\n\nLYMPH NODES: There is similar appearance of enlarged left para-aortic lymph\nnodes, measuring up to 14 mm (3:66). There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The infrarenal abdominal\naorta and iliac vessels appear ectatic. Mild atherosclerotic disease is\nnoted.\n\nBONES: The patient is status post bilateral hip replacements. Extensive streak\nartifact from the bilateral hip prosthesis limits assessment of adjacent\nstructures, namely the bladder.\n\nSOFT TISSUES: Note is made of a fat containing umbilical hernia.", "output": "1. Limited evaluation on an unenhanced study. New right mild-to-moderate\nhydroureteronephrosis is seen extending to the mid right ureter at the level\nof the right iliac bifurcation, possibly from new intraluminal mass vs\nextrinsic compression from enlarging lymph nodes vs UVJ obstruction from\nbladder cancer.\n2. Left nephroureteral stent is in unchanged position with persistent\nthickening of the left ureter and associated periureteral stranding. Stable\nmild left hydroureteronephrosis.\n3. Similar appearance of enlarged left para-aortic lymph nodes, measuring up\nto 14 mm.\n\nRECOMMENDATION(S): A dedicated MR ___ can be obtained to evaluate for\npossible ureteral mass." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nImage coregistration errors limit evaluation of the upper abdomen with coronal\nand sagittal reformations.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys contain several subcentimeter hypodensities,\nstatistically most likely cysts. Arising from the posterior interpolar aspect\nof the left kidney is a well-circumscribed 17 x 15 mm exophytic simple cyst\n(series 602, image 31).\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. Appendix contains air, has normal caliber without evidence of fat\nstranding.\nRETROPERITONEUM: There is no retroperitoneal or mesenteric lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is mild calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: The patient is post hysterectomy. Bilateral ovarian cysts\nmeasure 10 mm on the left and 14 mm on right (series 602, image 54).\n\nBONES AND SOFT TISSUES:\nThere is no worrisome lesion. Abdominal and pelvic wall is within normal\nlimits.", "output": "1. No intra-abdominal or intrapelvic mass correlating to the known right\ncerebellar mass. No intra-abdominal or intrapelvic lymphadenopathy.\n2. Left and right ovarian cysts measure 10 mm and 14 mm, respectively. No\nconcerning adnexal mass. These can be reassessed in ___ months with a pelvic\nultrasoud." }, { "input": "LOWER CHEST: The lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are two subcentimeter hepatic cysts in segments VI and VII. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. Multiple\nair-containing stones are seen within the gallbladder (01:23). There is no\npericholecystic fluid or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout. There is a 1.6 cm\ncystic lesion in the tail of the pancreas (01:27) and other scattered tiny\nhypodensities throughout the pancreas are most compatible with side-branch\nIPMNs, and better assessed on the prior MRI. No enhancing pancreatic lesions\nare identified. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. \nRe-demonstrated is a 16 mm cyst in the inferior most portion of the spleen\n(01:24)\n\nADRENALS: The right adrenal gland is unremarkable. The left adrenal gland\ndemonstrates nodular thickening, unchanged from prior.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRe-demonstrated are bilateral renal masses, which enhance heterogeneously\nsimilar to renal cortex, on the right measuring 2.2 x 3.2 x 4.4 cm, and on the\nleft measuring 4.6 x 3.6 x 3.9 cm, compatible with renal cell carcinoma. The\nmass on the right is located in the upper pole but extends into the renal\nsinus fat. The mass on the left is centrally located within the renal sinus. \nFiducial seeds are seen within the left mass. There is no evidence of renal\nvein invasion. These masses have not changed since the prior examination. \nBilateral renal cysts are also stable. There is no perinephric abnormality.\nThere are two left and one right renal arteries. A 2.2 x 1.2 cm right renal\nartery aneurysm just inferior to the mass remains unchanged from prior.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is no small or large\nbowel obstruction. There are scattered colonic diverticula, without evidence\nof acute diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple fibroids are seen within the enlarged uterus. \nNo adnexal masses are seen.\n\nLYMPH NODES: Again noted is a mildly enlarged right common iliac lymph node on\nseries 2, ___ 56 measuring 1.3 cm in short axis. Other nonenlarged\nretroperitoneal lymph nodes remain unchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: Mild anterolisthesis of L4 on L5 and L5 on S1 are noted. No suspicious\nfocal bony lesion or acute fracture is identified.\n\nSOFT TISSUES: There is a tiny fat-containing umbilical hernia.", "output": "1. Unchanged appearance of bilateral renal masses, compatible with renal cell\ncarcinoma. No vascular invasion.\n2. Unchanged 2.2 x 1.2 cm right renal artery aneurysm just inferior to the\nmass.\n3. Stable, mildly enlarged right common iliac lymph node. No other evidence\nof abdominopelvic metastases. No new lesions seen.\n4. Cholelithiasis." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis top-normal in size with areas of aortic valvular and mitral annular\ncalcification. No pleural or pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver contains several tiny hypodensities, previously\ncharacterized by MRI as simple cysts. No new liver lesion is seen. Main\nportal vein and central branches are patent. No biliary ductal dilation. The\ngallbladder contains numerous stones and there is no CT evidence for acute\ncholecystitis.\n\nPANCREAS: Several cystic lesions are noted within the pancreas, the largest of\nwhich is seen in the distal body on series 2, image 24 measuring 16 x 16 mm,\nunchanged from recent prior, better characterized on prior MR abdomen.\n\nSPLEEN the spleen is normal in size. A hypodensity along the inferior pole of\nthe spleen is unchanged, likely a simple cyst.\n\nADRENALS: Left adrenal gland appears thickened as on prior without frank\nnodule. The right adrenal gland is normal.\n\nURINARY: Kidneys enhance symmetrically and demonstrate prompt excretion of\ncontrast. Bilateral renal masses are re-demonstrated. The right renal mass\nis again seen arising from the upper pole measuring 3.3 x 4.9 x 3.6 cm \n(previously 3.2 x 4.7 x 3.5 cm). Again, this lesion appears to enhance\nheterogeneously and exert mild mass effect on the collecting system. Right\nrenal artery aneurysm along the inferior aspect of the mass is unchanged\nmeasuring approximately 1.7 x 1.2 x 2.0 cm. On the left, a mass is again seen\nin the interpolar region containing 2 fiducials. This lesion currently\nmeasures 3.6 x 4.4 x 5.0 cm (previously 3.5 x 4.3 x 4.7 cm). There is\nassociated mass-effect on the central renal pelvis. Several small cysts are\nnoted within the kidneys, the largest on the right measuring 1.6 x 1.7 cm. No\nevidence of vascular invasion.\n\nGASTROINTESTINAL: The stomach is decompressed. The duodenum is normal. \nImaged small and large bowel loops are unremarkable. No free air or free\nfluid is seen.\n\nLYMPH NODES: No lymphadenopathy within the imaged portion of the abdomen.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPartially visualized facet arthropathy is noted in the lower lumbar spine. \nThere is grade 1 anterolisthesis of L4 relative to L5 which appears unchanged\nfrom the prior exam.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Bilateral renal masses, consistent with renal cell carcinoma. Marginal\nincrease in size compared with prior. Fiducials again noted within the left\nrenal mass. No signs of vascular invasion.\n2. Size stable right renal artery aneurysm adjacent to the mass.\n3. Cholelithiasis without evidence of cholecystitis.\n4. Pancreatic cystic lesions, grossly unchanged, better characterized on prior\nMRI of the abdomen." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: 11 mm lesion at the hepatic dome (series 4, image 38) is\nmoderately decreased in size (previously 19 mm). An 11 mm hypodensity in\nsegment 5 (4, 49) previously measured 19 mm. Subcentimeter hypodensities in\nsegment 2 and 3 are compatible with simple cysts better evaluated on prior MR.\n\n___: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Asymmetric rectal\nwall thickening compatible with known malignancy is noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is focal ectasia of the infrarenal aorta measuring up to 2.2\ncm with chronic eccentric thrombus, unchanged (11, 38). Moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Known rectal cancer, better evaluated on MR. ___ decrease in two\nhepatic metastases. No new foci of metastatic disease." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple hypoattenuating liver lesions, measuring 1.9\ncm in segment 5 and 1.9 cm in segment 7 which appear ill-defined on the\ndelayed phase and are suspicious for hepatic metastases. Additional\nsubcentimeter lesions within segment 2 are too small to characterize. The\nliver parenchyma appears otherwise homogeneously enhancing. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\nunremarkable. There is thickening and hyper enhancement within the rectum\n(axial series 3, image 112) particularly along the posterior wall likely\ncorresponding to the patient's known primary malignancy. Note is made that a\nstaging MRI was performed same date which will be reported separately and\nwhich better characterizes the local staging for this lesion. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nSubcentimeter lymph node noted along the course of the superior rectal artery.\nthere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted with calcified and noncalcified plaque along the left lateral\nwall of the infrarenal abdominal aorta.\n\nBONES: Several sclerotic foci within the left femoral head and right pubic\nbone adjacent to the symphysis are nonspecific and may represent small bone\nislands. Peripherally sclerotic well-circumscribed lesion within the right\nproximal femur is nonspecific but has a nonaggressive appearance.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple hypodense hepatic lesions highly suspicious for metastatic\ndisease.\n2. Hyperenhancing mass within the rectum, better characterized on MRI\nperformed same day, reported separately.\n3. Moderate atherosclerotic disease within the infrarenal abdominal aorta." }, { "input": "LOWER CHEST: Please refer to the separately dictated report of CT chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen remains markedly enlarged measuring 22 cm (previously\nmeasured 20 cm. It again shows replacement with innumerable hypoenhancing\nareas of varying sizes.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nStable appearance of the small cortical cysts in the left kidney. There is no\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is markedly distended with normal wall thickness.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are again seen with\nmild interval decrease in size, index ones are described as below:\nPre aortic infrarenal (series 2, image 66) measuring 1.3 cm (previously 1.4\ncm).\nAortocaval (series 2, image 68) measuring 1.1 cm (previously 1.8 cm).\nAortocaval (series 2 image 70) measuring 1.4 cm (previously 1.5 cm).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Interval increase in the marked splenomegaly which shows multiple internal\nhypodense rounded foci. Multiple prominent retroperitoneal lymph nodes\nshowing slight interval decrease in size.\n\nUnderlying neoplastic process cannot be excluded." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2:61, 602b:23).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No appendicitis or other acute process in the abdomen or pelvis." }, { "input": "Visualized portions of the left lower lung demonstrate atelectasis. Visualized\nportions of the heart and pericardium are within normal limits.\n\nCT of the abdomen: The liver enhances homogeneously with no focal hepatic\nlesions identified. There is no intrahepatic biliary ductal dilatation. The\ngallbladder has been surgically removed. Surgical clips are seen in the right\nupper quadrant. The pancreas is normal. There is no pancreatic duct dilatation\nor peripancreatic fluid collections. The adrenal glands are normal. The\nspleen is homogeneous and normal in size. In the lower pole of the left\nkidney, there is redemonstration of a 3.4 x 2.4 cm hypodensity which measures\nup to 5 Hounsfield units, characterized as a complex cystic lesion on prior MR\nfrom ___ (series 5, image 41). Additionally, there is\nredemonstration of a 10 mm left peripelvic cyst. A small 6 mm exophytic\nlesion in the interpolar region of the left kidney is again seen, better\nassessed on prior MR, and suspicious for renal cell carcinoma (series 5, image\n36). The kidneys otherwise enhance symmetrically and excrete contrast without\nevidence of hydronephrosis. There is mild to moderate amount of perihepatic\nascites.\n\nThe stomach is normal. Patient is status post bilateral colectomy. Both right\nand left colonic anastomoses appear grossly intact. However, note is made of\nmultiple mildly dilated fluid filled loops of small bowel, measuring up to 3.7\ncm. No transition point is identified and fluid is seen in portions of the\ndistal colon. These findings could relate to ileus. Two foci of air are seen\nadjacent to the duodenum and could reflect a potential leak versus residual\npost-operative air (series 5, image 29). There is redemonstration of a 6.8 x\n4.7 cm fat attenuating lesion in the right upper quadrant (series 5, image\n29).\n\nSurrounding the duodenum, there is a well organized fluid collection with a\nmild hyperdense rim measuring 3.7 (TV) x 2.9 (AP) x 3.9 (CC) cm (series 5,\nimage 22; series 8, image 29). In the right paracolic gutter, there is an\nadditional new well organized and hypodense fluid collection with a hyperdense\nrim which abuts multiple loops of bowel and measures approximately 4.3 (TV) x\n3.2 (AP) x 9.3 (in coronal view) cm (series 5, image 37; series 7, image 28).\nLastly, there is a smaller hypodense fluid collection with a hyperdense rim in\nthe right lower quadrant, just inferior to the rectus sheath on the right\nwhich measures 5.2 x 1.0 cm (series 5, image 58). In the left upper quadrant,\njust inferior to the spleen, there is redemonstration of presumed surgical\nmaterial, possibly Surgicel, surrounded by a small amount of free fluid,\nmeasuring up to 3.9 x 3.2 cm (series 5, image 23).\n\nThe abdominal aorta is tortuous with moderate amount of atherosclerotic\ncalcifications. The celiac axis, SMA, bilateral renal arteries and ___ are\npatent. Along the anterior abdominal wall at midline, there is an open wound,\nwith surrounding fat stranding, likely related to recent surgery.\n\nCT of the pelvis: A moderate amount of air is seen in the urinary bladder,\nwhich could relate to recent instrumentation. There is redemonstration of a\nright bladder diverticulum which now contains a small amount of air (series 5,\nimage 80). Multiple surgical clips are seen in the pelvis, patient is status\npost prostatectomy. There is a moderate amount of low density attenuating\nfluid in the pelvis. The rectum is grossly intact. There are bilateral fat\ncontaining inguinal hernias. The one on the left contains a small\nunobstructed loop of bowel. Penile imlpants are in place.\n\nOsseous structures: No blastic or lytic lesion concerning for malignancy.\nMultilevel moderate degenerative changes are noted along the lumbar spine with\nanterior osteophytosis, multilevel vacuum disc phenomenon and endplate\nsclerosis.", "output": "1. Multiple new organized fluid collections within the abdomen as described\nabove, raising concern for abscess/infection.\n\n2. Two foci of air are seen adjacent to the duodenum, could reflect a\npotential leak versus residual post-operative air.\n\n3. Right and left colonic anastomoses appear grossly intact.\n\n4. Multiple fluid-filled dilated loops of small bowel with no definite\ntransition point identified and fluid seen in distal colon. Findings could\nrelate to postsurgical ileus.\n\n5. Moderate intra-abdominal ascites.\n\n6. 6.8 cm fat attenuating lesion in the right upper quadrant, for which\ndifferential diagnoses include lipoma versus low grade liposarcoma.\n\n7. Moderate amount of air seen within the urinary bladder, likely relates to\nrecent instrumentation. Correlation with history recommended.\n\n\nNOTIFICATION: Findings #1 and #3 were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 2:05 ___, 15 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Please refer to the separately dictated report of same day CT\nchest\n\nABDOMEN:\n\nHEPATOBILIARY: Evidence of prior orthotopic liver transplant. No discrete\nfocal lesions seen within the limitations of an unenhanced scan. There is\nintrahepatic or extrahepatic biliary dilatation. There is evidence of\npneumobilia in the left hepatic duct indicating patency of the hepaticoenteric\nanastomosis. The gallbladder is surgically absent.\n\nPANCREAS: Unenhanced appearance of the pancreas is grossly unremarkable.\n\nSPLEEN: The spleen is borderline enlarged measures 13 cm in the AP dimension..\n\nADRENALS: Unenhanced appearance is grossly unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel\nloops are normal in caliber. Evidence of colonic diverticulosis without\nevidence of acute diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative disc disease at L3-4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Multiple\nradiopaque densities seen underneath the anterior abdominal wall above the\npubic symphysis may represent prior abdominal wall repair.\n\nLOWER CHEST: Please refer to the separately dictated report of same day CT\nchest.", "output": "Within limits of an unenhanced CT, no evidence of a mass lesion or\nlymphadenopathy in the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Note is made of relative\nlow-density of the blood pool, suggesting anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post orthotopic liver transplant without\nevidence of complication on limited assessment. There is no evidence of focal\nlesions within the limitations of an unenhanced scan. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic, bilaterally. The patient is status post\nright renal transplant, which appears prominent and possibly edematous. There\nis a surgical drain at the inferior and medial aspect of the transplant. A\nurinary drain extends from the transplanted renal pelvis into the urinary\nbladder. At the medial aspect of the transplant there is a 7.6 x 4.1 x 12.7\ncm high density collection, concerning for hematoma. There is no definite\nsignificant compression of the transplanted kidney by the hematoma and mild\nsurrounding perinephric stranding, which extends into the abdominal wall\nmusculature and superficial soft tissues, is likely postoperative. Evaluation\nof the vascular anastomosis is limited without intravenous contrast.\n\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Heavy atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a re-demonstrated high density collection within the\nsuperficial soft tissues anterior to the pelvic wall musculature (series 2,\nimage 68), measuring up to 15.9 x 5.0 cm (series 601, image 16), compatible\nwith hematoma and increased from ultrasound ___ (Previously 3.4 x\n7.7 x 13.4 cm).", "output": "1. New large peritransplant hematoma at the medial aspect of renal transplant\nin the region of the vascular anastomosis. Evaluation of the transplant and\nthe vascular anastomosis is limited without intravenous contrast, however the\ntransplant kidney does appear prominent and possibly edematous. No definite\ncompression of the transplant kidney by the hematoma.\n2. Large superficial soft tissue anterior abdominal wall hematoma, appears\nmildly increased.\n3. Orthotopic liver transplant without evidence of complication.\n\nNOTIFICATION: The findings were discussed with the transplant surgery team by\n___, M.D. on the telephone on ___ at 5:21 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is evidence of prior orthotopic liver transplant. There\nis no intra or extrahepatic biliary duct dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas is atrophic. There is no pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic. Redemonstration of right lower\nquadrant renal transplant. There is mild fullness of the transplant\ncollecting system with a nephroureteral stent in place. A high-density fluid\ncollection at the medial aspect of the transplant kidney has decreased in\nsize, now measuring 5 cm (03:53). A right surgical drain remains in place\nwithinhematoma.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. There is a left iliopsoas\nhematoma measuring 8.7 x 6 cm (603:56). This is increased in comparison to\nthe prior examination.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A high-density collection within the superficial soft tissues\nanterior to the pelvic wall is similar in appearance to exam dated ___.", "output": "1. Redemonstration of a right lower quadrant renal transplant with decreased\nsize of the peritransplant hematoma at the medial aspect of the transplant.\n2. Stable appearance of a superficial anterior abdominal wall hematoma.\n3. Mild enlargement of a left iliopsoas hematoma.\n4. Stable appearance of the liver transplant.\n\nNOTIFICATION: The findings were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 4:14 pm." }, { "input": "LOWER CHEST:\nImaged lung bases are unremarkable without evidence of pulmonary nodule or\nmass. There is no pleural or pericardial effusion. Coronary artery\ncalcifications are dense.\n\nABDOMEN:\n\nHEPATOBILIARY: Postsurgical changes are consistent with provided history of\nhepatic transplantation. Few subcentimeter hypodensities scattered throughout\nthe liver are too small to accurately characterize but likely represent cysts\nversus biliary hamartomas. The liver otherwise demonstrates homogenous\nattenuation throughout. There is no evidence of suspicious focal lesion. \nThere is mild central biliary ductal prominence possibly edema with a biliary\nstent in the common duct. The gallbladder is surgically absent. There is\nmoderate volume simple ascites. Fluid collection in ___ pouch measuring\n2.6 x 4.7 cm may represent focal collection of ascites, seroma, or biloma\ncould have similar appearance. There is no evidence of active contrast\nextravasation or hematoma.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: Spleen is mildly enlarged measuring 13.1 cm. There is normal splenic\nparenchymal attenuation.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. There are descending and sigmoid colonic\ndiverticula without evidence of diverticulitis. Colon and rectum are otherwise\nwithin normal limits. The appendix is not visualized in this examination.\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy. There is no evidence of retroperitoneal hematoma.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. There are mild degenerative\nchanges of the lower lumbar spine. Abdominal and pelvic wall is within normal\nlimits.", "output": "1. No evidence of abdominal or retroperitoneal hematoma. No evidence of\nextravasation.\n2. Moderate volume simple ascites.\n3. Postsurgical changes consistent with provided history of hepatic\ntransplantation.\n4. Mild central biliary ductal dilatation.\n5. 2.6 x 4.7 cm fluid in ___ pouch may represent focal collection of\nascites, however seroma or small biloma could have similar appearance given\nrecent postoperative state.\n6. Diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: There is minimal atelectasis the dependent lung bases\nbilaterally. Trace left pleural effusion is noted. There is no right pleural\nor pericardial effusion. Low-density blood pool in the left ventricle\ncompared with intraventricular septal myocardium suggests anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is post liver transplantation. The transplanted\nliver is homogeneous in attenuation, with no focal lesions identified based on\nan unenhanced scan. Moderate volume upper abdominal perihepatic and\nperisplenic ascites is low-density, similar in extent compared to the prior\nCT. There is also a focal fluid collection and ___ pouch spanning\napproximately 3.8 x 2.6 cm (02:26), slightly decreased in size compared to the\nprior study. Moderate extra hepatic and intrahepatic biliary ductal dilation\nseen on prior is difficult to assess in the absence of intravenous contrast,\nbut appears overall similar compared to the prior study. There has been\ninterval removal of a common bile duct stent. The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is borderline enlarged, measuring up to 13.2 cm greatest\ncraniocaudal dimension (601b:38), unchanged. Splenic parenchymal attenuation\nis unremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Thickened folds in the\nascending colon are noted (601b:31, 2:39). Fluid adjacent to the ascending\ncolon is of low density (16.9 ___, and there is no evidence of leak of enteric\ncontrast, which reaches the level of the sigmoid colon. Numerous diverticula\nare noted throughout the sigmoid colon, with no evidence of diverticulitis. \nThe appendix is not visualized.\n\nPELVIS: Moderate volume pelvic free fluid is low-density. The urinary bladder\nis unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mesh repair of a right inguinal hernia is again noted.", "output": "1. No evidence of leak of enteric contrast or extraluminal air.\n2. Mucosal fold thickening in the ascending colon is likely related to recent\ncolonoscopy with thermal therapy of multiple angioectasias as described in the\ncolonoscopy report in the ___ medical record.\n3. Moderate volume simple abdominopelvic ascites.\n4. Focal fluid collection in Morison's pouch, possibly a seroma, slightly\nsmaller compared to the prior study.\n5. Sigmoid diverticulosis, with no evidence of diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are small bilateral fat containing inguinal hernias.", "output": "No acute intraabdominal abnormalities identified." }, { "input": "LOWER CHEST: Limited assessment of the lung bases demonstrates bilateral\nlower lobe atelectasis. Coronary artery calcifications are present. There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are again noted to be irregular in contour with several\nbilateral stones largest at the interpolar region of the right kidney\nmeasuring up to 2.4 cm with multiple additional stones measuring greater than\n1 cm in the upper and lower poles of the right kidney. Mild right\nhydronephrosis with mild right hydroureter is stable. The left kidney\ncontains a conglomerate of stones within the interpolar region measuring\napproximately 1.7 x 0.4 cm. Within the lower pole a 2.1 x 0.9 cm stone is\nnoted. There is progression of chronic left hydronephrosis which is now\nsevere with associated hydroureteronephrosis. A double-J stent starts in the\nmid left ureter and terminates in the bladder, unchanged in position since\nprior examination and approximately 7.5 cm from the left UPJ. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. A large amount of stool is seen\nwithin the rectum and sigmoid colon anteriorly displacing the bladder and\ndistal ureters. The colon is otherwise within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder is decompressed with a suprapubic catheter. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size.\n\nLYMPH NODES: Few prominent retroperitoneal lymph nodes largest measuring 1.6\nx 0.6 cm (02:49) within the left para-aortic region is noted. There is no and\nlarge retroperitoneal or mesenteric lymph nodes by CT size criteria. There is\nno pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: 2 densely sclerotic lesions measuring 1.2 x 0.8 and 0.5 x 1 cm (2:85,\n90) are stable and most consistent with bone islands. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small fat containing umbilical hernia is present. The\nabdominal and pelvic wall is within normal limits.", "output": "1. Progression of now severe left hydroureteronephrosis\n2. Double-J left ureteral stent with superior pigtail within the mid ureter\nand inferior pigtail within the bladder, unchanged since prior examination.\n3. Multiple bilateral renal calculi largest measuring up to 2.4 cm within the\nright kidney and 2.1 cm within the lower pole of left kidney.\n4. Stable mild right hydroureteronephrosis.\n5. Abundant stool burden within the rectum and sigmoid colon." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. No evidence of steatosis (60 ___. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic with fatty infiltration, without evidence\nof focal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney measures 11.38 cm and the left 10.69 cm. Bilateral\nscarring is seen peripherally in the lower poles. Hypo density in the upper\npole is noted with no interval change since the previous study. There is\nsignificant calcification burden with no significant change since ___. Average attenuation of calcification is 502 ___. On the right, the\ncalcification is pretty much casting the entire collecting systems. On the\nleft, the mid and lower pole only. The a right ureteral stent has been\nremoved\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is considerable stool\nburden throughout the colon and the marked distention of the rectal ample with\nlarge amount of fecal load\n\nPELVIS: The urinary bladder was empty at the time of the exam, contains a\nsuprapubic catheter.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No significant change in extensive bilateral, right greater than left,\nstone burden compared to the previous exam of ___" }, { "input": "Images of the lower chest and upper abdomen are limited by extensive streak\nartifact from the patient's arms.\n\nLOWER CHEST: There is a moderate-sized nonhemorrhagic right pleural effusion\nwith associated right lower lobe consolidation concerning for atelectasis\nversus pneumonia. There is mild dependent atelectasis on the left. No\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is distended, but there are no signs of\ncholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right nephroureteral stent is unchanged in position. Two\npercutaneous nephrostomy drains are unchanged in position. There are multiple\nsmall locules of air within the collecting system of the right kidney, likely\ndue to recent intervention. Evaluation of the stone burden on the right is\nlimited due to contrast from the patient's recent nephrostogram. The largest\nconglomeration of stones within the right upper pole is no longer visualized. \nThe largest stone on the right measures 17 mm within the lower pole (series 3,\nimage 53). There has been no change in size or distribution of the multiple\nstones within the left kidney measuring up to 21 mm. The hydronephrosis on\nthe left has improved compared to ___, now mild.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is a large fecal load\nwithin the ascending colon and the rectum. The appendix is normal.\n\nPELVIS: The bladder is decompressed by a suprapubic catheter. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple subcentimeter periaortic retroperitoneal lymph\nnodes. There are no pathologically enlarged retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: The sclerotic foci within the left iliac wing are stable since at least\n___. Degenerative changes are noted within the lumbar spine. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged position of right nephroureteral stent and 2 percutaneous\nnephrostomy drains.\n2. Evaluation of the stone burden on the right is somewhat limited due to\ncontrast from the patient's recent nephrostogram. Within these limitations,\nthe largest conglomeration of stones within the right upper pole is no longer\nvisualized. There continues to be a 17 mm stone within the right lower pole.\n3. Unchanged size and distribution of renal stones on the left, with improved\nhydronephrosis, now mild.\n4. Moderate-sized right pleural effusion with associated consolidation,\nconcerning for atelectasis versus aspiration pneumonia.\n5. Large stool ball within the rectum." }, { "input": "LOWER CHEST: There is a partially visualized 5 mm perifissural nodule in the\nright lower lobe (2:1). There is a likely 4 mm pulmonary nodule in the left\nlower lobe (2:5). There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is severe right cortical thinning. There are focal areas of\nmarked left cortical atrophy. There is no evidence of focal renal lesions\nwithin the limitations of an unenhanced scan. There is severe right\nhydronephrosis, with dilation of the proximal and mid ureter approximately to\nthe level of the aortic bifurcation (2:53). There is medialization of the\nbilateral ureters. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal (2:62).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is abnormal soft tissue anterior to the aorta and extending\ndown to the aortic bifurcation and along the iliac vessels. There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "-Severe chronic right hydronephrosis, with dilation of the right ureter\napproximately to the level of the aortic bifurcation. There is\nretroperitoneal soft tissue extending along the aorta and iliac vessels, and\nmedialization of the bilateral ureters, likely representing retroperitoneal\nfibrosis causing hydronephrosis.\n-Possible tiny basal pulmonary nodules. Follow-up CT can be performed in ___\nyear if risk factors for pulmonary neoplasm\n\nRECOMMENDATION(S): The updated findings were discussed by Dr. ___ with\nDr. ___ on the telephone on ___ at 9:39 am, 2 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRight peripelvic cysts are incidentally noted. Possible left upper calyx tiny\nnon-obstructing calcified stones. There is no evidence of focal renal lesions\nor hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes are noted in the visualized spine,\nnotably at the L5-S1 vertebral level. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute findings in the abdomen or pelvis to explain patient's symptoms.\n2. Punctate foci in the left upper renal calyx may represent tiny\nnon-obstructing calcified stones." }, { "input": "LOWER CHEST: The lung bases are clear. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. Focal fatty infiltration adjacent\nto the falciform ligament. No suspicious liver mass. The common bile duct is\nprominent measuring up to 7 mm. The gallbladder is unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. 9 mm accessory splenic tissue adjacent to the\nsplenic hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are unremarkable. Subcentimeter renal cortical\nhypodensities are too small to characterize but likely represent small cysts. \nNo hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small sliding-type hiatus hernia. The small and large bowel\nare normal in caliber. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The appendix is normal.\n\nPELVIS: The bladder is only partially filled but appears grossly unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Moderate compression deformity of the T12 vertebral body is stable\ndating back to ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Unremarkable study. No explanation for the patient's symptoms is identified." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis is noted. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding. A 4 mm\ncalcification seen in the region of the pancreatic body (02:20) may represent\nsequela of prior inflammation or vascular calcification from the splenic\nartery.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal (02:50).\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The coarse calcifications are seen in the prostate. The\nseminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nOld right lateral seventh and eighth rib fractures are noted (602:10). \nMild-to-moderate degenerative changes are noted in the lumbar spine, worse at\nL2-L3. There is mild narrowing of the spinal canal at L3-L4 secondary to\nbroad-based posterior disc bulge.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "1. No acute findings in the abdomen or pelvis, within the limitations of\nunenhanced study.\n2. Chronic findings, as above." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Please note the liver dome is not completely imaged on this\nexamination. Geographic hypodensity adjacent to the fissure for the falciform\nligament is compatible with focal fatty deposition, as demonstrated on prior\nMR. ___, image liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is a main pancreatic duct stent, which appears appropriately\npositioned, and terminates within the duodenum. There is no ductal\ndilatation. Multiple punctate pancreatic parenchymal calcifications are seen.\nThe pancreatic parenchyma is heterogeneous, likely reflecting chronic\npancreatitis. There is no new peripancreatic stranding or focal fluid\ncollections to suggest active inflammation. There are no focal lesions.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The appendix is fluid-filled and measures up to 10 mm in\nmaximal diameter, which has increased compared to the CT dated ___\n(series 6, image 53 and series 8, image 22). There is minimal adjacent\nfascial thickening. The interval change raises suspicion for early acute\nappendicitis. The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Multiple small\nradiopaque objects are seen within the terminal ileum and cecum, likely\ningested. There appears to be fatty deposition within the ascending colonic\nwall, which may reflect chronic inflammation. Otherwise, the colon and rectum\nare within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple small but prominent mesenteric lymph nodes\nwithin the right lower quadrant measuring up to 11 mm in short axis, similar\ncompared to the prior examination, likely reactive. There is no new\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia. Otherwise, the abdominal\nand pelvic wall is within normal limits.", "output": "1. Interval increase in caliber of the fluid-filled appendix, raising concern\nfor early acute appendicitis although there are no significant adjacent\ninflammatory signs. Please correlate clinically.\n2. Main pancreatic duct stent appears appropriately positioned without new\nperipancreatic stranding or focal fluid collections. Heterogeneous pancreatic\nparenchyma with multiple parenchymal calcifications, compatible with chronic\npancreatitis.\n3. Fatty deposition within the ascending colonic wall, which may reflect\nchronic inflammation. Multiple small mesenteric lymph nodes within the right\nhemiabdomen are similar compared to prior, likely reactive in nature.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:31 pm, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Right basilar atelectasis is demonstrated. Otherwise, visualized\nlung fields are within normal limits. There is a small right pleural\neffusion. No pericardial or left pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is not well as stented but grossly unremarkable.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnot visualized.\n\nPELVIS: The urinary bladder is slightly compressed enlarged partially\ncalcified fibroid uterus. Large volume ascitic fluid as noted above.\n\nREPRODUCTIVE ORGANS: There is an enlarged and globular partially calcified\nuterus, suggestive of calcified fibroids. The ovaries are not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. There is however suggestion of\npossible nodularity along the omentum (02:36).\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Large volume ascites. Suggestion of possible nodularity of the omentum\nwhich raises possibility of malignant ascites. Correlation with analysis of\nthe ascitic fluid is suggested. No visualized primary malignancy identified\non this CT scan.\n2. No other acute intra-abdominal process or other findings to explain\nsymptoms.\n3. Enlarged multi fibroid uterus.\n\nNOTIFICATION: Update discussed with Dr. ___ by Dr. ___." }, { "input": "LOWER CHEST: A small right pleural effusion with adjacent atelectasis is\ndemonstrated, slightly increased from prior study.\n\nABDOMEN:\nLarge volume abdominal ascites is demonstrated extending into the pelvis,\nslightly increased from the prior study. There is again extensive omental\ncaking consistent with carcinomatosis in addition to the mildly irregular\nthickening and enhancement seen more generally along peritoneal surfaces.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates within the stomach, which is\notherwise unremarkable. Mid small bowel is dilated up to 37 mm in diameter\nand Fluid of filled leading up to a transition point in the anterior upper\npelvis (07:20 and a high 4:63 close). This is followed by completely\ncollapsed small bowel. There is no obvious soft tissue infiltration at the\nsite.\n\nPELVIS: The urinary bladder not well distended limiting evaluation. There is\nabdominal ascites tracking into the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and contains multiple fibroids,\nsome of which are calcified. The ovaries are not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nInguinal lymph nodes are not enlarged by size criteria but have increased\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is new apparent narrowing of the origin of the splenic vein,\nwithout obvious soft tissue masses, although subtle tumor infiltration may\nexplain this appearance.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Th injection site with trace Fluid in air located in\nsubcutaneous fat over lying the left lower quadrant.", "output": "1. Large volume ascites, mildly increased. Extensive carcinomatosis.\n2. Findings consistent with small-bowel obstruction with transition in the\nupper anterior pelvis. This could be due to subtle of malignant infiltration\nat the site of transition, which seems most likely noting widespread\ncarcinomatosis. Adhesion is an alternative possibility.\n3. Small to medium right pleural effusion, increased.\n4. New mild narrowing of the splenic vein possibly due to tumor infiltration.\n5. Increased inguinal nodes, possibly reactive, potentially metastatic.\n\nNOTIFICATION: Findings in this report discussed with Dr. ___ at 9:45\npm by telephone on ___." }, { "input": "There is minimal atelectasis at the right lung base. No large pleural effusion\nor pericardial effusion identified.\n\nCT of the abdomen: There is a tiny hypodensity at the right hepatic lobe\n(2:12). The liver otherwise enhances homogeneously with no focal hepatic\nlesions identified. There is no intra or extrahepatic biliary ductal\ndilatation. The gallbladder is normal. There is no pericholecystic fluid or\ngallbladder wall thickening. The adrenal glands, pancreas and spleen are\nnormal. Incidental note is made of an 8 mm accessory spleen. There are\nbilateral extrarenal pelvises. The kidneys otherwise enhance symmetrically\nand excrete contrast without evidence of hydronephrosis or renal masses.\n\nThe stomach is collapsed. There is no evidence of small bowel obstruction. \nSmall and large bowel are grossly unremarkable. Patient is status post\nappendectomy and surgical sutures are seen in the right lower quadrant. There\nis no retroperitoneal or mesenteric lymph node enlargement by CT size\ncriteria. There is minimal atherosclerotic calcifications of the\nintraabdominal aorta. The celiac axis, SMA, bilateral renal arteries are\npatent. The aorta is of normal diameter. There is no free air. There is no\nfree fluid.\n\nCT of the pelvis: The urinary bladder and terminal ureters are normal. There\nis prominence of the uterine/ovarian vessels, slightly increased since prior\nCT examination from ___. The rectum is normal. There is no pelvic free fluid.\nThere is no inguinal or pelvic lymph node enlargement by CT size criteria.\n\nOsseous structures: No blastic or lytic lesion concerning for malignancy is\nidentified.", "output": "1. Status post appendectomy with no acute intra-abdominal findings.\n\n2. Prominence of pelvic vessels slightly increased since prior examination\nfrom ___ with reflux down the left gonadal vein can be seen with pelvic\ncongestion syndrome, in the appropriate clinical setting." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusion. There is a small lymph\nnode adjacent to the distal esophagus measuring approximately 6 mm in short\naxis.\n\nABDOMEN: There is severe intrahepatic and extrahepatic biliary ductal dilation\nsimilar to that seen on same-day ultrasound. At the level of the hepatic\nhilum, there is abnormal soft tissue density thought to reflect\nlymphadenopathy. Dilated CBD abruptly tapers at the level of the hepatic\nhilum, likely due to malignant obstruction. There is also a markedly abnormal\nappearance of the pancreatic head which has a bulky heterogeneous appearance\nnew from prior, concerning for infiltrative metastatic disease. Also noted,\nis a new nodular implant just anterior and inferior to the pancreatic midbody\nseen best on series 2, image 30 measuring 2.5 x 2.4 cm, new from prior. \nIncreased bulky adenopathy is noted along the root of small-bowel mesentery\nwith larger and more numerous mesenteric nodular implants compared with prior.\nThe spleen is normal in size though there is a small volume perisplenic\nascites. A new nodular lesion at the splenic hilum measures 2.2 x 3.1 cm,\nseries 2, image 20. The adrenals are normal. The kidneys enhance\nsymmetrically. Fullness of the bilateral renal collecting systems is noted. \nRetroperitoneal adenopathy is increased from prior. The abdominal aorta is\nnormal in course and caliber without significant atherosclerotic\ncalcification. The stomach appears normal. There is soft tissue surrounding\nthe third portion of the duodenum causing mild to moderate narrowing.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. Bulky\nimplants are seen in the small bowel mesentery for example on series 2, image\n50 in the right mid abdomen measuring 6.9 x 4.0 by 8.1 cm. Mesenteric vessels\nare encased though appear patent. The appendix is normal. The colon is\nunremarkable. An implant is noted along the left pelvic sidewall on series 2,\nimage 53, increased measuring 12 x 12 mm. An implant along the left pelvic\nsidewall seen on series 2, image 68 measures 3.8 x 3.1 cm, significantly\nincreased from prior. An implant in the deep pelvis best seen on series 2\nimage 66 measures 5.1 x 1.9 cm not seen on prior. A large mass in the left\nlower quadrant along the external iliac chain is increased in size, previously\n2.0 x 2.8, currently 3.9 x 4.6 cm. No inguinal adenopathy.\n\nBONES: No worrisome lytic or blastic osseous lesion.", "output": "1. Significant interval progression of disease with increased size and number\nof metastatic implants within the abdomen/pelvis.\n2. New adenopathy at the hepatic hilum with malignant obstruction of the CBD.\n3. Bulky adenopathy of the small bowel mesentery, increased. New metastatic\nnodule at the splenic hilum.\n4. Heterogeneous prominence of the pancreas concerning for infiltrative\nmetastatic disease.\n5. Soft tissue encasement of the third portion of the duodenum causing mild to\nmoderate luminal narrowing of the duodenum.\n6. Increased size of pelvic nodular implants." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: 5 mm hypodensity within segment 7 of liver is too small to\ncharacterize (02:18). The liver otherwise demonstrates homogenous attenuation\nthroughout. There is no evidence of additional focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is mildly distended. The pylorus is mildly\nthick-walled likely related to contraction. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal, air -filled without\nadjacent fat stranding or mucosal hyper enhancement.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of acute appendicitis.\n2. Mild wall thickening of the gastric pylorus is most likely related to\npyloric contraction rather than inflammation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild fecal\nloading. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No CT evidence to explain patient's symptoms. Specifically no evidence of\nacute appendicitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nhypoattenuating lesion in segment VI is too small to completely characterize,\nstatistically likely a hepatic cyst. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not definitively identified,\nthough a candidate in the right lower quadrant abutting loops of small bowel\nwould be normal (series 2, image 60; series 601, images 28 through 30). No\nsecondary evidence of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted. An intrauterine device is\nappropriately position. The adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of acute pathology in the abdomen or pelvis." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusion is seen.\n\nABDOMEN: The liver enhances normally. There is a tiny hypodensity within\nhepatic segment 6, unchanged, likely a cyst or hamartoma. No worrisome liver\nlesion is seen. The intrahepatic biliary tree appears minimally prominent\nthough this is unchanged. The common bile duct is normal in size. The\ngallbladder appears normal. The spleen is normal. The adrenal glands are\nunremarkable. The pancreas enhances normally. The kidneys enhance\nsymmetrically and excretion of contrast is prompt and equal. No\nhydronephrosis or signs of pyelonephritis. The abdominal aorta is normal in\ncourse and caliber. The stomach and duodenum appear normal. No free air,\nfree fluid or lymphadenopathy.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is clearly visualized in the right lower quadrant, series 2, image 53\nand series 601, image 23. The colon is notable for moderate fecal load. No\nsigns of colitis or bowel obstruction. The uterus contains an IUD which\nappears well positioned. The ovaries appear normal bilaterally. Distal\nureters appear normal in size. Urinary bladder is normal though only\npartially distended. There is no pelvic free fluid. No pelvic sidewall or\ninguinal adenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Normal appendix.\n2. No adnexal mass, free fluid or findings to account for abdominal pain.\n3. Moderate fecal load within the colon.\n4. IUD appears well positioned." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous hypoattenuation throughout,\nconsistent with hepatic steatosis. There is no evidence of focal lesions\nwithin the limitations of an unenhanced scan. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nmild right hydronephrosis. There are few nonobstructing stones in the left\nkidney measuring up to 8 mm. There is mild bilateral symmetric perinephric\nstranding, nonspecific.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal (601:21).\n\nPELVIS: The urinary bladder is unremarkable. There is a 3 mm stone in the\ndistal right ureter (2:82). There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted. There is mesh\nalong the anterior abdominal wall likely related to prior ventral hernia\nrepair.", "output": "1. 3 mm stone in the distal right ureter, with mild right\nhydroureteronephrosis.\n2. Multiple additional nonobstructing stones in the left kidney.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Coronary artery calcifications\nare incidentally noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Small bilateral adrenal nodules are re-demonstrated compatible with\nadenomas.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. The proximal and mid right ureter appear mildly prominent,\npossibly related transient distention. A punctate calcification adjacent to\nthe expected course of the ureter probably reflects a tiny phlebolith as it\nappears to correspond to the location of the right ovarian vein as seen on the\n___ CT abdomen/pelvis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient appears status-post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Severe compression fractures extending throughout the imaged thoracic\nand lumbar spine are unchanged. No evidence of new fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No cause for the patient's right flank pain identified. No urolithiasis or\nhydroureteronephrosis. Normal appendix.\n2. Severe compression fractures extending throughout the imaged thoracic and\nlumbar spine are unchanged. No evidence of new fracture.\n3. Diverticulosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. 2.1 cm accessory spleen is noted posteriorly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized portions of the\nsmall large bowel are unremarkable.\n\nLYMPH NODES: In the region of the porta hepatis, there is a prominent lymph\nnode measuring up to 1.0 cm in short axis (series 10; image 40). There is no\nretroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal walls within normal limits.", "output": "No evidence of liver mass or upper abdominal mass to explain right-sided pain." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Sub\ncm hepatic hypodensities are consistent with simple hepatic cysts. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSub cm hypodensity in the kidneys, bilaterally are consistent with simple\nrenal cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Numerous retroperitoneal and mesenteric lymph nodes measure up to\n1.7 cm (series 2, image 50, 51, 60). There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is concentric\nhypodense mural thickening involving the proximal abdominal and visualized\nthoracic aorta, which may represent atypical atheroma or aortitis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mesenteric and retroperitoneal lymphadenopathy is of unclear etiology,\nclinical correlation is recommended.\n2. There is crescentic aortic wall thickening without significant enhancement\nor calcification. These findings may represent an atypical atheroma or less\nlikely aortitis. There is no evidence of dissection. MR is recommended for\nfurther evaluation.\n\nRECOMMENDATION(S): Thoracoabdominal aorta MRI to evaluate for aortitis." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. Bilateral tubular fluid-filled\nstructures in the adnexa bilaterally are suggestive of bilateral hydrosalpinx.\nFindings are essentially unchanged on the left but new on the right when\ncompared to ___.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of nephrolithiasis or hydronephrosis.\n2. Bilateral tubular fluid-filled adnexal structures suggestive of bilateral\nhydrosalpinges, new on the right compared to prior exam from ___." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic. In segment V, there is a new 1.6 x 1.7\ncm arterially enhancing lesion that demonstrates washout but no pseudo capsule\nthat does not meet strict criteria for OPTN 5 lesion but is suspicious (03:33\n). There is an ablation zone from previous RFA in the left lateral segment\nthat measures 2.7 x 5.4 cm and does not demonstrate any nodularity, abnormal\nenhancement or other findings to suggest recurrent or residual disease. Just\ninferior to the ablation zone in segment III, there is an 8 mm lesion with\nequivocal arterial enhancement and possible washout that may be\n___ in nature but for which attention on future follow-up is\nrecommended (03:40). There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder demonstrates multiple layering gallstones\nwith no evidence of cholecystitis.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is are two subcentimetric hypoattenuating lesions in the lower pole of\nthe left kidney which are too small to characterize but may represent cysts an\nappear unchanged from previous. There is a 6 mm non-obstructing right renal\nstone. There is no evidence of focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Visualized small and large bowel loops demonstrate normal\ncaliber, wall thickness and enhancement with no evidence of obstruction or\nsuspicious lesion.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries. There are\nnumerous portosystemic collateral varices, including multiple large varices\naround the gastric fundus. The portal and hepatic veins are patent. Hepatic\narterial anatomy is traditional.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. There is a ventral hernia in the\nright the superior abdomen that contains fat and varices.", "output": "1. Status post RFA to the left lateral segment with a unchanged ablation zone\nand no evidence of residual tumor.\n2. New arterial enhancing lesion with washout in segment V measuring 1.7 cm\nthat does not meet strict OPTN criteria for HCC but is suspicious. Continued\nattention to this lesion advised in 3 months.\n3. Gallstones and non-obstructing left renal stone." }, { "input": "LOWER CHEST: Bibasilar atelectatic changes are noted. No suspicious pulmonary\nlesions. The lung bases are otherwise within normal limits.\n\nABDOMEN:\n\nHEPATOBILIARY: Again, the liver is shrunken and dysmorphic compatible with the\nknown underlying history of cirrhosis. There are 2 previous RFA zones noted, 1\nin the left lobe (3B: 138) and a second, more recent area in segment 8\n(3b:135). There is some arterial enhancement noted surrounding the left lobe\nRFA zone (3b:145). This was not definitely seen on the prior study, however\nthere is no suspicious washout associated with this area. Overall, this area\nappears somewhat geographic, although there is mild bulge of the hepatic\ncontour at this location, somewhat suspicious. The region does not meet OPTN\ncriteria, but close follow-up on interval imaging is recommended.\n\nAn arterially enhancing lesion with washout and pseudo capsule is noted in\nsegment 6 (06:33). It measures approximately 1.7 cm. This corresponds to an\nOPTN 5A lesion.\n\nA second 9 mm arterially enhancing focus is noted in segment 6 (3B: 177),\nwith no corresponding washout or pseudo capsule. This lesion does not meet\ncriteria, but is suspicious and close attention on follow-up is recommended.\n\nNo other suspicious hepatic lesions are seen.\n\nThere is a replaced left hepatic artery arising from the left gastric artery. \nOtherwise, hepatic artery and portal venous branch in our anatomic in this\npatient.\n\nFew gallstones are seen within the gallbladder. The gallbladder and biliary\ntree is otherwise unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: No suspicious renal lesions. Nonobstructing stone is seen at the\nlower pole of the right kidney measuring 5 mm.\n\nGASTROINTESTINAL: The visualized small and large bowel loops are unremarkable.\n\nLYMPH NODES: No size significant lymphadenopathy is identified. 1.2 cm short\naxis porta hepatis lymph node is seen.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nMultiple perigastric varices are noted.\n\nBONES AND SOFT TISSUES: Focus of mixed sclerotic/ lucency seen at the\nlateral aspect of the right seventh rib likely represents fibrous dysplasia\n. It is unchanged since ___. No definite suspicious bony lesions are seen.\n\nAn anterior abdominal wall hernia is seen containing omental fat and vessels,\nwith a 1.4 cm defect .", "output": "1. 2 radiofrequency ablation zones as detailed above, including a more recent\none in segment 8 and a second RFA zone in the left lobe of the liver. There is\nsome arterial enhancement surrounding the RFA zone in the left lobe, new from\nprevious. There is no associated washout. It remains nonspecific but close\nattention on follow-up is recommended.\n2. Arterially enhancing lesion with washout and suspected pseudo capsule in\nsegment 6 (06:33), as detailed above. It measures 1.7 cm, and is consistent\nwith an OPTN 5A lesion.\n3. Second arterially enhancing lesion in segment 6 (3B: 177) measuring 8 mm\nwith no definite washout or pseudo capsule. This is nonspecific but\nsuspicious, and close attention on follow-up is recommended.\n4. Replaced left hepatic artery." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis. Otherwise visualized lung fields\nare clear. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates nodularity consistent with history of\ncirrhosis. Three radiofrequency ablation zones are again noted and are\nrelatively unchanged in size; in the left anterior hepatic lobe, in segment 8,\nand segment 6. The ablation zone in the anterior left hepatic lobe measures\n5.0 x 3.1 cm on image (3A, 27) previously measuring 4.9 x 3.2 cm. The\nablation site in segment 8 measures 3.3 x 3.1 cm in image (3 a, 33) previously\nmeasuring 3.4 x 3.0 cm. The lesions in segment 6 measures 3.2 x 2.3 cm in\nimage (3 a, 62) previously measuring 2.2 x 2.5 cm.\n\nIn Segment ___, (3 a, 13) there is a hyperdense lesion noted in the late\narterial phase which washes out in the equilibrium phase (3min delay),\nmeasuring 1.0 x 0.7 cm which is new compared to the study done in ___.\n\nSegment 8: (3A, 21) there is a peripherally enhancing lesion previously\nmeasuring 1.0 x 1.4 cm and now measuring 1.5 x 1.4 cm which continue to\nenhance in the portal venous phase and then becomes isodense in the\nequilibrium phase. In (3a, 23; 3a, 25), there is 3 hyperdense lesions\nmeasuring around 1cm that enhances in the late arterial phase and washes out\nin the equilibrium phase not previously seen in CT from ___. In (___,\n26) there is a 0.7cm hyperdense lesion in the arterial phase that becomes\nisodense in the equilibrium phase. In (___, 27), there is a hyperdense lesion\ninferior to the segment 8 RFA bed that has grown to 1.5 cm from 1.2 cm\npreviously seen in ___ and from less than 0.8cm in ___ with a\nring of enhancement that washes out on the equilibrium phase in image (6, 26)\nmost concerning for recurrence.\n\nJust Inferior to the segment 8 RFA bed, in segment ___, there is another\nhyperenhancing lesion that washes out in equilbrium phase on image (3a, 40)\nthat now measures 0.9cm, previously measuring 0.5mm.\n\nSegment 6: New arterially hyperenhancing lesion measuring 1.0 cm on image\n(3a, 43) that washes out in equilibrium phase not previously seen and\npreviously hyperenhancing lesion on image (___, 62) measuring 0.9 cm increased\nfrom 0.6 cm with washout in equilibrium phase as well. Just inferior is\nanother previously demonstrated hyperenhancing lesion measuring 1.4 cm\npreviously measuring 1.2 cm (3a, 71) that appears isodense in equilibrium\nphase.\n\nSegment 4B; there is a ring-enhancing 1.1 x 1.6 cm lesion previously measuring\n1.0 x 1.1 cm in ___ (3a, 41)\n\nHypodense lesion in segment 5 (3, 46) previously demonstrated remains\nunchanged.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains nonobstructive gallstones, is nondistended, and has no\ngallbladder wall thickening. No evidence of ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nIn the right kidney there are multiple kidney stones with the largest\nmeasuring 6 mm in the lower pole that was also present on previous imaging. \nIn the left kidney there is a 0.5 x 0.9 cm kidney stone in the left proximal\nureter with left-sided hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The bowel is not fully imaged\nhowever the visualized small bowel and colon are normal colon is filled with\nstool appendix is not visualized in this study\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing ventral hernia is unchanged", "output": "1. There are 5 new hyperenhancing hepatic lesions, all of which wash out and\nare around 1 cm in size concerning for recurrence. Among the previously seen\nlesions, the largest is 1.5cm in size, grown from previous imaging, with a\nring of enhancement concerning for recurrence, best seen on image (___, 27).\n2. New 0.9cm obstructing left kidney stone with hydronephrosis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 16:25 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\n The findings were discussed with ___, M.D. by ___, M.D. on\nthe telephone on ___ at 5:55 ___, 90 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Atelectasis noted in the lung bases. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver appears shrunken and nodular, compatible with known\ncirrhosis. Patient is status post TACE with scattered areas of residual of\nlipiodol deposition in segment 4 (series 6: Image 41), segment 7 (series 6:\nImage 17), segment 6 (series 6: Image 46). There are again 3 hypodense\nregions which are unchanged compared to the prior study in ___,\ncompatible with prior RFA sites. The previously described region of arterial\nenhancement in the inferior margin of the RFA site in segment 5 appears\nsmaller and less conspicuous on today's exam. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. There is enlargement of a\nhypodense lesion in the segment 7 of the liver measuring 1.6 x 1.4 cm,\npreviously measuring up to 1.3 cm in ___, which does not appear to\nenhance on today's exam, possibly representing treated lesion.\n\nThere is again portal vein thrombosis involving the distal main portal vein\nand extending into the right and left portal veins (series 9: Image 34). The\nthrombus material does not appear to demonstrate enhancement on today's exam,\nlikely representing bland thrombus. In particular, previously seen tumor\nthrombus within the right posterior portal branch no longer enhances. There\nis an arterioportal fistula which demonstrates enhancement of the left hepatic\nlobe (series 6: Images 33-43). There is an accessory left hepatic artery off\nthe left gastric artery.\n\nThe gallbladder contains gallstones. There is gallbladder wall edema, likely\nreactive due to the underlying liver pathology. Extensive gastric and splenic\nvarices are again noted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring up to 14.0 cm. An accessory spleen\nis incidentally noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is again a radiopaque density seen in the proximal left ureter,\nmeasuring 6 x 6 mm, with associated mild left hydroureteronephrosis, which\nappears mildly progressed since the prior exam in ___. A few\npunctate nonobstructing renal stones are seen in the left renal calices. \nAdditionally, multiple nonobstructive renal stones are seen in the right\nkidney, the largest measuring up to 8 mm in the right lower kidney calices. \nThere is no right hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed. There is no distal hydroureter. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland appears unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Again seen is anomalous hepatic arterial anatomy, with early\nbranching of the right hepatic artery (series 6, image 44) as well as an\naccessory left hepatic artery arising from the left gastric (series 6, image\n30).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A fat containing ventral hernia is seen slightly to the right of\nthe midline in the upper abdominal wall (series 3: Image 30). The umbilical\nfat containing hernia is incidentally noted.", "output": "1. Enlargement of a 1.6 cm segment 7 hypodense lesion since the prior study in\n___, but without evidence of internal enhancement on the current\nstudy.\n2. Known portal vein thrombosis without enhancing components. No enhancing\ntumor detected within the right posterior portal thrombus, now bland,\nreflecting Y-90 response.\n3. Post-treatment changes again seen in a cirrhotic liver with stigmata of\nportal hypertension including splenomegaly and multiple varices.\n4. A 6 mm renal stone is again seen in the left proximal ureter with mild\nassociated hydroureteronephrosis. Multiple non-obstructing renal stones are\nunchanged bilaterally.\n5. Arterioportal fistula arising from the left hepatic lobe, also noted on\nprior angiography.\n6. Cholelithiasis without evidence of cholecystitis.\n7. Early branching of the right hepatic artery from the common hepatic artery.\n8. Accessory left hepatic artery arising from the left gastric." }, { "input": "LOWER CHEST: Linear scarring at the left lung base is unchanged. There is a\ncalcified granuloma in the right lower lobe. No worrisome mass or\nconsolidation. No pleural effusion. The imaged portion of the heart is\nunremarkable.\n\nABDOMEN: The liver is enlarged measuring 24.8 cm in length. No focal liver\nlesions are seen. Small amount of perihepatic ascites is noted. The spleen is\nunchanged with a small chronic appearing lower pole infarct. The spleen is not\nenlarged. Gallbladder is normal. The pancreas appears normal. The adrenal\nglands are unremarkable. Kidneys enhance symmetrically and excrete contrast\npromptly without hydronephrosis or worrisome focal lesion. A metallic density\nclip is again noted along the proximal stomach in this patient with history of\ngastric cancer. Stomach appears decompressed. Duodenum appears normal. The\nabdominal aorta is normal in course and caliber. Hyperdensity within the\nretroperitoneal and inguinal lymph nodes likely reflect sequelae of prior\nlymph angiogram. No discrete lymphadenopathy is seen.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction.\nMild stranding along the root of mesenteric is stable from prior exam. The\nappendix is clearly visualized and is normal. There is diffuse thickening of\nthe colon with associated fat stranding compatible with colitis. In addition,\nthere is subtle hyperemia of the mucosa throughout the colon most notable\nalong the sigmoid colon. Trace free fluid is noted extending into the deep\npelvis. No free air is seen. No fluid collection. Urinary bladder is mostly\ndecompressed. Previously noted filling defect within the right common femoral\nvein is no longer visualized.\n\nBONES AND SOFT TISSUES: No worrisome lytic or blastic osseous lesion is seen.", "output": "1. Acute pancolitis. Differential considerations favor infectious (C. Diff),\nless likely inflammatory or ischemic etiologies.\n2. Small volume free fluid.\n3. Hepatomegaly.\n4. Residual contrast within the retroperitoneal and inguinal lymph node chains\nlikely relating to prior lymphangiogram." }, { "input": "LOWER CHEST: There is calcified granuloma (02:10) in the right lower lobe. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is mild intrahepatic biliary\ndilatation which is unchanged from CT ___. The common bile duct\nmeasures 7 mm, top-normal in size, unchanged from ___. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere are millimetric renal hypodensities which are too small to characterize.\nThere is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post total gastrectomy and Roux-en-Y\nesophagojejunostomy as indicated by sutures (02:14 and 32). Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. The appendix is not visualized\nbut there are no secondary signs of acute appendicitis. There are high\ndensity foci in bilateral iliac veins likely from prior lymphangiogram.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of abscess or other acute abnormality in the abdomen or pelvis." }, { "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: Peripheral wedge-shaped hypodensities within the spleen likely\nrepresent prior infarctions, appearance is unchanged from prior studies.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Patient is status post low anterior resection and extended\nright hemicolectomy with diverting ileostomy. There is no evidence of\nobstruction or wall thickening and in the remaining large or small bowel. A GJ\ntube is in unchanged position. A persistent collection containing air and oral\ncontrast is seen between the spleen and diaphragm, measuring 6.6 x 4.3 cm\n(02:16), minimally smaller compared with the prior study.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. Persistent gastric leak into a perisplenic fluid collection containing air\nand oral contrast, minimally smaller compared with the prior study.\n2. Stable appearance of prior splenic infarctions.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\non ___ at 18:30, 15 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness, throughout. Several small bowel loops\ncontain fecalized content, suggesting slow transit. There is a substantial\nstool burden throughout the colon. The colon and rectum are within normal\nlimits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus enlarged compatible with recent postpartum\nstate. A few hyperdense foci are noted along the endometrium which may\nrepresent small foci of hemorrhage/clot.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No pelvic hematoma is seen.\n2. A few hyperdense foci are noted along the endometrium which may represent\nsmall foci of hemorrhage/clot.\n3. Substantial stool burden throughout the colon." }, { "input": "LOWER CHEST: There is atelectasis the lung bases. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Pneumobilia with mild central\nintrahepatic biliary ductal dilatation likely related to prior surgery. The\ngallbladder surgically absent\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is mild splenomegaly measuring up to 13.5 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral simple cysts in the kidneys measuring up to 2.3 cm. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis seen throughout the descending and sigmoid colon without\nevidence of acute diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a pigtail catheter within the soft tissues along the\nright flank. There has been significant interval decrease in size of right\nflank predominantly extraperitoneal fluid collection. There is a small\nresidual collection measuring up to 1.5 cm seen on series 2, image 34. There\nis a tract extending to the subcutaneous soft tissues seen on series 2, image\n42. No radiopaque gallstones are seen.", "output": "1. Significant interval decrease in size of predominantly extraperitoneal\nfluid collection along the right flank with pigtail catheter in place. Small\nresidual fluid collections measuring up to 1.5 cm are seen. No drainable\nfluid collection. No radiopaque gallstones are visualized.\n2. A tract can be seen extending to the subcutaneous tissues of the anterior\nabdominal which likely represents sinus tract seen on clinical exam.\n3. Diverticulosis without evidence of acute diverticulitis." }, { "input": "LOWER CHEST: Linear opacity at the left lung base is most consistent with\natelectasis. There is no pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances homogeneously without focal lesions. The\ngallbladder surgically absent. Pneumobilia is likely related to prior\nsurgery. There is mild central intrahepatic biliary duct dilation. There is\nno fluid within the gallbladder fossa. The portal vein is patent. There is\ntrace perihepatic ascites adjacent to the inferior right lobe of the liver.\n\nPANCREAS: There are no focal pancreatic lesions seen. There is no\nperipancreatic abnormality.\n\nSPLEEN: The spleen is top-normal in size measuring 12.9 cm. There are no\nsplenic lesions. The spleen enhances homogeneously.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically. There are\nbilateral simple cysts with the largest in the right upper pole measuring\napproximately 2.3 x 2.3 cm. Additional smaller subcentimeter hypodensities in\nthe bilateral kidneys are too small to characterize. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. The\nsmall bowel is normal in caliber without wall thickening. The large bowel is\nnormal in caliber without focal wall thickening. The appendix is not\nvisualized but there are no secondary signs of appendicitis within the right\nlower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is mildly enlarged measuring 5.4 x 3.9 cm with\ncoarse calcifications centrally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. There are mild degenerative changes most pronounced at L5/S1\nwhere there is mild anterolisthesis.\n\nThere is extensive fat stranding and phlegmonous change involving the right\nflank extending from the inferior edge of the liver to approximately 2.6 cm\nabove the right iliac crest. There is expansion of the musculature with\nmultiple small interdigitating rim enhancing fluid collections, the largest\nlocated at the level of the midpole of the right kidney measuring\napproximately 1.5 x 3.3 x 2.4 cm (transverse by AP by CC) (series 4, image\n40). Additional fluid collections include one located in the right anterior\nsubcutaneous fat measures approximately 1.4 x 2.4 x 1.8 cm (AP by transverse\nby CC) (series 4, image 43). The majority of inflammatory change is\nextraperitoneal displacing the ascending colon medially although there is\ntrace intra-abdominal ascites adjacent to the inferior right edge of the\nliver. No radiopaque gallstone is seen in the region of inflammation.\n\nThere is no abdominal wall hernias. Postsurgical changes from midline\nabdominal wall hernia defect repair are seen (series 4, image 54)", "output": "1. Extensive phlegmonous change with small interdigitating abscesses in the\nright flank, the largest measuring 1.5 x 3.3 x 2.4 cm, differentials include\ninfection versus infected hematoma. No drainable collection.\n2. Status post cholecystectomy. No fluid collection in the gallbladder fossa.\n3. Pneumobilia, likely post surgical.\n\nNOTIFICATION: Findings were discussed with Dr. ___ by Dr. ___ on\nthe telephone on ___ at 16:15, 5 minutes after they were made. In\naddition, findings were discussed with the patient in person. The patient will\nreturn to the emergency department this evening (___) to be admitted to the\nsurgical service." }, { "input": "Heart size is top normal without significant pericardial fluid. Imaged lung\nbases are clear.\n\nCT abdomen without contrast: Liver, collapsed gallbladder, spleen, pancreas,\nadrenal glands and kidneys are unremarkable in the context of a noncontrast\nexamination.\n\nStomach, duodenum and remainder of the loops of small bowel are normal caliber\nwithout evidence for obstruction. Pancolonic sigmoid predominant\ndiverticulosis is unchanged, with overall appearance unchanged from the prior\nstudy dated ___. Adjacent to sigmoid diverticula, focal peritoneal\nthickening, bladder dome thickening (2:79) and surrounding fat stranding is\nmild, however has increased compared to ___. On the ___ examination, the same finding had intervally decreased compared to ___. The more proximal large bowel is without pericolonic fat\nstranding. No fluid collection.\n\nAbdominal aorta is normal caliber. A few prominent mesenteric lymph nodes in\nthe left lower quadrant measure up to 8 mm, increased from prior study\nprobably reactive to current process. No mesenteric or retroperitoneal\nadenopathy. Rectus diastases with small fat containing umbilical hernia. No\nfrank ventral abdominal hernia. No ascites or pneumoperitoneum.\n\nCT pelvis without contrast: Remainder of the bladder is unremarkable.\nProstate, seminal vesicles and rectum are unremarkable. No free fluid or air.\nInguinal and pelvic sidewall lymph nodes are not enlarged.\n\nBones and soft tissues: No suspicious focal bone lesion.", "output": "Minimal interval increase in peritoneal thickening, fat stranding and bladder\ndome wall thickening adjacent to prominent sigmoid diverticula equivocal for,\nbut likely representing recurrent acute, uncomplicated sigmoid diverticulitis.\nNo pneumoperitoneum or organizing fluid collection." }, { "input": "The lung bases are clear. There is no pleural or pericardial effusion.\n\nCT of the abdomen: Evaluation of solid abdominal viscera is limited by lack of\nIV contrast. The liver however is grossly homogeneous and no focal hepatic\nlesions are identified. There is no intra or extrahepatic biliary ductal\ndilatation. The gallbladder is normal. The adrenal glands, pancreas and\nspleen are within normal limits. There is no surrounding peripancreatic fluid\nor inflammatory changes to suggest acute pancreatitis on this noncontrast\nenhanced CT. The nonenhanced kidneys are normal.\n\nThe stomach and small bowel are grossly unremarkable. There is extensive\ncolonic diverticulosis. There is redemonstration of focal peritoneal\nthickening, adjacent to multiple distal sigmoid diverticula, as seen on prior\nexamination and with slight interval increase in surrounding fat stranding,\nconcerning for acute diverticulitis. Presumed residual contrast from prior\nexaminations is seen within the large bowel. The appendix is visualized and\nis normal. There is no free fluid. There is no free air. Small mesenteric\nlymph nodes in the right lower quadrant are again seen. The abdominal aorta is\nof normal diameter. Vessel patency cannot be evaluated on this examination.\nAgain seen is rectus diastases with a small fat containing umbilical hernia.\n\nCT of the pelvis: There is no pelvic free fluid. Thickening of the bladder\ndome is not as evident as on prior examination, however the urinary bladder is\nnot fully distended on this exam. Small bilateral inguinal lymph nodes are not\npathologically enlarged.\n\nOsseous structures: No blastic or lytic lesion concerning for malignancy.", "output": "Redemonstration of increased peritoneal thickening and fat stranding along the\ndistal sigmoid colon, surrounding multiple diverticulae and with slight\ninterval increase in the degree of fat stranding as compared to prior\nexamination, concerning for acute sigmoid diverticulitis. No drainable fluid\ncollection is identified.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 10:01 ___, 5 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no nephrolithiasis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. The appendix is air-filled and normal.\n\nColonic diverticulosis is most notable within the sigmoid colon. Although the\ndegree of inflammatory fat stranding has decreased, there is persistent wall\nthickening of an approximately 6 cm segment of sigmoid colon located along the\nsuperior aspect of the urinary bladder dome (602b:44-45). There is a soft\ntissue tract extending from the sigmoid colon to the dome of the urinary\nbladder best visualized in the coronal plane (series ___, image 30). There\nis severe focal urinary bladder wall thickening in this region, measuring\napproximately 2.3 cm in thickness, unchanged from the prior examination. A\nlocule of air is trapped in the granulation tissue located outside the dome of\nthe urinary bladder at this site (602b:46), unchanged from the prior\nexamination. There is no intraluminal air seen within the urinary bladder\nitself. The previously noted fat stranding at the root of the mesentery has\nresolved.\n\nThere is no mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The distal ureters are unremarkable. There is no evidence of pelvic or\ninguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: Degenerative changes are seen in the lumbar spine. \nThere is no evidence of worrisome osseous lesions. A small fat containing\numbilical hernia is unchanged.", "output": "1. Sigmoid colonic diverticulosis with concentric wall thickening of the\nsigmoid colon affecting an approximate length of 6 cm of the sigmoid colon,\nwith interval decrease in the degree of surrounding fat stranding, compatible\nwith resolving/treated diverticulitis. No associated abscess noted.\n2. Persistent focal wall thickening at the dome of the urinary bladder\nadjacent to the segment of sigmoid colon previously affected by\ndiverticulitis. There is a soft tissue tract connecting the thickened sigmoid\ncolonic loop with the dome of the bladder containing a focus of extraluminal\ntrapped air, findings remain worrisome for developing colovesicular fistula. \nNo intraluminal air noted within the urinary bladder.\n3.No other acute intra-abdominal process seen. Normal appendix." }, { "input": "LOWER CHEST: Mild dependent atelectasis is present in the lung bases\nbilaterally. There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypoattenuating, compatible with hepatic\nsteatosis. There is no evidence of focal lesions within the limitations of an\nunenhanced scan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Chronic wall thickening of the\nsigmoid colon at the site of numerous diverticuli is again noted, along with\nadhesion to the superior left bladder dome. There is persistent soft tissue\nstranding along the tethered tract, essentially unchanged in appearance\ncompared to multiple prior examinations over the past year. The appendix is\nnormal.\n\nPELVIS: Continued left bladder dome wall thickening adjacent to the\nchronically thickened sigmoid colon is entirely unchanged in appearance\ncompared to prior examinations. There is no focus of intraluminal air. There\nis no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Sigmoid wall thickening with mild stranding along a tethered tract to the\nleft bladder dome is entirely unchanged in appearance compared to multiple\nprior studies over the past year, and reflective of changes from multiple\nprior bouts of diverticulitis with chronic inflammatory change involving the\nbladder wall.\n2. Continued bladder wall thickening at the left dome at the base of this\ncolovesical tethering, with no intraluminal air to confirm a patent\ncolovesicular fistula.\n3. Hepatic steatosis.\n\nRECOMMENDATION(S):\nAgree with previous recommendations from prior imaging reports and notes in\nthe ___ medical record for clinical follow-up and colonoscopy after\nresolution of symptoms. Also agree with previous recommendation to consider\ncystoscopy in order to exclude underlying mass lesion, though the CT\nappearance is compatible with chronic inflammatory change." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable. Mild thickening of the\nleft adrenal gland is unchanged.\n\nURINARY: The kidneys are symmetric in size. Mild fullness of the right\ncollecting system is unchanged. There are multiple peripelvic right renal\ncyst. There is no hydronephrosis. There are no renal stones.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel is normal in\ncaliber without focal wall thickening. There is unchanged chronic wall\nthickening and stranding surrounding a focal loop of the sigmoid colon in the\nregion of numerous diverticuli. There is an unchanged tethered tract between\nthe sigmoid colon and left bladder dome with associated bladder dome\nthickening (series 2, image 69). The appendix is visualized and normal.\n\nPELVIS: As described above, there is focal thickening and stranding around the\nleft bladder dome as seen previously with a tethered tract the sigmoid colon\n(series 2, image 69). No air is seen within the bladder. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Sigmoid wall thickening and stranding in the region of diverticula with a\ntethered tract to the left bladder dome, unchanged in appearance compared to\nprior CT, most likely reflect changes from multiple prior bouts of\ndiverticulitis with chronic inflammatory changes involving the bladder wall.\n\nRECOMMENDATION(S): As previously recommended, colonoscopy after resolution of\nsymptoms is recommended. In addition, further evaluation with cystoscopy in\norder to exclude underlying bladder mass can be considered." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right right adrenal gland is normal in size and shape. The left\nadrenal gland is thickened without definite nodule.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Unchanged chronic wall\nthickening and stranding surrounding a focal loop of the sigmoid colon in the\nregion of numerous diverticula. There is unchanged tethering between the\nsigmoid colon and left bladder dome with associated bladder dome thickening\n(___). There is minimal surrounding fat stranding. Diverticulosis of the\nsigmoid colon is noted, without evidence of wall thickening and fat stranding.\nThe appendix is normal.\n\nPELVIS: Focal thickening of the left bladder dome associated with an\nassociated loop of sigmoid colon, as described above. No air is identified in\nthe bladder. The distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. There are few prominent, though\nnonenlarged, mesenteric and bilateral inguinal lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small bilateral fat containing inguinal hernias.", "output": "1. No acute findings in the abdomen or pelvis. As seen on ___, there\nis sigmoid wall thickening and stranding with associated diverticula and a\ntethered track to the left bladder dome, likely reflecting changes of multiple\nprior bouts of diverticulitis with chronic inflammatory changes involving the\nbladder wall. As before, a colonoscopy is recommended if this has not\nrecently been performed. If there is concern for an underlying bladder mass,\nfurther evaluation with cystoscopy should be considered.\n2. No evidence of appendicitis, diverticulitis or small bowel obstruction. \nColitis cannot be entirely excluded on this noncontrast study, but there are\nno secondary signs to suggest acute colitis." }, { "input": "LOWER CHEST: Atelectasis is seen in the lung bases bilaterally. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is again chronic wall\nthickening and fat stranding surrounding a focal loop of sigmoid colon in the\npelvis. Irregular gas containing tract extending from the sigmoid colon to\nthe superior left lateral dome of the bladder is again demonstrated, with\nextrinsic soft tissue thickening involving the adjacent bladder dome. Volume\nof gas within this has increased compared to prior. Stranding of the\nmesenteric fat just anterior to the bladder dome is unchanged. There is no\ndefinite fluid collection concerning for abscess formation. Extensive\ndiverticulosis is seen throughout the descending and sigmoid colon. The\nappendix appears normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small umbilical fat containing hernia. Otherwise,\nthe abdominal and pelvic wall is within normal limits.", "output": "1. Appearances compatible with chronic diverticulitis and inflammatory/sinus\ntract extending to the wall of the bladder without definite intraluminal gas\nwithin the bladder to suggest fistula formation. Chronic thickening of the\nsuperolateral bladder dome is again seen and may be inflammatory but as on\nprior exam, a neoplastic process is not excluded at the bladder wall or\nsigmoid colon. Of note, the apparent sinus tract contains more gas than on\nprior exam but no drainable fluid collection is identified." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. The\ncaudate appears mildly prominent. There is no evidence of focal lesions\nwithin the limitations of an unenhanced scan. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is persistent fat\nstranding adjacent to the sigmoid colon consistent with diverticulitis. A \nprominent diverticulum with associated bowel wall thickening and pericolonic\nfat stranding appears tethered to the adjacent bladder dome, similar to the\nprior study in ___. The volume of gas appears to be increased as\ncompared to the prior exam. No fat plane is seen between the inflammatory mass\nand the bladder and there is eccentric bladder wall thickening in this region.\nNo definite gas is seen in the bladder lumen, however, these findings remain\nconcerning for developing colovesicular fistula. Stranding in the mesenteric\nfat anterior to the bladder dome is unchanged. There remains chronic\nthickening of the superolateral bladder dome, which may be related to\ndocumented chronic diverticulitis, however, neoplastic process is not entirely\nexcluded. There is no definite fluid collection concerning for abscess\nformation. Extensive diverticulosis is also seen throughout the descending\nand sigmoid colon. The appendix is grossly normal.\n\nPELVIS: The distal ureters are unremarkable. There is eccentric bladder wall\nthickening adjacent to the sinus tract from the sigmoid diverticulitis. This\nis unchanged in appearance when compared to the prior study. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThe bilateral SI joints appear to be fused. A hemangioma is noted in the left\niliac bone.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia, unchanged.", "output": "1. Similar appearance of inflammatory changes along a segment of sigmoid colon\nwith acute on chronic diverticulitis with a sinus tract extending to the level\nof the bladder without definite intraluminal gas seen within the bladder, as\ncompared to prior study in ___.\n2. Chronic thickening of the superolateral bladder dome is again seen and may\nbe inflammatory, but as on the prior exam, a neoplastic process is not\nexcluded. No definite fluid collection concerning for abscess formation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits with exception of\nmild left lower lobe opacification which might represent atelectasis, but a\ncomponent of aspiration would be difficult to exclude (02:22). There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Small 1.3 x 1.4 cm\nhypodensity in the right inferior pole kidney likely reflects a simple renal\ncyst (02:45). There is no evidence of focal suspicious renal lesions within\nthe limitations of an unenhanced scan. There is no hydronephrosis. There is\nno nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon without CT evidence to suggest diverticulitis. Short segment of\nconcentric wall thickening of the sigmoid colon in the left hemipelvis (2:\n64-69) is associated with soft tissue contiguity extending up to the dome of\nthe urinary bladder, virtually eliminating the fat planes between the two. \nThe soft tissue mass measures approximately 2.6 x 3.7 cm (601: 32), and does\nnot appear significantly changed compared to most recent CT abdomen pelvis\nperformed ___. Air locules are visualized within the fistulous\ntract between the bladder dome and the sigmoid colon with additional\nthickening of the bladder dome adjacent to the soft tissue lesion (601:31). \nThese findings are chronic and noted on multiple prior exams dating back to\n___, with progressive increase in soft tissue thickening around the\nfistulous tract. These changes likely reflect sequela of chronic colovesicular\nfistula, however an underlying neoplasm cannot be completely excluded. There\nis no evidence of a drainable fluid collection. There is no evidence of free\nintraperitoneal air. The appendix is normal.\n\nPELVIS: Eccentric wall thickening along the bladder dome, in the area adjacent\nto the colovesicular fistula. No evidence of air locules within the bladder. \nThe distal ureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Again demonstrated is a fat containing umbilical hernia.", "output": "1. No acute intra-abdominal process, no change since prior.\n2. Chronic changes of circumferential sigmoid colonic wall thickening in\nassociation with multiple diverticula and findings suggestive of a\ncolovesicular fistula with secondary bladder wall thickening. Further\nevaluation with colonoscopy and tissue sampling should be considered, if not\nalready performed.\n3. Small left lower lobe opacification may represent atelectasis, however a\ncomponent of aspiration or infection is difficult to exclude.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:58 am, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: A subcentimeter hypodensity in the posterior right lobe (02:20)\nis unchanged and incompletely characterized. The liver is otherwise\nunremarkable. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The bilateral adrenal glands are unremarkable.\n\nURINARY: A 1.1 cm simple cyst in the right lower pole and multiple peripelvic\ncysts are stable. The unenhanced kidneys are otherwise unremarkable. There\nis no hydronephrosis.\n\nGASTROINTESTINAL: Redemonstration of findings of chronic inflammation\ninvolving an approximately 7 cm segment of sigmoid colon (2:72), as evidence\nby wall thickening and mild pericolonic fat stranding, similar to prior. \nThere is a persistent colovesical fistula (601:34), with air again seen within\nthe bladder lumen.\n\nThere is a small hiatal hernia. No gastrointestinal obstruction. Extensive\nsigmoid diverticulosis is again noted. The appendix is unremarkable (2:69). \nNo pneumoperitoneum, free intra-abdominal fluid or fluid collections.\n\nPELVIS: The bladder is under distended. Persistent colovesicular fistula, as\ndescribed above. There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no abdominal, pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "Redemonstration of a colovesical fistula. No bowel obstruction or additional\nacute findings in the abdomen or pelvis.\n\nRECOMMENDATION(S): Consider colonoscopy, if not recently performed." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates hypoattenuation consistent with hepatic\nsteatosis. There is no evidence of focal lesions within the limitations of an\nunenhanced scan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. A 1.2 cm cyst is seen in the\nlower pole the right kidney multiple peripelvic cysts are seen bilaterally. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia, otherwise the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. Similar to prior there is a focal area of chronic circumferential\nthickening extending for 6 cm along the sigmoid colon which abuts the bladder\nwith mild surrounding fat stranding and a focus of air within the bladder (2;\n81). No evidence of drainable fluid collection or pneumoperitoneum. The\nappendix is normal.\n\nPELVIS: As above the colon directly abuts the bladder with a focus of air seen\nwithin the bladder consistent with a colovesicular fistula. The distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Prominent mesenteric lymph nodes are seen in the lower abdomen\nadjacent to the area of colonic thickening (601; 24). There is no\nretroperitoneal lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral inguinal hernias and umbilical hernia containing fat\nare noted.", "output": "1. Again seen is chronic inflammatory changes along a 6 cm segment of sigmoid\ncolon with a persistent colovesicular fistula. No acute findings or drainable\nfluid collections. No pneumoperitoneum.\n2. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Redemonstration of a\n1.3 cm cyst within the lower right renal pole cortex, unchanged in size from\nprior. Additionally, multiple bilateral parapelvic cysts are again seen. \nThere is no evidence of additional focal renal lesions within the limitations\nof an unenhanced scan. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patulous esophagus. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber and wall thickness throughout. \nCompared with prior exam, there is a similar appearance of circumferential\nthickening of the distal sigmoid colon that abuts the superior aspect of the\nbladder. Redemonstration of previously seen colovesicular fistula (series\n601, image 35), not significantly changed from prior. Diverticulosis of the\nentire colon is noted. The appendix is normal.\n\nPELVIS: Redemonstration of colovesicular fistula as demonstrated by focal wall\nthickening at the dome of the bladder with loss of fat planes between it and\nthe adjacent sigmoid colon and associated presumed contained extraluminal air\n(602:49). Slightly thickened bladder wall, which may be due to bladder\nunderdistension or a component of chronic cystitis. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Umbilical hernia containing fat are noted.", "output": "1. Unchanged circumferential thickening of the sigmoid colon with lack of fat\nplane between it and the bladder and unchanged appearance of colovesicular\nfistula. Overall appearance is unchanged. No definite findings of acute\ndiverticulitis.\n2. Slightly thickened bladder wall, which may be due to bladder\nunderdistension, reactive changes from the fistula or a component of cystitis.\n3. No CT evidence of pancreatitis." }, { "input": "LOWER CHEST: There is a 1.6 cm nodule in the left lower lobe (02:26). Please\nrefer to separate report of CT chest performed on the same day for detailed\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple foci of calcification within the liver parenchyma, likely\nrepresenting calcified granulomas. An 8 mm hypodensity is seen in segment 7\n(02:35) near the hepatic dome, indeterminate. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The portal and hepatic veins\nare patent. The gallbladder is collapsed with mild wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is markedly enlarged. A 2.6 cm accessory spleen is noted\nalong the inferior margin.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Mild free\nfluid is seen in the abdomen and pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is extensive mesenteric lymphadenopathy. A confluent group\nof periportal lymph nodes measure 4.0 x 3.3 cm (02:51) an enlarged portacaval\nlymph node measures 3.2 x 1.6 cm (02:50) and contains a foci of calcification.\nAn enlarged para-aortic lymph node measures 1.4 cm short axis diameter. There\nis also increased number of mesenteric lymph nodes, not individually size\nsignificant. Within the pelvis, there are numerous bilateral enlarged common\nand external iliac lymph nodes, the largest on the left measuring 3.4 x 1.8 cm\n(2:96). There is also bilateral inguinal adenopathy, the largest on the right\nmeasuring 2.1 x 1.4 cm (2:100). There are no necrotic lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is a left total hip arthroplasty. There is an old right-sided\nhip fracture or with cerclage wires around the greater trochanter. The right\nfemoral head is not present and significant soft tissue attenuation is seen\nsurrounding the remaining femoral neck. A dense 5 mm sclerotic foci is seen\nwithin the L4 vertebral body and may represent a small bone island. There is\ndegenerative disc disease most severe at L4-5 with anterolisthesis of L4 on L5\nsecondary to bilateral pars defects.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Extensive retroperitoneal and pelvic lymphadenopathy with massive\nsplenomegaly, concerning for lymphoma.\n2. Mild abdominal ascites.\n3. No evidence of intra or extrahepatic biliary ductal dilatation.\n4. Please refer to report for CT scan of the chest performed on the same day\nfor description of intrathoracic findings, including a 1.6 cm left lower lobe\nnodule." }, { "input": "LOWER CHEST: Mild dependent atelectasis. Two calcified granulomas are seen at\nthe right base. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is mild hepatic steatosis. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: A subcentimeter hypodensity in the uncinate process the pancreas is\nunchanged from ___, and likely represents an IPMN (2:31). No pancreatic\nductal dilatation or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. No evidence of small bowel\nobstruction. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. Bilateral adnexae are\nwithin normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No acute process within the abdomen or pelvis to account for the patient's\nsymptoms.\n2. Mild hepatic steatosis." }, { "input": "LOWER CHEST: Please refer to dedicated CT chest report on same day for\nintrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is intra and extrahepatic\nbiliary dilatation which appears grossly unchanged as compared to CTA chest ___ the gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic\ndiverticulosis without evidence of diverticulitis. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a fibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is grade 1 anterolisthesis of L5 over S1. There are moderate\nmultilevel degenerative changes of the lower thoracic and lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of malignancy in the abdomen and pelvis.\n2. Intra and extrahepatic biliary dilatation measuring up to 1.2 cm in the\ncommon bile duct is grossly unchanged dating back to chest CTA ___\nand likely secondary to post cholecystectomy state.\n3. Please refer to dedicated CT chest report on same day for intrathoracic\nfindings." }, { "input": "LOWER CHEST: Tiny subpleural nodule in the left lower lobe is not fully imaged\n(series 2, image 1). No pleural effusion. No evidence of a pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Tiny\nhypodensity in the right hepatic dome is too small to accurately characterize,\nprobably biliary hamartoma or cyst (series 601, image 24). No evidence of\nconcerning focal lesions. No evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nTiny hypodensities in the kidney are too small to accurately characterize on\nCT, statistically most likely cysts. No hydronephrosis or perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is distended with mild mucosal\nhyperemia and wall thickening. There is mild surrounding fat stranding in the\nright lower quadrant. No free fluid or organized fluid collections. No\nevidence of extraluminal gas. Within the midportion of the appendix appears\nto be a small appendicular ith measuring up to 4 mm (series 2, image 55;\nseries 602, image 34). There is minimal edema at the base of the appendix\n(series 602, image 30; series 2, image 58). The appendix is retrocecal,\ncourses superiorly, takes a turn and then courses inferiorly. No bowel\nobstruction.\n\nPELVIS: The urinary bladder is underdistended, limiting evaluation. There is\nexcreted intravenous contrast in the urinary bladder. A right ureteral jet is\nvisualized.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits. There is probably a\nnabothian cyst near the cervix. Normal follicular activity is seen in the\nright ovary. No left adnexal mass.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No calcified atherosclerotic disease\nis noted. The main portal vein, SMV, and splenic vein are patent.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are mild in the spine. A broad-based central disc bulge\nat L5-S1 is mild and indents the anterior thecal sac (series 2, image 57;\nseries 602, image 41).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute appendicitis with at least one appendicolith seen in the mid appendix\nand mild edema at the base. No extraluminal abscess or gas.\n\nNOTIFICATION: The findings and impression were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 4:16 am, 1 minutes\nafter discovery of the findings." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nnotable for mild enlargement, prosthetic mitral valve, prosthetic tricuspid\nvalve, with pacer leads entering the right atrium and right ventricle. No\npericardial or pleural effusion.\n\nABDOMEN: The unenhanced appearance of the liver is normal. The gallbladder is\ndecompressed containing a small stone. The pancreas appears slightly atrophic\nwithout focal lesion or signs of inflammation. The spleen is normal in size. \nThe adrenal glands are normal bilaterally. No hydronephrosis or renal stone. \nA subtle hyperdense focus within the midpole left kidney is seen best on\nseries 2 image 74 measuring 12 x 12 mm, not fully characterize, possibly a\nhemorrhagic cyst though not clearly seen on the prior exam. The abdominal\naorta is moderately calcified though normal in caliber. No retroperitoneal\nlymphadenopathy. The stomach and duodenum appear normal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. \nSuture material is noted in the right lower quadrant reflecting prior small\nbowel resection. Contrast is seen within distal loops of colon. The appendix\nis normal. The uterus is atrophic and there is no adnexal mass. The urinary\nbladder is mostly decompressed and appears unremarkable. No pelvic free\nfluid. No pelvic sidewall or inguinal adenopathy.\n\nBONES: No worrisome lytic or blastic osseous lesion. No fracture. There is\ngrade 1 anterolisthesis of L4 relative to L5 which appears unchanged with\nsignificant L4-5 degenerative disc disease.\n\nBODY WALL: Along the anterior abdominal wall extending inferiorly from the\numbilicus is a fluid collection which measures approximately 11.7 x 12.3 x 4.1\ncm, concerning for an organized subacute hematoma. Please correlate\nclinically. The possibility of superinfection is difficult to entirely\nexclude. No hernia.", "output": "1. New anterior pelvic wall collection measuring 11.7 x 12.3 x 4.1 cm, could\nrepresent an organized subacute hematoma, superinfection not excluded.\n2. Newly conspicuous small hyperdense lesion within the mid to lower pole left\nkidney could represent a hemorrhagic cyst though not fully characterized. ___\nconsider a nonemergent renal ultrasound to further assess.\n3. Additional nonemergent findings as described above." }, { "input": "LOWER CHEST:\n\nA small left pleural effusion is of intermediate density (23 Hounsfield\nunits). Bibasilar consolidations likely reflect atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Since the prior study, there has been interval improvement in\ndegree of pneumobilia related to prior choledochoduodenostomy. A 1.6 x 2.2 cm\nhypodensity in hepatic segment II likely represents a cyst or biliary\nhamartoma, and is unchanged.\n\nOtherwise, the liver enhances homogeneously, with no evidence of focal\nlesions. Mild central intrahepatic biliary ductal dilatation is noted. The\nportal veins are patent. Postsurgical changes related to recent Whipple\nprocedure are noted, including hepaticojejunostomy, with apparently intact\nanastomosis, and no surrounding focal fluid collection or abscess. Two\nsurgical drainage catheters enter the right lower quadrant, and course along\nthe right lateral aspect of the abdomen, terminating in the mid abdomen just\nanterior to the aorta at the level of the superior mesenteric artery origin\n(02:34), in the region of mesenteric fluid, as well as a second drainage\ncatheter, terminating in the gastrohepatic recess. Tiny locules of gas along\nthe more superior drainage catheter (02:26) are within postoperative limits.\n\nPANCREAS: The pancreatic tail is unremarkable. The pancreaticojejunostomy is\nnormal in appearance, with a pancreatic ductal stent extending directly into\nthe jejunum (02:30). No surrounding focal fluid collection or abscess is\nnoted, and only a small amount of low density mesenteric free fluid is noted\nalong the anterior pararenal space (02:35), with surrounding fat stranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The bilateral kidneys enhance symmetrically, with no evidence of\nstones, hydronephrosis, or focal renal masses. A stable left upper pole\nhypodensity was previously described as a cyst. No urothelial renal or\nureteral lesions are identified.\nGASTROINTESTINAL: The stomach is filled with enteric contrast material, and a\npercutaneous gastrostomy is in place (02:37), with associated small locules of\ngas along the subcutaneous tract, and a well-seated balloon within the gastric\nlumen. The gastroejunostomy tube is in place, an enteric material passes\nthrough the stomach, into the distal small bowel, with no evidence of holdup\nor leak. Distension of the biliary limb up to 4.6 cm (02:30) is likely related\nto postoperative ileus rather than obstruction, as contrast passes distally,\nwith no transition point to suggest mechanical obstruction. The visualized\nlarge bowel is unremarkable. No extraluminal leakage enteric contrast is\nnoted.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no significant\ncalcium burden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is only trace free fluid in the\npelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\nThere is no concerning osseous lesion. Ooverlying skin staples and\nsubcutaneous gas locules (02:43), are within postsurgical limits.", "output": "1. Extensive postsurgical changes related to recent prior Whipple procedure,\nas described above, with no organized fluid collection. Low density fluid and\nfat stranding along the anterior pararenal space, in contact with surgical\ndrains. Should the drainage be suspicious for a pancreatic duct leak, a\nsecretin-MRCP could be considered for further evaluation.\n2. Distension of the biliary limb of the jejunum up to 4.6 cm is likely\npostoperative ileus, as no mechanical obstruction is identified.\n3. Low-density small left pleural effusion, with bibasilar atelectasis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 4:39 ___, 5 minutes after discovery of the findings." }, { "input": "LOWER CHEST: There is mild left basilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is heterogeneous in enhancement, likely reflecting\nphase of contrast. A region of hyperenhancement surrounding the the\ngallbladder fossa is likely a transient hepatic attenuation difference. \nSubcentimeter hypodensities in the right lobe of the liver are too small to\ncharacterize. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter hypodensity in the upper pole of the left kidney is too small\nto characterize. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall volume intermediate density free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. Again seen, is an\napproximately 2.5 x 1.7 cm left ovarian cyst better evaluated are not same-day\npelvic ultrasound peer\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of diverticulitis. Normal appendix.\n2. Small amount of intermediate density fluid in the pelvis, possibly sequela\nof ruptured hemorrhagic cyst." }, { "input": "LOWER CHEST: Subsegmental bibasilar atelectasis.\n\nABDOMEN: The liver, gallbladder, spleen, adrenal glands, and pancreas appear\nunremarkable except for regions of focal fat in the liver.\n\nURINARY: The kidneys are unremarkable. No urolithiasis or hydronephrosis.\n\nGASTROINTESTINAL: No obstruction or ascites. The appendix is unremarkable.\n\nPELVIS: There is no free fluid in the pelvis. The uterus and adnexa are\nunremarkable on CT for age. A Foley catheter is present.\n\nLYMPH NODES: There is extensive retroperitoneal and mesenteric\nlymphadenopathy, the latter associated mild mesenteric stranding. For\nexample, there is an enlarged right ___ lymph node measuring 1.3\ncm (series 4: Image 25), previously 0.8 cm. There is a newly paracaval lymph\nmeasuring 1.2 cm (series 4: Image 29). An enlarged para-aortic lymph node\nmeasures 1.3 cm (series 4: Image 36) as well as a newly enlarged\ninteraortocaval lymph node measuring 1.6 cm. Additionally, there are enlarged\nbilateral pelvic lymph nodes, measuring up to 1.2 cm (series 4: Image 80). \nThe mesenteric lymph nodes are also subcentimeter, however more prominent than\non prior with associated increased soft tissue stranding. These findings are\nhighly concerning for lymphoma.\n\nBONES: No aggressive osseous lesions. Incidental note is made of edema and\nfoci of gas in the anterior subcutaneous tissues, likely injection sites.", "output": "1. New retroperitoneal and mesenteric lymphadenopathy with associated mild\nmesenteric stranding. These findings are nonspecific, however suspicious for\nlymphoma.\n2. No urolithiasis or hydronephrosis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:43 am, 1 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 0.8 cm calcified lesion in segment 6 of the liver (series 2, image\n27). No concerning lesions identified. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a punctate calcification seen at the lower pole of the right\nkidney. The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen throughout the lumbar spine. \nAdditionally, there is wedge deformity of unknown chronicity seen at T11 and\nT12.\n\nSOFT TISSUES: Within the right posterior flank, there is a 5.0 x 2.9 cm fat\ncontaining hernia (series 2, image 34). There is also a small cartilaginous\nspur seen along the anterior aspect of the eighth rib (series 2, image 23).", "output": "1. 5.0 cm fat containing hernia in the right posterior flank.\n2. Small cartilaginous spur along the anterior aspect of the eighth rib.\n3. Wedge deformity of unknown chronicity involving T11 and T12 vertebral\nbodies." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 13 mm hypodensity within segment II of the liver\n(series 2, image 63), not visualized on the ultrasound dated ___,\nwhich should be evaluated with MR. ___, the liver demonstrates\nhomogenous attenuation throughout. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple simple cysts within the kidneys bilaterally\nmeasuring up to 6.4 cm within the left upper pole. Otherwise, the kidneys are\nof normal and symmetric size with normal nephrogram. There is no evidence of\nsolid renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post esophagectomy and gastric\npull-through. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: Incidental note is made of a urachal remnant anterior to the bladder. \nOtherwise, the urinary bladder and distal ureters are unremarkable. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable. There is calcification of\nthe vas deferens bilaterally, which is closely associated with diabetes.\n\nLYMPH NODES: There are multiple subcentimeter periaortic retroperitoneal lymph\nnodes and multiple mesenteric lymph nodes measuring up to 7 mm (series 2,\nimage 68, 90), which warrant attention on follow-up examinations. There is no\nenlarged retroperitoneal or mesenteric lymphadenopathy by CT size criteria. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. There is mild narrowing at the origin of the celiac artery\n(series 2, image 159 and series 602b, image 50), likely due to compression\nfrom the median arcuate ligament.\n\nBONES: There are moderate degenerative changes within the lumbar spine and\nhips bilaterally. There is a Pitt's pit in the right lateral femoral head. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are small bilateral fat containing inguinal hernias. .", "output": "1. New 13 mm hypodensity within the left lobe of the liver, which should be\nfurther evaluated with an MRI.\n2. Multiple subcentimeter retroperitoneal and mesenteric lymph nodes, which\nwarrants attention on follow-up examinations.\n3. Mild narrowing at the origin of the celiac artery, likely due to\ncompression from the median arcuate ligament.\n4. Please refer to the chest CT with the same date for evaluation of the intra\nthoracic structures.\n\nRECOMMENDATION(S): MRI is recommended to evaluate the new 13 mm hypodensity\nwithin the left lobe of the liver.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:10 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: There is a small loculated left-sided pleural effusion, unchanged\nfrom CT ___. Associated compressive atelectasis is minimally\nchanged. There is no evidence of pleural or pericardial effusion. .\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is minimal central periportal\nedema. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is mild pericholecystic fluid and the gallbladder bladder\ncontains dense sludge, unchanged from ___\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 15.8 cm in length in AP dimension\n(series 302:20), grossly unchanged in size from ___. There is no\nfocal lesion.\n\nADRENALS: Both adrenal glands are hyptertrophied.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a moderate hydronephrosis of the right kidney, unchanged dating back\nto CT ___. There is no focal lesion or perinephric abnormality.\n\nGASTROINTESTINAL: Oral contrast is seen to the level of the ascending colon. \nGastric suture lines appear grossly unremarkable. Percutaneous gastrostomy\ntube is coiled in terminates within the gastric body, unchanged in position\nfrom ___. A percutaneous jejunostomy tube appears unremarkable. \nThere are uniformly dilated small bowel loops diffusely to the terminal ileum.\nFor example, ileal loops measure 4.1 cm in maximal diameter (series 2:63),\nunchanged in degree of dilatation as compared to CT abdomen pelvis ___. There is no evidence of a transition point. There is a mild amount of\ninterloop free fluid. Large bowel loops are unremarkable. The appendix not\nvisualized but there is no secondary sign of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\ntrace amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. Intrauterine device is noted in\nsitu.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is moderate facet arthropathy of the lumbar spine.\n\nSOFT TISSUES: There is diffuse anasarca.", "output": "1. Uniformly dilated small bowel loops without evidence of a transition point\nare grossly unchanged in appearance as compared to CT abdomen and pelvis ___. There is distal passage of oral contrast into the cecum and\nascending colon. There is no evidence of a mechanical obstruction. These\nfindings are most compatible with an ileus.\n2. Persistent moderate right-sided hydronephrosis without a cause is unchanged\nas compared to CT abdomen pelvis ___.\n3. No intraabdominal drainable fluid collection.\n4. Splenomegaly; cholelithiasis; appropriately positioned percutaneous\ngastrostomy and jejunostomy catheters; diffuse anasarca are additional\nfindings." }, { "input": "Of note, the study is suboptimal due to body habitus.\n\nLOWER CHEST: Consolidations are noted in the left lower lobe, which can be\nconcerning for infection in the appropriate clinical setting. A small\nloculated pleural effusion is redemonstrated in the left lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild periportal edema. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen appears enlarged, measuring up to 15.3 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is redemonstration of moderate hydronephrosis without definite\nsource of obstruction, similar to the prior exam in ___. The left\nkidney appears grossly normal. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Roux-en-Y gastric bypass. Incidental\nnote is made of a G tube and a J-tube. The small bowel loops again appear\ndiffusely dilated, measuring up to 4 4.8 cm (series 601: Image 30), similar to\nthe prior study in ___ without definite transition point. The colon and\nrectum are within normal limits. The appendix is not well visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. A small\namount of ascites is noted in the right lower quadrant, unchanged.\n\nREPRODUCTIVE ORGANS: An IUD is noted in the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Extensive soft tissue edema and anasarca is noted, similar to\nthe prior study in ___.", "output": "1. Of note, this is a suboptimal study due to body habitus. Within these\nlimitations, diffuse dilatation of multiple small bowel loops are again noted\nwithout definite transition point.\n2. Moderate hydronephrosis is again seen without definite source of\nobstruction, similar to the prior study on ___.\n3. Postsurgical changes are noted following Roux-en-Y gastric bypass. \nIncidental note is made of a G-tube and a J-tube.\n4. Consolidations are seen in the left lower lobe, which can be concerning for\ninfection in the appropriate clinical setting.\n5. Small loculated left pleural effusions unchanged.\n6. Splenomegaly and cholelithiasis.\n7. Diffuse anasarca, unchanged." }, { "input": "LOWER CHEST: There are small left and trace right pleural effusions and\nadjacent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones or\nsludge without wall thickening or surrounding inflammation. There is moderate\nnonhemorrhagic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring 16 cm, without focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Roux-en-Y gastric bypass, with\nsurgical sutures seen at the GE junction. An enteric tube terminates in the\njejunal limb. Administered contrast remains in the dilated esophagus and does\nnot pass through the gastrojejunal junction. There is no evidence of\nextraluminal contrast extravasation. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is not visualized. There is no free\nintraperitoneal air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is present in the uterus. No adnexal abnormality\nis seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. The portal vein, SMV and splenic vein are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No free intraperitoneal air.\n2. Oral contrast remains in the dilated esophagus and does not pass through\nthe gastrojejunal anastomosis, suggesting stricture recurrence.\n3. Cirrhosis sequela of portal hypertension including splenomegaly and\nmoderate ascites.\n4. Small left and trace right pleural effusions and bibasilar atelectasis." }, { "input": "LOWER CHEST: Consolidations at the left lung base likely represent\natelectasis, similar to compared to prior, however underlying infection cannot\nentirely be excluded. Trace left pleural effusion. Right pleural effusion. \nNo pericardial effusion.\n\nABDOMEN:\nSmall volume ascites.\n\nHEPATOBILIARY: Please note the superior most liver is not imaged on this\nexamination. There is cirrhotic in appearance. There is mild periportal\nedema. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. Multiple stones are seen\nwithin the gallbladder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 16.3 cm, no focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is mild right hydronephrosis, unchanged compared to prior. No\nhydronephrosis on the left. The kidneys are of normal and symmetric size with\nnormal nephrogram. There is no evidence of focal renal lesions. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass. A\nG-tube is seen appropriately positioned within the stomach. Numerous\ndistended loops of small bowel with air-fluid levels are unchanged compared to\nprior without a definitive transition point, likely representing ileus. The\ncolon and rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: An IUD is seen within the endometrial canal. Uterus and\nbilateral adnexa are otherwise unremarkable in appearance.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Extensive diffuse body wall edema. Surgical clips are seen in\nthe region of the prior jejunostomy. A serpiginous density is unchanged\ncompared to prior, likely surgical sutures (series 2, image 41). There is a\nmoderate amount of stranding within the adjacent subcutaneous fat, as well as\nsubcutaneous emphysema, both expected changes. Evaluation for fistula is\nlimited given lack of oral contrast. There are no focal fluid collections.", "output": "1. Interval removal of the jejunostomy without focal fluid collections to\nsuggest abscess formation. Evaluation for a fistula is limited without IV\ncontrast. Adjacent fat stranding and subcutaneous emphysema are present.\n2. Diffuse distension of small bowel loops with air-fluid levels, unchanged\ncompared to prior, likely representing ileus.\n3. Cirrhotic appearing liver with sequela of portal hypertension including\nsplenomegaly and diffuse anasarca.\n4. Airspace opacity at the left lung base, likely atelectasis, however\nunderlying infection cannot entirely be excluded.\n5. Unchanged mild right hydronephrosis.\n6. Cholelithiasis." }, { "input": "LOWER CHEST: Consolidation is again seen at the left lung base, likely\nreflecting atelectasis, though underlying infection cannot entirely be\nexcluded. Trace bilateral pleural effusions with peripheral enhancement of\nthe pleura on the left as seen previously. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout, with\nnodular contour, consistent with cirrhosis. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation. There is a small amount of perihepatic fluid, as\nbefore.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen measures 16 cm, with attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMild right hydronephrosis is again seen. There is no left hydronephrosis. \nThere is no evidence of focal renal lesions. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass. A\nG-tube is seen within the stomach. Small bowel loops are mildly dilated\nthroughout, with multiple air-fluid levels. Contrast is seen to the level of\nthe terminal ileum. The colon and rectum are within normal limits. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is seen in the endometrial canal. The uterus and\nbilateral adnexa are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Again seen is diffuse subcutaneous soft tissue edema. Surgical\nclips are again seen in the region of prior to jejunostomy, with a small\namount of subcutaneous emphysema.", "output": "1. Mild dilation of small bowel loops with air-fluid levels likely represents\nileus. Contrast is seen to the level of the terminal ileum.\n2. Cirrhotic liver with anasarca and splenomegaly.\n3. Mild right hydronephrosis, unchanged.\n4. Left basilar opacity likely represents atelectasis, unchanged from prior. \nUnderlying infection cannot be excluded." }, { "input": "LOWER CHEST: Left basilar airspace opacities similar in severity compared to\n___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular in contour consistent with known history\nof cirrhosis. Unable to evaluate for focal liver lesions without intravenous\ncontrast. There is trace perihepatic ascites. There is cholelithiasis\nwithout CT evidence of acute cholecystitis. Limited evaluation for the\nbiliary tree without intravenous contrast.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 16.3 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size. There is unchanged right\nhydronephrosis. There is no left hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Surgical changes from Roux-en-Y gastric bypass are noted. \nGastrostomy tube is in place. Oral contrast extends through the proximal\nsmall bowel. There is diffuse small bowel dilation, somewhat increased in\nseverity compared to prior CT scans from ___ and ___ although without\ntransition point seen. The colon is stool filled and distended.\n\nPrior site jejunostomy noted in the left upper/mid abdomen. There is\nincreased soft tissue measuring approximately 6.9 x 4.1 cm in the subcutaneous\ntissues deep to the prior jejunostomy, which has increased from ___. \nMatted loops of small bowel are seen in this location although without\nintravenous/oral contrast reaching this area it is difficult to differentiate\ninflammation from bowel loops and also difficult to assess for a\nenterocutaneous fistula. No liquified fluid collection or foci of air are\nseen in this location. There is mild associated skin thickening at the site\nof the jejunostomy.\n\nPELVIS: The bladder is decompressed. There is small amount of pelvic\nfree-fluid including nonspecific presacral edema.\n\nREPRODUCTIVE ORGANS: Partially imaged IUD in place. The ovaries are not\nvisualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse anasarca. Superficial varices are noted.", "output": "1. Skin thickening at the site of prior jejunostomy. No liquified fluid\ncollection identified in this location.\n2. Increased soft tissue deep to the previous jejunostomy site located in the\nvicinity of matted loops of small bowel, without oral contrast reaching this\nlocation, it is unclear if there is an enterocutaneous fistula or if soft\ntissue findings just represent inflammatory tissue or hematoma. Consider\nrepeat delayed imaging once oral contrast has traversed this location to\nevaluate for underlying fistula.\n3. Dilated small bowel loops increased in severity compared to recent prior CT\nscans without transition point, findings favor ileus.\n4. Diffuse anasarca.\n5. Cirrhosis with sequela of portal hypertension.\n\nRECOMMENDATION(S): Consider repeat delayed imaging\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:03 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There is trace left pleural effusion with subjacent atelectasis. \nThe heart is mildly enlarged. No pericardial effusion. There is suggestion\nof some coronary artery calcifications, as seen previously.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver has a nodular contour, consistent with cirrhosis. There\nis no evidence of focal lesions within the limitations of an unenhanced scan. \nThere is minimal central intrahepatic biliary dilation. The common bile duct\nmeasures 6 mm, tapering near the ampulla. The gallbladder contains\ngallstones, without wall edema or pericholecystic fluid. There is small\nvolume perihepatic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation.\n\nSPLEEN: The spleen is enlarged, measuring 16 mm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. \nRight-sided mild hydronephrosis is unchanged. No left-sided hydronephrosis.\n\nGASTROINTESTINAL: Postsurgical changes following Roux-en-Y gastric bypass are\nre-demonstrated. A percutaneous gastrostomy tube is in place.\n\nA percutaneous drainage catheter is present in the left upper abdomen, at the\nsite of the previously seen soft tissue density.\n\nThere is dilation of several loops of distal ileum, which appears overall\nsimilar to the prior study of ___. There is no definite\ntransition point. The colon is filled with stool throughout, but is grossly\nthin-walled..\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A IUD is seen centrally within the uterus. No adnexal\nabnormality is detected.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse anasarca. A cutaneous defect overlying the\nleft upper abdomen is noted. Subcutaneous edema is seen.", "output": "1. Trace left pleural effusion with subjacent atelectasis.\n2. Cholelithiasis without evidence of cholecystitis.\n3. Cirrhotic liver with splenomegaly, varices and ascites consistent with\nportal hypertension.\n4. Dilated loops of small bowel without a definite transition point appears\nsimilar to ___, and ileus is favored over obstruction. There is\na very large stool burden throughout the colon.\n5. Re-demonstrated mild right hydronephrosis.\n6. Likely some coronary artery calcifications are again noted, of note in a\npatient of this age." }, { "input": "LOWER CHEST: A trace left pleural effusion with adjacent atelectasis is\nsimilar to prior. Otherwise, the visualized lung fields are within normal\nlimits. The heart is mildly enlarged. There is no evidence of pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver contour is nodular, as on prior. Small volume,\nperihepatic fluid is unchanged. The liver demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen measures 16 cm. Otherwise, the spleen shows normal size\nand attenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions. Mild right hydronephrosis is\nunchanged. No left hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Surgical clips are seen near the GE junction, as on prior. \nA percutaneous gastrostomy tube is in place, as is a percutaneous drainage\ncatheter in the left upper quadrant. Multiple, fluid-filled small bowel loops\nare dilated to 4.6 cm (2:74), mildly increased from prior. Enteric contrast\nis seen within the jejunum. A transition point is not definitively\nidentified. No decompressed small bowel loops are seen. Within the right mid\nabdomen (601:24, 02:58), a short segment of small bowel appears of normal\ncaliber, relatively decompressed compared to the rest of the small bowel, the\nappearance of wall thickening which is thought to be due to relative\n___. The colon and rectum are within normal limits. The appendix\nis not visualized, however there are no secondary signs of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid within the pelvis, if any.\n\nREPRODUCTIVE ORGANS: An IUD is seen within the uterus. The uterus and\nbilateral adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No significant interval change in multiple, fluid-filled, dilated small\nbowel loops. No transition point or decompressed loops are identified to\nsuggest obstruction.\n2. Unchanged cirrhotic appearance of the liver with splenomegaly and small\nvolume perihepatic fluid.\n3. Unchanged mild right hydronephrosis." }, { "input": "LOWER CHEST: A trace left pleural effusion with adjacent homogeneously\nenhancing atelectasis is similar to the prior exam. No right pleural\neffusion. No evidence of a pericardial effusion. Opacity in the lingula is\nprobably atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular appearing liver, unchanged. No evidence of focal liver\nlesions. No evidence of intrahepatic or extrahepatic biliary dilation. The\ngallbladder contains several calcified gallstones. No gallbladder wall\nthickening. Ascites is small volume, predominantly around the liver.\n\nPANCREAS: Pancreas is slightly atrophic. The pancreas has normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nNo peripancreatic stranding.\n\nSPLEEN: The spleen remains enlarged measuring up to 15.5 cm. No evidence of a\nfocal splenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMild-to-moderate right hydronephrosis and prominence of the proximal right\nureter is similar to the prior exam. No evidence focal renal lesions. No\nperinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical anatomy of the stomach is stable. Ingested\nenteric contrast is seen within this is. There is a G-tube that appears well\npositioned within the stomach lumen. Enteric contrast is seen up to the mid\nto distal small bowel. The small bowel loops with oral contrast are not\nmarkedly distended. There are however distended loops of more distal small\nbowel with fecalized material. No discrete transition point identified nor\ndecompressed small bowel loops. Overall the degree of dilation is perhaps\nslightly worse compared to prior. No definite transition point. The colon is\nmoderately distended with stool. The rectum is unremarkable. No organized\nfluid collection or free air. Appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis related to ascites.\n\nREPRODUCTIVE ORGANS: An intrauterine device is seen within the uterus.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Extensive collaterals seen in the\nanterior abdominal wall.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is soft tissue edema, unchanged. Pigtail catheter\nprojects over the left mid abdomen, not definitively intraperitoneal and\nappears along the anterior abdominal wall. No drainable collection in this\narea.", "output": "1. Enteric contrast reaches the mid-distal small bowel. The more distal small\nbowel is distended, perhaps slightly worse compared to prior and now contains\nmore extensive fecalized material suggesting slow transit. No discrete\ntransition point identified nor decompressed distal small bowel loops to\nfurther support an obstruction. Colon is also moderately distended with\nstool. Could consider repeat abdominal radiographs to confirm enteric\ncontrast passage through the bowel as clinically warranted.\n2. No evidence of abscess. Pigtail catheter seen along the left anterior\nabdominal wall without associated collection in this region.\n3. Nodular liver with small volume ascites.\n4. Persistent moderate right hydronephrosis with mild dilation of proximal\nright ureter, unchanged.\n5. Cholelithiasis.\n6. Persistent small left pleural effusion with some left lower lobe\natelectasis." }, { "input": "LOWER CHEST: Trace bilateral pleural effusions with associated compressive\natelectasis at the bases. No pericardial effusion. Mild coronary artery\ncalcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is shrunken and nodular consistent with cirrhosis. No\nfocal lesions seen. No biliary dilation. Cholelithiasis is again noted.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Spleen is again noted to be enlarged measuring up to 15.9 cm.\n\nADRENALS: Unremarkable.\n\nURINARY: There is mild right-sided hydronephrosis and proximal hydroureter\nwhich appears slightly improved compared to prior. Left kidney is\nunremarkable without hydronephrosis.\n\nGASTROINTESTINAL: Status post Roux-en-Y gastric bypass. Percutaneous G-tube\nis noted within the stomach. Dilated fecalized loops of distal small bowel\nare again noted, however the distension of small-bowel loops is improved\ncompared to prior exam. There is a small volume abdominopelvic ascites,\nsimilar prior.\n\nPELVIS: Small volume loculated fluid in the right hemipelvis is similar to\nprior.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. IUD is noted. No adnexal\nabnormalities are seen.\n\nLYMPH NODES: No abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Diffuse subcutaneous edema similar prior. A left upper quadrant\napproach pigtail catheter terminates in stable position in the subcutaneous\ntissues at this location. There is no surrounding collection. Numerous\nvascular venous collaterals are again noted in the thoracoabdominal wall.", "output": "1. Cirrhosis with findings or portal hypertension and small amount of ascites\nand unchanged trace bilateral pleural effusions.\n2. Chronic partial small bowel obstruction with improved small bowel\ndistention compared to prior.\n3. Mild right-sided hydronephrosis and proximal hydroureter appears slightly\nimproved compared to prior.\n4. Unchanged position of a left upper quadrant approach catheter which\nterminates in the subcutaneous tissues at this location. No surrounding fluid\ncollection." }, { "input": "LOWER CHEST: Moderate atelectasis in the left lung base and a trace left\npleural effusion are similar. No right pleural or pericardial effusion is\nseen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken with a nodular contour, consistent with\ncirrhosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged at 15.6 cm, previously 15.9 cm. No focal\nlesions are identified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is post reversal of Roux-en-Y gastric bypass. A\npercutaneous gastrostomy tube is in unchanged position.\n\nA left upper quadrant approach percutaneous drain at site of patient's old\npercutaneous jejunostomy tube is again seen, without surrounding fluid\ncollection seen. A continuous stream of contrast is seen connecting the tip\nof the drain and the adjacent small bowel loop (02:40), compatible with an\nenterocutaneous fistula.\n\n No extraluminal leak of oral contrast into the peritoneal cavity is\ndemonstrated. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is not visualized. Moderate to large stool burden and small\nvolume abdominopelvic ascites are similar.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is noted in the endometrial cavity. No adnexal\nabnormality is seen.\n\nLYMPH NODES: Prominent porta hepatis nodes measuring up to 1.1 cm (2:25) are\nunchanged. There is no evidence of pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes are noted in the anterior abdominal wall. \nDiffuse subcutaneous edema is similar to prior. Numerous venous collaterals\nare again seen in the thoracoabdominal wall.", "output": "1. Enterocutaneous fistula at the site of patient's subcutaneous drain in the\nleft anterolateral abdominal wall. No surrounding fluid collection seen.\n2. No extraluminal leak of oral contrast into the peritoneal cavity.\n3. Cirrhotic liver morphology with sequela of portal hypertension, including\nsmall volume abdominopelvic ascites and splenomegaly, similar to prior.\n4. Moderate to large stool burden.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:11 am, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate mild bilateral pleural\neffusions measuring less than 2 mm on the right and likely less than 4 mm on\nthe left associated with mild atelectatic/scarring changes more prominent on\nthe left than on the right lung base. There is a right lung base calcified\ngranuloma. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular and mildly shrunken consistent with\ncirrhosis. There is no evidence of focal lesions within the limitations of an\nunenhanced scan. There is no evidence of intrahepatic biliary dilatation. \nCommon bile duct measures 8 mm, overall stable when compared with prior. The\ngallbladder contains gallstones without wall thickening or evidence of\ninflammation. There is mild ascites surrounding the liver and in the pelvis.\n\nPANCREAS: The pancreas has normal attenuation throughout but is atrophic. \nThere is no evidence of focal pancreatic lesions within the limitations of an\nunenhanced scan. There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: Stable splenomegaly, measuring 16.6 cm\n\nADRENALS: The right adrenal gland is normal in size and shape. Left adrenal\ngland is now hyperplastic.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\na new mild right hydronephrosis, the right renal pelvis measures 13 mm of AP\ndimension. No obstructing lesion identified. There is a nonobstructing 2 mm\nnephrolithiasis in the lower pole of the right kidney. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post gastrojejunostomy with subsequent\nreversal. The site of prior percutaneous gastrostomy tract is similar in\nappearance, with no definite fat stranding (series 2, image 48). Soft tissue\nis again seen at the site of prior left mid abdomen percutaneous jejunostomy\ntract. This area is not well assessed on this unenhanced study. Some air\nbubbles are seen, either due to subtle herniation of a small bowel loop, or\npresence of fistulous tract. These air bubble do not extend toward the skin\nsurface likely just due to the presence of small-bowel loop that herniated in\nthe vicinity. Correlate clinically.\n\nThere is dilation of small bowel loops measuring up to 4.8 cm in the right\nflank, with edematous changes involving the mesentery. Edematous changes are\nalso seen at the root of the mesentery and in the retroperitoneum. The distal\nsmall-bowel loops are collapsed, even though we do not definitely see a\ntransition point, subocclusion is of concern. There is no thickening of small\nbowel wall, pneumatosis or pneumoperitoneum. Of note, the prior jejunostomy\ntract is not in relationship with these dilated bowel loops.\n\nThe colon and rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable without\ndefinite evidence of ureterolithiasis. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Paraesophageal and splenorenal varices are noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a rectus abdominis diastasis. There is third spacing\nwith edema involving the subcutaneous tissues.", "output": "1. Findings concerning for partial/early small bowel obstruction with mild\nincrease in ascites noted and edematous changes in the mesentery and the\nretroperitoneum. There is limited assessment of small bowel loop given the\nlack of IV and oral contrast.\n2. Mild new right hydronephrosis, without definite identifiable cause of\nobstruction on today's examination. Contrast-enhanced CT should be considered\nfor better delineation of the right ureter.\n3. Stable aspect of prior percutaneous gastrostomy tube and percutaneous\njejunostomy tube sites. These cannot be adequately assessed given the lack of\nIV and oral contrast.\n4. Liver cirrhosis with signs of portal hypertension." }, { "input": "LOWER CHEST: There is a small left effusion with overlying atelectasis versus\nairspace disease, slightly increased when compared to the prior examination.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver has a nodular contour, consistent with cirrhosis. No\nfocal hepatic lesions within limitation of this noncontrast examination. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged, as on prior examinations, measuring up to 16.5\ncm, consistent with portal hypertension.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post takedown of a Roux-en-Y\ngastrojejunostomy with gastric gastrostomy and J-tube placement. There are\ndilated loops of jejunum proximal to the patient's jejunal anastomosis,\nwithout complete obstruction. Contrast is seen throughout loops of jejunum\nand ileum. Jejunostomy tube again noted. There is small to moderate volume\nascites without focal collection. The colon and rectum are within normal\nlimits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Intrauterine device noted.\n\nLYMPH NODES: Prominent periportal and retroperitoneal nodes are again likely\nreactive. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes are seen along the anterior abdominal wall.\nDiffuse subcutaneous stranding is likely related to anasarca.", "output": "1. Mildly dilated loops of jejunum proximal to the patient's jejunal\nanastomosis, without evidence for complete obstruction. Contrast passes into\nmore distal loops of jejunum.\n2. No evidence for leak or intra-abdominal collection.\n3. Stigmata of cirrhosis and portal hypertension, with small to moderate\nvolume simple ascites.\n4. Left pleural effusion and diffuse subcutaneous stranding, likely related to\nanasarca.\n5. Prominent retroperitoneal and periportal nodes, likely reactive." }, { "input": "CHEST:HEART AND VASCULATURE: A right-sided central catheter is present with\nthe tip in the right atrium. The thoracic aorta is normal in caliber. The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: Large left pleural effusion with associated compressive\natelectasis.\nLUNGS/AIRWAYS: Patchy and confluent opacities in the left upper lobe with air\nbronchograms. Mild right upper lobe ground-glass opacities (02:34), likely\nrepresent infection or inflammation. 2 mm lingular calcified granuloma\n(02:43). The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: An enteric tube is present with the tip in the proximal\nstomach. The liver has a nodular contour, consistent with cirrhosis. No\nfocal hepatic lesions within limitation of this noncontrast examination. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. Vicarious\nexcretion of contrast in the gallbladder is unchanged since the prior CT dated\n___.\n\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation . There is no peripancreatic stranding.\n\nSPLEEN: Persistent splenomegaly, measuring up to 16 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. No hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube is present with the tip in the mid stomach. \nPost takedown Roux-en-Y gastrojejunostomy with gastrogastrostomy and J-tube\nplacement. The percutaneous jejunostomy tube initially courses retrograde\nhowever loops on itself with the final tip located just upstream of the\nballoon. There are multiple prominent loops of small bowel containing\nair-fluid levels, the largest of which measures up to 4.8 cm and are slightly\nmore pronounced than on the prior exam. No definite transition point is\nidentified and contrast is noted throughout the colon. There is no free\nintraperitoneal air, portal venous gas or pneumatosis intestinalis. The colon\nand rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small to\nmoderate volume intraperitoneal ascites. Evaluation for organized collections\nis limited due to the lack of intravenous contrast.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable. An IUD is\npresent within the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Absence of intravenous contrast limits evaluation for vascular\npathology. Mild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: Diffuse anasarca.", "output": "1. Prominent loops of fluid-filled small bowel measuring up to 4.8 cm, likely\nreflective of ileus or partial small bowel obstruction. No transition point\nis identified and enteric contrast is noted throughout the colon. No\nintraperitoneal free air, pneumatosis intestinalis or portal venous gas.\n2. Post takedown Roux-en-Y gastrojejunostomy with gastrostomy and J-tube\nplacement as described above.\n3. Cirrhosis, with findings of portal hypertension including moderate volume\nintraperitoneal ascites and splenomegaly.\n4. Large left pleural effusion with overlying compressive atelectasis.\n5. Patchy and confluent opacities in the left upper lobe may represent\npneumonia in the appropriate clinical setting.\n6. Evaluation for organized fluid collections is limited given the lack of\nintravenous contrast.\n\nNOTIFICATION: The findings were discussed with Dr. ___, by Dr.\n___, on the telephone on ___ at 4:47 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "CHEST:HEART AND VASCULATURE: A right-sided central catheter is present with\nthe tip in the right atrium. The thoracic aorta is normal in caliber. The\nheart, pericardium, and great vessels are within normal limits. No pericardial\neffusion is seen.\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present.\n\nPLEURAL SPACES: Large left pleural effusion with associated compressive\natelectasis.\nLUNGS/AIRWAYS: Patchy and confluent opacities in the left upper lobe with air\nbronchograms. Mild right upper lobe ground-glass opacities (02:34), likely\nrepresent infection or inflammation. 2 mm lingular calcified granuloma\n(02:43). The airways are patent to the level of the segmental bronchi\nbilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: An enteric tube is present with the tip in the proximal\nstomach. The liver has a nodular contour, consistent with cirrhosis. No\nfocal hepatic lesions within limitation of this noncontrast examination. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. Vicarious\nexcretion of contrast in the gallbladder is unchanged since the prior CT dated\n___.\n\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation . There is no peripancreatic stranding.\n\nSPLEEN: Persistent splenomegaly, measuring up to 16 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. No hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube is present with the tip in the mid stomach. \nPost takedown Roux-en-Y gastrojejunostomy with gastrogastrostomy and J-tube\nplacement. The percutaneous jejunostomy tube initially courses retrograde\nhowever loops on itself with the final tip located just upstream of the\nballoon. There are multiple prominent loops of small bowel containing\nair-fluid levels, the largest of which measures up to 4.8 cm and are slightly\nmore pronounced than on the prior exam. No definite transition point is\nidentified and contrast is noted throughout the colon. There is no free\nintraperitoneal air, portal venous gas or pneumatosis intestinalis. The colon\nand rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small to\nmoderate volume intraperitoneal ascites. Evaluation for organized collections\nis limited due to the lack of intravenous contrast.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable. An IUD is\npresent within the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Absence of intravenous contrast limits evaluation for vascular\npathology. Mild atherosclerotic disease is noted.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: Diffuse anasarca.", "output": "1. Prominent loops of fluid-filled small bowel measuring up to 4.8 cm, likely\nreflective of ileus or partial small bowel obstruction. No transition point\nis identified and enteric contrast is noted throughout the colon. No\nintraperitoneal free air, pneumatosis intestinalis or portal venous gas.\n2. Post takedown Roux-en-Y gastrojejunostomy with gastrostomy and J-tube\nplacement as described above.\n3. Cirrhosis, with findings of portal hypertension including moderate volume\nintraperitoneal ascites and splenomegaly.\n4. Large left pleural effusion with overlying compressive atelectasis.\n5. Patchy and confluent opacities in the left upper lobe may represent\npneumonia in the appropriate clinical setting.\n6. Evaluation for organized fluid collections is limited given the lack of\nintravenous contrast.\n\nNOTIFICATION: The findings were discussed with Dr. ___, by Dr.\n___, on the telephone on ___ at 4:47 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There is mild dependent and subsegmental atelectasis in the left\nlower lobe. There is no pleural or pericardial effusion. There has been\nresolution of large left-sided pleural effusion seen on CT abdomen and pelvis\n___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver has a nodular contour compatible with cirrhosis. \nThere is no evidence of a focal lesion. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is vicarious excretion of contrast\nin the gallbladder, unchanged from CT abdomen pelvis ___. There is\nsmall volume ascites, decreased from ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged measuring 16.0 cm in AP diameter (02:23), unchanged\nfrom ___. There is no focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminates in the mid stomach.\nPost takedown Roux-en-Y gastrojejunostomy with gastrogastrostomy and J-tube\nplacement. The percutaneous jejunostomy tube courses retrograde and loops on\nitself, unchanged in position from ___. There are dilated small\nbowel loops measuring up to 5.5 cm in the proximal jejunum (02:45), mildly\nincreased in degree of distention since ___, previously measuring up\nto 4.6 cm. There is no transition point. Contrast is noted throughout the\ncolon. The colon and rectum are grossly unremarkable. A rectal tube is\nnoted. The appendix is not visualized.\n\nPELVIS: A Foley catheter is noted in the bladder. The urinary bladder and\ndistal ureters are unremarkable. There is a small amount of ascites in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable apart from an IUD being\npresent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. There is no evidence of portal venous gas. Marked abdominal\nvarices are present.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse anasarca", "output": "1. Multiple dilated small bowel loops measuring up to 5.4 cm are mildly more\ndistended since CT abdomen and pelvis ___., Previously measuring up\nto 4.6 cm, without a discrete transition point likely representing an ileus. \nContrast is noted in the colon and rectum which are unremarkable.\n2. Post takedown Roux-en-Y gastrojejunostomy with GJ-tube unchanged in\nposition from ___.\n3. placement as described above.\n4. Cirrhosis with moderate volume ascites and splenomegaly." }, { "input": "LOWER CHEST: A small loculated left pleural effusion is slightly decreased\ncompared to the examination obtained 2 days prior. Associated compressive\natelectasis is minimally changed. A punctate granuloma in the anterior right\nmiddle lobe is unchanged (series 2, image 9).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is mild gallbladder wall edema not\nsignificantly changed compared to prior examinations. Dense biliary sludge is\nalso minimally changed. No common bile duct dilation. Small volume ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is diffusely enlarged measures 15.8 cm in the axial plane. \nNo focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMild right hydronephrosis is unchanged. No left hydronephrosis. No\nsuspicious renal lesions. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Probable small hiatal hernia. Gastric suture lines appear\ngrossly unremarkable without evidence of oral contrast extravasation. A\npercutaneous gastrostomy tube is coiled in the gastric body. A percutaneous\njejunostomy tube appears unremarkable. Small bowel loops are diffusely\ndilated measuring as much as 4.2 cm in the third portion of the duodenum, 4.5\ncm in the ileum. No discrete transition point. The colon is similarly filled\nwith a combination of fluid, stool, and gas. The appendix is not visualized.\n\nPELVIS: Apparent urinary bladder wall thickening is likely related to\nunderdistention.\n\nREPRODUCTIVE ORGANS: The uterus is slightly anteverted and an intrauterine\ndevice is midline.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse fat stranding throughout subcutaneous soft\ntissues reflecting anasarca.", "output": "1. Minimally changed dilation of both large and small bowel loops without a\ndiscrete transition point, most consistent with an ileus.\n2. Small volume ascites and moderate anasarca.\n3. Gallbladder sludge/cholelithiasis without acute cholecystitis.\n4. Splenomegaly.\n5. Slightly decreased loculated left pleural effusion." }, { "input": "LOWER CHEST: Small left and moderate right pleural effusions are noted with\nadjacent atelectasis. There is no pericardial effusion. Coronary artery\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The liver is nodular in contour,\nconsistent with cirrhosis. There is minimal intrahepatic ductal dilatation in\nthe left lobe. The common bile duct is prominent in appearance. The\ngallbladder is within normal limits. There is massive ascites with associated\ncompression and mass effect on intra-abdominal contents. There is slight\nthickening/enhancement of the peritoneum posteriorly (2:46).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of suspicious focal renal lesions or hydronephrosis. \nSmall subcentimeter hypodensities are seen bilaterally, too small to\ncharacterize. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is collapsed. Small and large bowel loops are\ncompressed secondary to large volume ascites, but appear grossly unremarkable.\nSuture material is seen among bowel loops in the pelvis (2: 76-77), likely\nreflecting prior surgery with anastomosis. The appendix is not visualized.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications are seen in the prostate. The\nseminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions. Patient is status\npost posterior fusion from L4-S1, with bilateral pedicle screws and posterior\nrods. Screws at L4 extends slightly beyond the vertebral body anteriorly. \nThere is no evidence of hardware loosening. L4-L5 and L5-S1 intervertebral\nbody spacers are noted. Mild degenerative changes are seen in the remainder\nimaged lower thoracic spine and lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Massive ascites with associated compression and mass effect on\nintra-abdominal contents.\n2. Slight thickening/enhancement of the peritoneum posteriorly. Peritonitis\ncannot be excluded.\n3. Minimal intrahepatic biliary dilatation in the left lobe and prominent\nappearance of the common bile duct. Please correlate with liver function\ntesting to evaluate for possible obstruction.\n4. Small left and moderate right pleural effusions.\n5. Status post posterior fusion from L4-S1, with bilateral pedicle screws and\nposterior rods. Screws at L4 extends slightly beyond the vertebral body\nanteriorly. No evidence of hardware loosening." }, { "input": "LOWER CHEST: There are left greater than right moderate bilateral pleural\neffusions with associated compressive atelectasis, unchanged compared to prior\nCT of the abdomen/pelvis from ___. There is no pericardial\neffusion. Coronary artery calcifications are noted in the LAD and left\ncircumflex.\n\nABDOMEN:\n\nHEPATOBILIARY: There is nodular contour of the liver consistent with\ncirrhosis. There is no evidence of focal lesions within the limitations of\nthis single-phase study. There is mild central and left intrahepatic biliary\ndilation, similar to the prior exam. The gallbladder is within normal limits.\n\nPANCREAS: There is moderate diffuse atrophy of the pancreas. There are no\nfocal lesions or main ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The there is diffuse dilation\nof intraperitoneal small bowel loops, concerning for small bowel obstruction,\nunchanged from prior. Bowel loops appear clustered and surrounded by\nthickened enhancing peritoneum, concerning for sclerosing encapsulating\nperitonitis. Configuration of small bowel is essentially the same as the\nprior study from 3 days ago, consistent with frozen abdomen. A colonic\nanastomosis is noted in the pelvis. Appendix not visualized.\n\nThere is a moderate amount of intra-abdominal ascites, unchanged. There is a\nsmall amount intraperitoneal of loculated free air beneath the right\nhemidiaphragm, not significantly changed from prior, presumably post\nprocedural in nature. There is no evidence of peritoneal nodules.\n\nPELVIS: The bladder wall is circumferentially thickened, likely secondary to\nunderdistention. There is moderate amount of ascites in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate contains calcifications but is otherwise\nunremarkable. Seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. The common hepatic artery arises from the SMA. The portal\nconfluence is narrowed but patent. No large gastroesophageal varices are\nseen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPosterior spinal fusion hardware is noted from L4 through S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.There is\nmild diffuse subcutaneous edema.", "output": "1. Diffuse dilation of intraperitoneal small bowel loops, concerning for small\nbowel obstruction, unchanged compared to prior CT of the abdomen/pelvis from\n___. Bowel loops appear clustered and surrounded by thickened\nenhancing peritoneum, concerning for sclerosing encapsulating peritonitis,\nwith unchanged configuration consistent with stated frozen abdomen. No\nperitoneal nodules.\n2. Unchanged moderate intra-abdominal ascites.\n3. Small amount intraperitoneal free air beneath the right hemidiaphragm, not\nsignificantly changed from prior, presumably post procedural in nature.\n4. Cirrhotic morphology of the liver. No focal hepatic lesion within the\nlimits of this single-phase study.\n5. Left greater than right moderate bilateral pleural effusions with\nassociated compressive atelectasis, unchanged." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hepatic hypodensities are too small to characterize, but likely\nrepresent simple cysts. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a 2.2 x 1.9 x 2.0 cm exophytic lesion arising from\nthe greater curvature of the stomach (series 5, image 20). Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\nappendix is normal. Fatty infiltration of sigmoid colonic wall is suggestive\nof chronic inflammation. There is equivocal mild active inflammation\ninvolving segments of the descending and sigmoid colon (series 6, image 32,\nseries 5, image 67).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is in mid position. No concerning adnexal\nlesions are detected.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Equivocal mild wall thickening and hyperemia of the descending and sigmoid\ncolon may represent mild colitis. There is background chronic inflammatory\nchanges along the sigmoid colon.\n2. 2.2 cm exophytic mass arising from the greater curvature of the stomach. A\nGIST is favored, and EUS and tissue sampling are recommended.\n\nRECOMMENDATION(S): Upper endoscopy and EUS of the exophytic gastric lesion." }, { "input": "LOWER CHEST: Calcified left hilar lymph node. Mild dependent atelectasis. No\nfocal consolidations. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post gastric bypass. Small bowel\nloops demonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged measuring 5.1 x 3.7 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Moderate degenerative changes throughout the lumbar spine with mild\ndextroconvex scoliosis. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abnormalities within the abdomen or pelvis. No bowel obstruction." }, { "input": "LUNG BASES: In this patient status post right-sided VATS, there is mild\nresidual subcutaneous emphysema along the right lateral chest wall. A small\nright pleural effusion persists. Areas of nodularity in the right lower lung\nare unchanged.\n\nABDOMEN: The liver appears homogeneous in attenuation without focal lesion. \nThere is no intrahepatic duct dilation. The portal veins appear patent. The\ngallbladder is without radiopaque cholelithiasis.\n\nIll-defined heterogeneously enhancing mass within the distal body of the\npancreas measures approximately 3.2 x 5.3 cm (02:25), better characterized\nprior MRI. This lesion abuts the lesser curvature of the gastric wall with\nloss of intervening fat plane. Apparent thickening of the gastric wall in\nthis region the focus the possibility of direct tumor invasion. Prominent\nleft upper quadrant collateral vessels likely reflect splenic vein thrombosis.\nThere is no pancreatic duct dilation. Several small tissue nodules within the\nmesentery measure up to 1.7 x 1.0 cm (2:64, 02:56, 02:52,) worrisome for\nperitoneal deposits.\n\nThe spleen and bilateral adrenal glands are normal in appearance. Kidneys\nenhance symmetrically with prompt excretion of contrast. There is no\nhydronephrosis. A peripherally calcified right renal upper pole lesion\nmeasures approximately 1.9 x 2.1 cm (02:29) previously characterized as a\nhemorrhagic cyst on MR dated ___ in keeping with Bosniak 3 complex\nrenal cyst. A smaller 1.3 x 0.8 cm lesion within the lower pole of the left\nkidney (02:40) is better characterized on prior MR.\n\n___ is a small hiatal hernia. Contrast fills nondistended loops of small\nbowel. There is no bowel obstruction. A small anterior abdominal wall\nmidline umbilical hernia contains fat with a fascial defect measuring\napproximately 1.5 cm (02:46). The appendix is normal. A large amount of\nfecal loading of the colon is noted which may contribute to symptoms of\ndiscomfort.\n\nThe abdominal aorta is tortuous with moderate atherosclerotic calcifications. \nNote is made of prominent calcifications at the origin of the superior\nmesenteric artery. There is no aneurysmal dilatation.\n\nPELVIS: The bladder is not well distended. Air within the bladder may be\niatrogenic. Prostate gland demonstrates coarse central calcifications. Trace\npelvic free fluid is noted. There is no pelvic or inguinal adenopathy.\n\nBONES: There are no osseous lesions worrisome for malignancy or infection. \nPosterior spinal fusion hardware is noted at the L4-L5 level. Severe\ndegenerative disc disease at the L5-S1 persists.", "output": "1. No bowel obstruction or ileus. Save significant fecal loading of the\n___ contribute to symptoms of abdominal pain.\n2. Pancreatic mass, detailed above, with loss of fat plane with the adjacent\nstomach, difficult to exclude invasion. Small nodular implants along the\nsmall bowel mesenteries could represent carcinomatosis.\n3. Small right pleural effusion in this patient with recent VATS. Small\nresidual right chest wall subcutaneous emphysema.\n4. Complex renal lesions better assessed on prior MRI.\n5. Venous collaterals in the left upper quadrant likely reflect chronic\nsplenic vein thrombosis." }, { "input": "LOWER CHEST: There are small slightly heterogeneous consolidations at the lung\nbases. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout. \nThere is an ill-defined hypodense lesion in the right hepatic lobe, as seen on\nultrasound performed on same day. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended with fluid and food particles. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is normal (2:54).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No appendicitis or other acute process in the abdomen or pelvis.\n2. Diverticulosis, with no evidence of acute diverticulitis.\n3. Hepatic steatosis.\n4. An ill-defined hypodense lesion in the right hepatic lobe, as seen on\nultrasound performed on same day, is incompletely characterized. Outpatient\nMRI is recommended for further characterization.\n5. Small slightly heterogeneous consolidations at the lung bases are\nconcerning for infection or aspiration.\n\nRECOMMENDATION(S): Outpatient MRI liver." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is enlarged and heterogeneous with a mildly nodular\ncontour consistent with known cirrhosis. There is small to moderate simple\nperihepatic, perisplenic, and free intraperitoneal ascites. The paraumbilical\nvein is recanalized. Hypodensity in segment VII corresponds to the simple\ncyst or biliary hamartoma seen on recent MRCP (02:18). There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is\ndecompressed, limiting assessment.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: There is moderate to severe splenomegaly with the spleen measuring up\nto 18 cm in greatest coronal dimension (601:41).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Enteric tube courses through\nthe stomach and terminates in the third portion of the duodenum. Small bowel\nloops demonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy,\nalthough mesenteric lymph nodes are increased in number, likely reactive. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No evidence of acute intra-abdominal process within the confines of a\nnoncontrast study. Specifically, no bowel obstruction, ileus, or gross\nperforation.\n2. Cirrhotic liver with small to moderate ascites, moderate to severe\nsplenomegaly, paraumbilical vein recanalization, and intra-abdominal varices." }, { "input": "LOWER CHEST: Evaluation of pulmonary parenchymal details is slightly limited\nby motion. Within this limitation, prominent markings are seen bilaterally\nwith no focal consolidation. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Cirrhotic morphology with low-density perihepatic fluid. An\nirregular hypoattenuating lesion measuring 1.6 cm is present in segment 7\n(02:17). Otherwise, no focal lesions are demonstrated within the limitations\nof unenhanced scan. A recanalized paraumbilical vein is noted. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: Ascitic fluid is seen within the lesser sac anterior to the\npancreatic body. However, the pancreas has normal attenuation throughout,\nwithout evidence of focal lesions within the limitations of an unenhanced\nscan. There is no pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Low-density perisplenic fluid is noted. The spleen measures 16.7 cm. \nOtherwise, the spleen is unremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The previously noted post pyloric enteric tube is no longer\npresent. The stomach is unremarkable. Small bowel loops demonstrate normal\ncaliber and wall thickness throughout. The colon and rectum are within normal\nlimits. The appendix is not definitely visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall volume of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: A prominent portacaval lymph node measuring approximately 8 mm is\nnoted (02:42). Several prominent retroperitoneal lymph nodes not meeting CT\ncriteria for lymphadenopathy are also present. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: A lucent lesion in the right iliac bone measuring 1 cm is unchanged\n(2:79). Otherwise, there is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Moderate ascites without evidence of hematoma in the abdomen or pelvis.\n2. No evidence of obstruction or pneumoperitoneum." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no 1.3 x 0.9 cm hypodensity in segment II of the liver, (3:13) which\nis consistent with a simple hepatic cyst. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Diffuse spinal degenerative disease .\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Well circumscribed, 1.3 x 0.9 cm liver hypodensity which is consistent with\na simple hepatic cyst.\n2. No evidence of abdominal or pelvic malignancy.\n3. Diffuse spinal degenerative disease.\n4. Please refer to dedicated CT chest done on the same day for thoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nUnchanged 1.3 and 1.2 cm hypodense lesions in segment 2 of the liver,\nsuggestive of cysts. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: G tube is noted in position. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The rectum is\nfluid-filled. Mild circumferential hyper enhancement of the wall sigmoid,\nupper rectum, new since prior, suggest inflammatory or infectious colitis. \nThe remainder of the colon is within normal limits. Again noted is mild\nstranding throughout the mesentery, notably in the right lower quadrant along\nwith a trace free fluid in the pelvis (2:97).\n\nThere is new mild pneumoperitoneum below the right hemidiaphragm and\nanteriorly in the upper abdomen.\n\n\nPELVIS: Gas within the bladder is due to Foley catheter.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Note is made of a skin wound with mild subcutaneous emphysema\nwithin the right flank.", "output": "1. New mild pneumoperitoneum is indeterminate, could be related to interval\nplacement of a G-tube. Mild mesenteric stranding is redemonstrated in the\nright lower quadrant along with a new trace pocket of pelvic free fluid, may\nbe from fluid overload as there are new pleural effusions, and mesenteric\ninjury is less likely, cannot be excluded. Close clinical or follow-up scan\nrecommended.\n\n2. Mild wall thickening of the rectosigmoid is suggested, consider\ninflammatory or infectious colitis.\n\nNOTIFICATION: The findings were discussed with ___ by\n___, M.D. on the telephone on ___ at 7:34 ___, 5\nminutes after discovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a subcentimeter hypodensity in hepatic segment VI (___), too small\nto characterize. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is a 0.4 cm hypodensity in the uncinate process (___), which\nis nonspecific, but likely represents a side branch IPMN. Otherwise, the\npancreas has normal attenuation throughout, without evidence of pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are a few subcentimeter hypodensities in the left kidney, too small to\ncharacterize. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. Incidentally noted infrarenal IVC filter. There is a\nrounded hypodensity in the IVC inferior to the filter, possibly representing a\nnon-occlusive thrombus. The common femoral veins are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes of the imaged spine, including a large\nSchmorl's node in the L4 vertebral body (602/50). There is prominent\nposterior osteophytes at T9-T10, causing moderate spinal canal narrowing\n(___).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. There is prominent posterior osteophytes at the level of T9-T10, causing\nmoderate spinal canal narrowing. Recommend correlation for potential\nsymptoms.\n3. There is a 0.4 cm hypodensity in the pancreatic uncinate process, which is\nnonspecific, but likely represents a side branch IPMN. Consider MRI of the\npancreas in one year for further evaluation.\n4. Rounded hypodensity in the IVC inferior to the IVC filter is possibly a\nnonocclusive thrombus. The common femoral veins are patent.\n\nRECOMMENDATION(S): Consider MRCP in one year to re-evaluate the pancreas." }, { "input": "LOWER CHEST: There is bibasilar atelectasis without focal consolidation. \nThere is no pleural or pericardial effusion. Dense mitral annular and aortic\nroot calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is not definitively visualized.\n\nPANCREAS: Pancreas is mildly atrophic without evidence of focal lesion or main\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is bilateral renal cortical thinning. Kidneys are overall\nnormal in size. Previously seen large left renal cyst has decreased\nsignificantly compared to prior, now measuring 1.3 cm. There is no\nhydronephrosis. Again seen is bilateral nephrolithiasis. Stone burden on the\nright appears similar to prior with largest stone measuring 9 mm in the lower\npole. 4 mm upper pole and punctate interpolar right renal stones also appear\nunchanged. Previously seen 9 mm renal stone in the interpolar left kidney is\nno longer visualized on today's exam. There is unchanged to mildly decreased\nperinephric stranding.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes noted in the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process, no findings to explain acute symptoms.\n2. Bilateral renal cortical thinning. Multiple right-sided kidney stones,\nmeasuring up to 9 mm in the lower pole, similar in total stone burden compared\nto ___. Previously seen 9 mm renal stone in the interpolar left kidney is no\nlonger visualized on today's exam. There is unchanged to mildly decreased\nperinephric stranding. There is no hydronephrosis, no obstructing stone.\n3. Colon is within normal limits without suggestion of diverticulitis." }, { "input": "Please refer to the separate CT chest dictation regarding intrathoracic\nfindings.\n\nThe liver density is within normal limits. A well-circumscribed 6 mm\nhypodense lesion arising from the anterior aspect of segment II is unchanged\nsince ___, likely a hepatic cyst (series 6, image 47).\n\nThere are multiple new hypoenhancing hepatic masses. The largest, which is\ncentrally located and encompasses most of segments V and IVB, but with\ninvolvement of segments ___, and VI, measures 14.3 x 7.9 x 13.1 cm\n(series 6, image 60, series 8b, image 21). Additional satellite lesions are\nseen within segments IVb (3.7 x 3.0 cm, series 6, image 67), segment VII (13\nmm, series 6, image 48, and 14 mm, series 6, image 46), and segment III (7 mm,\nseries 6, image 63).\n\nPeripheral to the main mass are moderately dilated intrahepatic bile ducts\n(series 6, image 47). There is poor definition of the gallbladder wall, which\nis nearly encased by the main mass, demonstrating irregular wall thickening\nand enhancement (series 6, image 64, series 8b, image 20).\n\nThere are multiple gallstones, also seen on the ___ CT (series 6, image 74).\n\nThe CBD is not dilated.\n\nA 3.0 x 2.2 cm necrotic porta hepatis lymph node is present (series 6, image\n51). A 11 mm anterior peripancreatic node (series 6, image 55) and 2.4 x 2.3\ncm portacaval node (series 6, image 56) are not necrotic but abnormally\nenlarged.\n\nThe spleen size is normal. Multiple punctate calcifications throughout the\nsplenic parenchyma denote prior granulomatous disease exposure (series 6,\nimage 49). There is no enhancing splenic mass.\n\nThe pancreas demonstrates normal density and bulk. There is no pancreatic\nduct dilation. No focal pancreatic lesion is seen.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis. Multiple left perianal nephric renal cysts are unchanged\nsince the ___ examination. A 6 mm hypodensity arising from the posterior\ninterpolar aspect of the right kidney appears enlarged since ___,\nstatistically likely a tiny benign cyst, but incompletely evaluated on this\nsingle phase examination.\n\nThe stomach is normal. Intra-abdominal and intrapelvic loops of small and\nlarge bowel are normal in caliber, without focal mass. The appendix appears\nnormal (series 6, image 81). Subcentimeter hyperdense are nodules\nincidentally noted along the jejunum (series 6, image 64, 75, 80) appear to be\ndiverticula on coronal reconstructions.\n\nThere are moderate atherosclerotic calcifications throughout the abdominal\naorta, without flow limiting stenosis, dissection, or aneurysm. The celiac\ntrunk, SMA, renal arteries, and ___ are patent and normal in caliber. Portal\nbranches within the main hepatic mass are obscured.\n\nThe uterus is anteverted, and appears normal in size. No concerning adnexal\nmasses are detected. There is a moderate amount of intrapelvic free fluid\n(series 6, image 96). A Foley catheter resides within the bladder, which is\ncollapsed and contains a tiny focus of gas (series 9b, image 46) relating to\nrecent catheterization.\n\nThere is moderate diffuse anasarca.\n\nThere are no osseous lesions concerning for malignancy or infection. Moderate\ndegenerate changes are seen throughout the thoracolumbar spine. There is\ngrade 1 anterolisthesis of L4 over L5 (series 9b, image 45). There is\nmoderate disc space narrowing and vacuum phenomena at L5/S1.", "output": "1. 14 cm central hepatic mass with upstream mid intrahepatic bile duct\ndilation and at least four satellite metastases, involving segments III\nthrough IV, with necrotic porta hepatis lymphadenopathy and possible\ninvolvement of the gallbladder wall, highly suspicious for cholangiocarcinoma.\nThis appearance is less typical for metastatic breast cancer.\n2. Cholelithiasis.\n3. No CBD dilation.\n4. Mild jejunum diverticulosis.\n5. Moderate intrapelvic ascites and diffuse anasarca.\n6. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nRECOMMENDATION(S): Biopsy of the hepatic mass. This could be achieved with\npercutaneous approach under ultrasound guidance.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe ___ ___ at 9:19 AM, 10 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is slightly enlarged with significant peripancreatic\nfat stranding centered at the pancreatic head, uncinate process, and proximal\nbody. No well-formed fluid collection is seen on this unenhanced CT exam.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple calcified uterine fibroids are seen. No adnexal\nabnormalities identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute pancreatitis with no evidence of a well-formed or drainable fluid\ncollection on this unenhanced exam." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Foci of focal cortical\nthinning reflect prior infectious or ischemic insult. No suspicious renal\nlesion. No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is relatively diffuse low attention gastric wall\nthickening with submucosal hyper enhancement. There may be an ulcer in the\nbody of the stomach. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild lumbar spine degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Relatively diffuse low-attenuation gastric wall thickening and submucosal\nhyperenhancement with a possible ulcer in the gastric body, most consistent\nwith gastritis and peptic ulcer disease rather than malignancy. Recommend\ncorrelation with endoscopy to confirm.\n\nRECOMMENDATION(S): Relatively diffuse low-attenuation gastric wall thickening\nand submucosal hyperenhancement with a possible ulcer in the gastric body,\nmost consistent with gastritis rather than malignancy. Recommend correlation\nwith endoscopy." }, { "input": "LOWER CHEST: There is dependent atelectasis bilaterally, but otherwise the\nvisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There is a 2.0 x 2.0 cm hypodense\nlesion in the anterior interpolar region of the right kidney with ___ of 20\nconsistent with a renal cyst. Bilateral subcentimeter hypodense lesions are\ntoo small to characterize but likely represent cysts. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative changes are noted of the left eighth and eleventh\ncostovertebral joints. Sequelae from healed right ninth lateral rib fracture.\nThere is increased sclerosis of the posterior left eighth and eleventh ribs,\nboth of which were previously noted on CT chest ___. Irregularity\nin sclerotic appearance of the inferior endplate of the L4 vertebral body with\nvacuum phenomenon and posterior disc protrusion is unchanged since CT L-spine\nfrom ___.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "1. No acute intra-abdominal process.\n2. Left inguinal hernia containing fat.\n3. Degenerative changes of the left eighth and eleventh costovertebral joints\nare unchanged since ___.\n4. Degenerative changes of L4-L5 is similar to prior CT L-spine from ___." }, { "input": "LOWER CHEST: There is mild right basilar dependent atelectasis. There is\natelectasis of the left lower lobe, increased compared to prior with foci of\nhigh density within which on this noncontrast scan suggests possible\naspiration from the barium (3; 10). There is a small left pleural effusion,\nsimilar to prior. Previously noted small right pleural effusion has\nsignificantly improved. Trace pericardial fluid likely physiologic. \nPartially visualized ascending aorta appears to be dilated measuring up to 4.5\ncm (3; 1), similar to prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:\nThe stomach is unremarkable. Small bowel loops demonstrate normal caliber and\nwall thickness throughout. Scattered diverticular are noted throughout the\ncolon. There is a large stool ball measuring up to 7.9 cm in diameter (3;\n91). The appendix is not visualized.\n\nThere appears to be two resolving hematomas within the retroperitoneum, one\nadjacent to the duodenum measuring 4.7 x 6.0 cm, previously measuring 5.1 x\n7.2 cm and one anterior to the aorta measuring 2.6 x 4.5 cm, previously\nmeasuring 3.5 x 6.1 cm, both of which have decreased in size (3; 40, 48).\n\nThere is moderate ascites, which appears to have increased density within the\npelvis suggestive of hemorrhagic ascites (3___ 86) slightly increased in volume\ncompared to prior. There is multiple foci of free air noted within the abdomen\nand pelvis, new since prior (___) without obvious etiology. There is no\nextraluminal contrast.\n\nPELVIS: A Foley catheter is noted in the urinary bladder. Bladder is expected\ngiven instrumentation. Bladder is decompressed. There is layering of ascitic\nfluid within the pelvis with increased density more dependently measuring up\nto 44.8 ___ (___) compatible with hemorrhagic ascites.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is interval placement of an IVC filter. There is no abdominal\naortic aneurysm. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted. There is extensive\nsoft tissue edema throughout the abdominal wall.", "output": "1. Interval development of free air within the abdomen and pelvis without\ndefinite etiology. There is no extraluminal oral contrast to suggest bowel\nperforation.\n2. There is slight increase in volume of the hemorrhagic ascites.\n3. There is interval decrease in size of the hematomas anterior to the IVC as\nwell as adjacent to the duodenum.\n4. There is a large stool ball measuring up to 7.9 cm in greatest diameter. \nNo evidence of colitis or proctitis.\n5. Atelectasis of the left lower lobe with foci of increased density within\nthe parenchyma suggestive of possible mild aspiration of the oral contrast. \nSmall left pleural effusions similar to prior. Interval improvement in right\npleural effusion.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 3:31 pm, 10 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: There is a small left pleural effusion with adjacent atelectasis,\nunchanged. There is also trace right pleural effusion with minimal\natelectasis. There is no pericardial effusion. Heart size is normal.\n\nABDOMEN:\n\nEvaluation of internal structures limited by lack of intravenous contrast\nadministration. Within this limitation:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is filled with dense material which likely\nrepresents vicarious excretion of contrast administered during a recent\nangiographic procedure.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is distended with oral contrast. Oral contrast\nis seen within the small bowel and the proximal colon. Small bowel loops\ndemonstrate normal caliber throughout. Sigmoid diverticulosis is again noted.\n\nThere is a moderate amount of ascites in the abdomen and pelvis, slightly\nincreased from prior. There is an air-fluid level in the left lower quadrant\nalong the anti mesenteric border of a few jejunal loops, measuring\napproximately 14 cm in length and 6.3 x 4.4 cm in axial dimension, which is\nfavored to represent extraluminal gas trapped between jejunal loops and\nascites. There is no extraluminal oral contrast to indicate site of bowel\nperforation.\n\nHematoma adjacent to the duodenum and anterior to the IVC has decreased in\nsize, with a representative component measuring 4.0 x 4.8 cm (series 3, image\n50), previously 4.7 x 6.0 cm.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. There are locules of trapped\nextraluminal gas within pelvic ascites.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. An IVC filter is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse body wall edema. There is fluid within the\nleft lateral chest wall musculature, measuring 2.5 cm in thickness, previously\n1.9 cm.", "output": "1. Moderate volume ascites, slightly increased compared to the prior study\nfrom ___. Air-fluid level in the left lower quadrant along the\nanti mesenteric border of a few jejunal loops, favored to represent\nextraluminal gas trapped between jejunal loops and ascites. Additional\nlocules of trapped extraluminal gas seen within pelvic ascites. \nPneumoperitoneum also appears overall increased from prior.\n2. No extraluminal oral contrast indicate site of bowel perforation.\n3. Interval decrease in size of the hematoma adjacent to the duodenum and\nanterior to the IVC.\n4. Diffuse body wall edema. Increased fluid within the left lateral chest\nwall musculature." }, { "input": "LOWER CHEST: There has been interval worsening moderate bilateral pleural\neffusions left greater than right. There is complete collapse of bilateral\nlower lobe and partial collapse of the left upper lobe. High-density material\nwithin the lower lobes, may represent aspiration vs parenchymal\ncalcifications.\n\nHEPATOBILIARY: Unenhanced liver is unremarkable. High-density material in the\ngallbladder likely represents contrast.\n\nPANCREAS: There is interval progression of pancreatic enlargement and\npancreatic edema. The pancreatic borders are ill-defined. There are multiple\nperipancreatic loculated fluid collections likely from pancreatitis.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY:There is no hydronephrosis.\n\nGASTROINTESTINAL: Stomach is incompletely distended. High-density material is\nnoted within gastric fundus. Small bowel loops are normal in caliber. There\nare scattered colonic diverticulosis without diverticulitis.\n\nPERITONEUM: There is re-demonstration of moderate amount of intra-abdominal\nascites with associated peritoneal thickening along with the pockets of fluid\ndispersed throughout the abdomen consistent with peritonitis. The largest\npocket is within the pelvis. This continues to have small gas bubbles. The\namount of fluid in the abdomen has minimally decreased. There is a discrete\ncollection with air-fluid levels upper abdomen posterior to the fourth part of\nthe duodenum measuring up to 7.6 cm. This has mildly increased in size\ncompared to previously where it measures 6.3 cm. There is peritoneal\nnodularity along the Gerota's fascia anteriorly and along the left paracolic\ngutter. This is unchanged since ___ and is likely\nsecondary to pancreatitis.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with mild atherosclerotic\ndisease. There is an IVC filter in place.\n\nPELVIS: Urinary bladder is under distended with the presence of a Foley\ncatheter in place. Seminal vesicles are unremarkable.\n\nBONES:Osseous structures are unremarkable with mild degenerative changes of\nthe lower lumbar spine.\n\nSOFT TISSUES: There is diffuse subcutaneous soft tissue edema of the pelvis.", "output": "1. No evidence of retroperitoneal or intraperitoneal hemorrhage.\n2. Re--demonstrated minimally improved moderate amount of intraperitoneal\nfluid with peritoneal thickening and foci of air consistent with peritonitis.\n3. Multiple fluid collections around the pancreas with pancreatic enlargement\nand edema concerning for pancreatitis. Correlation with laboratory should be\nconsidered.\n4. Loculated collection with air-fluid levels in the left lower abdomen has\nslightly increased in size measuring 7.6 cm compared to 6.3 cm previously.\n5. Worsening pleural effusions. High-density material within the collapsed\nlungs concerning for aspiration of contrast previously.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 1:00 pm." }, { "input": "LOWER CHEST: Moderate bilateral pleural effusions, left greater than right,\nand adjacent consolidations at the lung bases, are unchanged. High-density\nmaterial within the lower lobes is similar to prior and may represent\naspiration versus parenchymal calcification.\n\nABDOMEN: The unenhanced liver, spleen, adrenal glands and kidneys unchanged. \nAgain seen are peripancreatic soft tissue stranding, similar to prior. \nLoculated pockets of fluid surrounding the second portion of the duodenal are\ndecreased, for instance the largest appears more loculated and measures 3.5\ncm, previously 3.9 cm. There is vicarious excretion of contrast in the\ngallbladder.\n\nGASTROINTESTINAL: Again seen is a moderate amount of loculated intra-abdominal\nascites with associated peritoneal thickening consistent with peritonitis. \nThe largest pocket in the pelvis which extends into the pericolic gutters is\nnot significantly changed in size, however has increased air within it, now\nconcerning for peritoneal abscess (2:82). No extraluminal oral contrast is\ndemonstrated. A previously described collection in the left upper abdomen\nwithin air-fluid level is decreased in size, currently measuring up to 5.3 cm,\ncompared with 7.6 cm previously (2:59). No new fluid collections.\n\nPELVIS: A Foley catheter is present in the decompressed bladder.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. Nodularity along the anterior\npararenal spaces and along the left pericolic gutter is unchanged and likely\nsecondary to pancreatitis.\n\nVASCULAR: There is no abdominal aortic aneurysm. An IVC filter is in place.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: There is diffuse anasarca, as on prior.", "output": "1. Re-demonstration of a moderate amount of loculated intraperitoneal fluid\nwith peritoneal thickening consistent with peritonitis. The largest\ncollection in the pelvis is not significantly changed in size, however has\nincreased air within it, concerning for a large peritoneal abscess. An\nadditional abscess in the left upper quadrant is slightly decreased in size. \nNo new fluid collections.\n2. No significant change in pancreatic enlargement and edema with multiple\nsurrounding peripancreatic fluid collections.\n3. No significant change in moderate bilateral pleural effusions and adjacent\nconsolidations at the lung bases.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 2:40 pm, 2 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: There is a small right and incompletely assessed left pleural\neffusion with overlying atelectatic lung, not significantly changed from ___. There is substantial left lower lobe atelectasis. There is a\nsmall pericardial effusion, slightly increased from prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. A pigtail catheter terminates\nin the right lower quadrant, with small amounts of nearby fluid without a\ndiscrete collection. Anterior to the drain, in the anterior pelvis there is a\n9.6 x 3.2 cm fluid collection (2:73, 601:24), representing a substantial\ndecrease in size of the previous fluid collection. The collection is\nresolved. In addition, there is a 3.0 x 2.4 cm interloop fluid collection,\n(02:51). Fluid collections within the left pericolic gutter, right pericolic\ngutter, the anterior pelvis and within loops of bowel wall decreased, and may\nbe interconnected. No extraluminal contrast is noted. Diverticulosis of the\nsigmoid, ascending and descending colon is noted, without evidence of wall\nthickening and fat stranding.\n\nPELVIS: There is a Foley catheter, with a inflated balloon within the bladder.\nThere is increased air within the bladder from prior, presumably due to the\nFoley.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Prominent mediastinal lymph nodes not enlarged by size criteria\nare likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. A filter is within the IVC.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Overall decrease in size of intra-abdominal fluid and air collections\nwithin the anterior pelvis, left and right pericolic gutters and within the\nloops of small and large bowel. The anterior pelvic fluid collection now\nmeasures 9.6 x 3.2 cm in the interloop collection measures 3.0 x 2.4 cm. \nGiven the decrease in size of all the previously seen collections to the\nplacement of the pigtail drain, as well as resolution of air, the collections\nmay be interconnected.\n2. No evidence for bowel perforation.\n3. Small right and incompletely assessed likely moderate left pleural effusion\nwith overlying atelectasis.\n4. Interval increase in size of a small pericardial effusion." }, { "input": "LOWER CHEST: There is mild interval improvement in bilateral small pleural\neffusions, left greater than right, with compressive atelectasis\n\nABDOMEN:\n\nHEPATOBILIARY: Unremarkable. Vicarious contrast excretion is seen in the\ngallbladder.\n\nPANCREAS: Mild peripancreatic stranding is compatible with sequela of\npancreatitis.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis.\n\nGASTROINTESTINAL: The pocket of loculated fluid adjacent to the duodenum is\nsimilar to mildly improved compared to the prior study in ___,\ncompatible with sequela of pancreatitis (04:39). Thickening and nodularity\nalong the left paracolic gutter and left pararenal space is new since ___ but stable since ___, and may also represent sequela of\npancreatitis.\n\nThere has been interval removal of a right lateral approach drainage catheter\nin the pelvis. Multiple fluid collections concerning for abscesses in the\nabdomen and pelvis are vastly improved, with small residual collection seen in\nthe left mid abdomen, measuring 2.1 cm (04:49), previously 3.5 cm. There is\nno bowel obstruction or ascites. There is no free air.\n\nPELVIS: No free-fluid.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: An IVC filter is in unchanged position.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: There is diffuse subcutaneous soft tissue edema. A small fat\ncontaining umbilical hernia is noted.", "output": "1. Interval removal of a right lateral approach drainage catheter. Multiple\nabdominal abscesses are almost completely resolved. A residual 2 cm pocket of\nfluid in the left mid abdomen is not only improved but surrounded by small\nbowel and too small to drain.\n2. Sequela of pancreatitis including small pocket of fluid in the duodenum and\nmild pancreatic inflammatory changes. Thickening and nodularity along the\nleft paracolic gutter and left anterior pararenal space may also represent\nsequela of pancreatitis.\n3. Additional findings as above." }, { "input": "LOWER CHEST: Similar left and mildly increased right pleural effusions with\ncompressive atelectasis. Trace pericardial effusion is similar.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild periportal edema is similar. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout. In the pancreatic\ntail there is a 0.9 cm fluid collection which is not well appreciated on prior\nstudies. Along the superior aspect of the pancreas there is a 2 x 1.3 cm\nfluid collection. An additional area of fluid along the posterior splenic\ntail measuring 2 cm which may have been there previously, however is difficult\nto accurately assess due to the prior study not having IV contrast. There is\nmild residual peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Mild fullness of the gastric folds in the fundus appears\nsimilar and is likely related to secondary inflammation. The bowel is normal\ncaliber. Scattered colonic diverticula. Otherwise the colon and rectum are\nwithin normal limits. The appendix is normal. There is a small amount of\nmesenteric edema and fluid within the paracolic gutters bilaterally. More\nfocal fluid collection lateral to the ___ portion of the duodenum measures 2.7\nx 2.2 cm is likely unchanged. Thickening nodularity along the left paracolic\ngutter and left anterior pararenal space is similar and may represent sequela\nof pancreatitis. Decreased ascites..\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Tortuous aorta. Mild\natherosclerotic disease is noted. The splenic vein and splenic artery are\npatent without abnormality.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild anasarca.", "output": "1. Several pancreatic pseudocysts around the pancreas are unchanged from the\nprior study with the largest measuring up to 2.7 cm.\n2. Similar left and mildly increased right pleural effusions.\n3. Decreased abdominal ascites." }, { "input": "There are small to medium sized pleural effusions that are very similar in\nsize with atelectasis, left greater than right, which is also similar to an\nearlier examination. Small pericardial effusion is also quite stable since\n___.\n\nWithin the marked limitations of a noncontrast study like this, no focal liver\nlesions are identified. There is no biliary dilatation. It is not possible\nto assess for any potential aberrant biliary ductal anatomy with this\nexamination. There is probably periportal edema that can be seen with fluid\noverload. The gallbladder is distended, again with hyperdense content\nreflecting stones or sludge. There is some mild wall thickening and profuse\nregional fat stranding about the gallbladder which, despite the presence of\nmore diffuse unchanged anasarca related changes, supports the likelihood of\nacute cholecystitis in the appropriate clinical setting.\n\nThere is no evidence for stones or hydronephrosis involving either kidney.\nPancreas is unremarkable. Spleen is normal in size. Adrenals appear normal.\n\nGastric and duodenal walls show some thickening, as seen previously,\npotentially inflammatory but more likely to relate to persistent fluid\noverload. Sigmoid diverticulosis is moderate. Structure suggesting a short\nnormal appendix is identified.\n\nProstate is mildly enlarged with central hypertrophy. Seminal vesicles and\nbladder are unremarkable. The bladder is unremarkable. Abdominal aorta is\nmoderately calcified, normal in caliber. Trace ascites is found about the\nliver and in the pelvic cul de sac. There is no lymphadenopathy.\n\nThere are no suspicious bone lesions. Mild compression deformity of the\nsuperior endplate of T12 shows no short-term change. There is a new mild\nsuperior endplate compression fracture of L2, however, since ___ although\nwithout any reason to suspect recent acuity.", "output": "Widespread fat stranding about distended gallbladder with stones and/or\nsludge, supportive of the likelihood of acute cholecystitis in the appropriate\nclinical setting, although widespread anasarca, including pleural and\npericardial effusions, as well as trace ascites, represents a confounding\nfactor." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically. There are\nbilateral subcentimeter renal hypodensities, too small to characterize, but\nstatistically likely simple cysts. There is no perinephric abnormality. \nThere is no hydroureteronephrosis.\n\nGASTROINTESTINAL: There is a small hiatal hernia. There is no bowel\nobstruction. There is mild fecal loading of the large bowel. Appendix is not\nvisualized but there are no secondary signs of appendicitis in the right lower\nquadrant. There is no intra-abdominal free fluid or free air.\n\nPELVIS: There is a focus of air in the bladder likely from prior\ninstrumentation. There is mild bladder wall thickening which could impart be\ndue to underdistention. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nThere are degenerative changes most pronouced at L4-5.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Bladder wall thickening, which can be seen in the setting of cystitis.\n2. Air in the bladder, correlate with history of recent instrumentation." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Soft tissue lesion in the left inguinal region is\nconsistent with an undescended testis, not significantly changed from prior\n(series 2, image 122).\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes. There are multiple scattered mesenteric lymph nodes\nwhich have not significantly changed compared to ___. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of lymphadenopathy in the abdomen or pelvis.\n2. Undescended left testis.\n3. Please see separate dictation for details of intrathoracic findings." }, { "input": "Lung bases: The imaged lung bases are clear. The imaged portion of the heart\nis normal. No pleural or pericardial effusion is seen.\n\nAbdomen: The liver enhances normally without focal concerning lesion. Clips\nare noted in the gallbladder fossa. Mild prominence of the biliary tree\nlikely reflect prior cholecystectomy. The pancreas appears normal. The\nspleen is enlarged up to 14.6 cm in length. The adrenal glands are normal\nbilaterally. The kidneys enhance symmetrically. No hydronephrosis or\nworrisome renal lesion. The abdominal aorta is normal in course and caliber\nwithout appreciable atherosclerotic calcification. There is an IVC filter in\nplace. There is no retroperitoneal lymphadenopathy. The stomach and duodenum\nappear normal. No free air or free fluid.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is visualized and is normal. The colon contains a mild fecal load. \nThe uterus is surgically absent. There is no adnexal mass. No pelvic free\nfluid. No pelvic sidewall or inguinal adenopathy.\n\nBones and body wall: No worrisome lytic or blastic osseous lesion is seen. \nThere is a fat containing umbilical hernia again noted.", "output": "No acute findings to account for right-sided abdominal pain. Incidental\nfindings include splenomegaly, fat containing umbilical hernia, postsurgical\nchanges from prior cholecystectomy and hysterectomy." }, { "input": "LOWER CHEST: Limited assessment of lung bases are notable for a lingular\natelectasis. No pleural or pericardial effusion. Pacer wires are seen within\nthe right ventricle and right atrium. Please refer to separate report of CT\nchest performed on the same day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.0.4 cm\nhypodensity (301:14) within segment 2 is too small to characterize. There is\nno evidence of additional focal lesions. Mild intrahepatic biliary duct\ndilatation with the common bile duct measuring 6 mm which is top -normal in\nsize. Findings are most consistent with biliary ductal ectasia. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 1.9 cm (3 01:25) hypodensity within the lower pole of left kidney and\n1.5 cm hypodensity within upper pole right kidney are consistent with simple\ncyst. Additional 1 cm hypodensity within the upper pole the left kidney is\nhyperdense measuring 46 Hounsfield units and may represent a hyperdense cyst. \nNo hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The colon and rectum are otherwise unremarkable. The appendix is\nnot visualized, however no secondary signs of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are not visualized. No large\nadnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is tortuous however there is no abdominal aortic\naneurysm. Moderate atherosclerotic disease is noted.\n\nBONES: Moderate degenerative changes are seen in the thoracolumbar spine with\nanterior osteophytes, endplate sclerosis and disc space narrowing. There is\nsevere dextro levoscoliosis. Evidence of healed left inferior and superior\npubic rami fractures are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Incompletely characterized 1 cm left upper pole renal hyperdense lesion\nlikely represents a hemorrhagic/ proteinaceous cyst however solid lesion\ncannot be excluded.\n2. No evidence of primary malignancy or metastatic disease within the abdomen\nor pelvis\n3. Severe dextroscoliosis.\n4. Chronic findings including diverticulosis, renal cysts, and biliary ductal\nectasia.\n\nRECOMMENDATION(S): Recommend dedicated renal ultrasound for further\nevaluation of left upper pole renal hyperdense lesion.\n\nNOTIFICATION: The updated findings were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 1:35 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nThe liver is hypoenhancing relative to the spleen with areas of sparing,\nlikely due to steatosis. Otherwise, the liver, spleen, adrenal glands,\npancreas and kidneys are unremarkable.\n\nGASTROINTESTINAL: There is no intestinal obstruction or ascites.\n\nPELVIS: A fibroid uterus is noted. The adnexa are unremarkable on CT for age.\n\nVASCULAR: No abdominal aortic aneurysm. The hepatic vasculature is patent.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes are visualized.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: Calcification in the right gluteal region\nmay be sequela of prior trauma or injections (3:96). No aggressive osseous\nlesions are demonstrated.", "output": "1. No findings of metastatic disease in the abdomen or the pelvis.\n2. Hepatic steatosis. Fibroid uterus.\n3. Please refer to the chest CT report from the same day for details on\nintrathoracic findings." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no pericardial or\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is high density material within the upper pole collecting\nsystem of the left kidney and along the percutaneous nephrostomy tract,\nconsistent with a small amount of blood product. Additionally, there is a\nsmall left perinephric hematoma. Air within the renal collecting system and\nwithin the left retroperitoneal space is postprocedural. There are scattered\npunctate residual calculi in the left upper pole collecting system. The\nlargest residual cluster of calculi is present in the left lower pole\ncollecting system measuring 13 x 11 mm (___ units 571). There is mild\nto moderate upper pole hydronephrosis. A nephroureteral stent is\nappropriately positioned, coiled in the lower renal pelvis.\n\nThere is a punctate 3 mm calculus in the right lower pole collecting system. \nThere is no right hydroureteronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The bladder is decompressed. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. The ovaries are not seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Residual 13 mm cluster of calculi in the left lower pole collecting system.\n2. Bilateral non-obstructing punctate renal calculi.\n3. Mild to moderate left upper pole hydronephrosis.\n4. Small amount of perinephric and left upper pole blood product." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is a moderate left and\nsmall right non hemorrhagic pleural effusion. No pericardial effusion. There\nis coronary artery calcification.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a subcentimeter hypodense lesion in segment VII\n(___), too small to characterize. The liver demonstrates homogenous\nattenuation throughout. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder has a small amount of sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There are a few subcentimeter hypodense lesions, too small to\ncharacterize. The spleen otherwise shows normal size and attenuation\nthroughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Compared to ___, no significant change in multiple simple cysts. \nThere are few subcentimeter hypodensities, bilaterally, too small to\ncharacterize. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is relatively contracted, limiting evaluation. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnot well seen. No free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis of unclear etiology.\n\nREPRODUCTIVE ORGANS: The uterus contains a non-specific 0.6 cm hypodensity\nwhich could represent a small fibroid. If clinically appropriate, this could\nbe re-assessed with pelvic ultrasound on a non-emergent basis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The aorta is tortuous. \nExtensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is dextro convex scoliosis of the lower lumbar spine, centered at L2. \nThe patient is status post right hip ORIF. There are cortical irregularities\nof the bilateral ischial tuberosities, likely representing sequelae of remote\nfractures. There is an old healed left twelfth rib fracture. There is\ndeformity of multiple multiple anterolateral left-sided ribs.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Examination of the lower abdomen and pelvis is limited by patient's body\nhabitus. Within these limitations, there is no evidence of diverticulitis,\nbowel obstruction or perforation.\n2. There is trace free fluid in the pelvis of unclear etiology.\n3. The uterus contains a non-specific 0.6 cm hypodensity which could represent\na small fibroid. If clinically appropriate, this could be re-assessed with\npelvic ultrasound on a non-emergent basis.\n4. No definite CT findings to explain patient's symptoms." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates heterogeneous attenuation throughout\nwhich may reflect the patient's known history of hepatitis. Morphology of the\nliver is otherwise normal. There is no evidence of focal lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a fluid\nseen within the ascending colon compatible with the history of diarrhea. The\nappendix is top-normal in size measuring 6-7 mm without definite signs of\ninflammation including no periappendiceal stranding. No evidence for bowel\nobstruction. Rectum is normal. No perirectal or pericolonic fat stranding is\npresent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Multiple prominent lymph nodes along the inferior mesenteric vein\nmeasure up to 7 mm (2:65) and are likely reactive. There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Inferior mesenteric vein is prominent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A a small umbilical hernia containing fat is noted.", "output": "1. Fluid within the ascending colon compatible with the history of diarrhea. \nOtherwise, no acute intra-abdominal or pelvic abnormalities. Specifically,\nthe appendix is borderline enlarged but there are no definite secondary signs\nto suggest acute appendicitis.\n2. Heterogeneous attenuation of the liver that may be due to known hepatitis. \nNo morphologic findings to suggest cirrhosis or portal hypertension." }, { "input": "LOWER CHEST: Limited evaluation of the lung bases shows mildly prominent right\ncardiophrenic lymph nodes.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular contour of the liver is redemonstrated with hypertrophy\nof the lateral segments of the left lobe in keeping with cirrhosis. There is\nno evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nThere is mild to moderate volume ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is again noted to be enlarged measuring 17.6 cm\ncraniocaudally.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon appears\nwithin normal limits. Small rectal varices. Small para-esophageal varices.\n\nPELVIS: Note is made of mild enhancing peritoneal thickening in the pelvis. \nThe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. Moderate\nsubcutaneous stranding throughout the abdominal wall in keeping with anasarca.", "output": "1. Cirrhotic liver with portal hypertension as evidenced by splenomegaly and\nascites.\n2. Enhancing mild peritoneal thickening in the pelvis raises concern for\nperitonitis. No evidence of intra-abdominal abscess.\n3. Small fat containing umbilical hernia.\n4. Anasarca.\n5. Limited evaluation of the lower chest shows mildly prominent right\ncardiophrenic lymph nodes are likely reactive." }, { "input": "LOWER CHEST: The lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is cirrhotic morphology of the liver. Patient is\nstatus post cholecystectomy. There has been interval resolution of ascites. \nThere is no biliary dilatation.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Again seen is splenomegaly with spleen measuring 17.6 cm in coronal\nplane (previously 19.2 cm in coronal plane).\n\nADRENALS: Unremarkable.\n\nURINARY: The unenhanced kidneys are unremarkable. There is no evidence of\nhydronephrosis in the upper abdomen.\n\nGASTROINTESTINAL: No bowel obstruction, ascites or free air in the upper\nabdomen.\n\nLYMPH NODES: There is no evidence of abdominal adenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Multiple\nintra-abdominal varices are noted, most notably in the perisplenic region.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Mild left retroperitoneal soft tissue stranding is stable,\nincompletely visualized. A ventral omentum containing hernia is similar in\nappearance.", "output": "Cirrhotic liver morphology with sequela of portal hypertension, including\nsplenomegaly up to 17.6 cm.\n\nOmentum containing ventral hernia, similar to prior. No additional CT\nfindings to explain abdominal pain." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Moderate enlargement of the\nheart is present.\n\nABDOMEN:\nThere is small volume nonhemorrhagic ascites throughout the abdomen and\npelvis.\n\nHEPATOBILIARY: The liver is cirrhotic in appearance. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 16.7 cm. No concerning focal splenic\nlesions are identified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter hypodensities within the right kidney are too small to\ncharacterize, but likely represent simple cysts. Otherwise, the kidneys are\nof normal and symmetric size with normal nephrogram. There is no evidence of\nconcerning focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Minimal\ndiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Portosystemic shunt is noted with prominent hemorrhoidal veins.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing supraumbilical ventral hernia with a\nfascial defect measuring 2.3 cm. A tiny fat containing umbilical hernia is\nalso noted.", "output": "1. No acute traumatic injury within the abdomen or pelvis.\n2. Cirrhotic appearing liver with sequela of portal hypertension including\nsplenomegaly and ascites.\n3. Fat containing ventral hernia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Coronary artery calcifications\nare noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nmild right-sided hydronephrosis and proximal hydroureter. There is\nright-sided perinephric stranding as well as stranding around the proximal\nright ureter. A 3 mm stone is seen in the distal right ureter just proximal\nto the right UVJ.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post prostatectomy and numerous\nsurgical clips are seen in the low pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Umbilical hernia contains fat and a loop of sigmoid colon\nwithout evidence of obstruction.", "output": "Obstructive 3 mm right UVJ stone causing mild right hydroureteronephrosis and\nright perinephric stranding. No evidence of aortic aneurysm or bowel\nobstruction." }, { "input": "LOWER CHEST: Lung bases included and show interval decrease in the size of the\nground-glass opacity in the left lower lung lobe which is suggestive of a\nresolving pneumonia. A chest CT is performed and will be reported\nindividually.\n\nAbdomen: The liver and spleen are normal in size. 2 new focal hepatic\nlesions are identified in the liver, 1 posteriorly in segment 7 measuring 1.6\ncm and the second in segment 6 measuring 2.5 cm. These lesions are compatible\nwith metastatic lesions. Additional stable low-density lesions are seen\nwithin the liver consistent with biliary hamartomas and hepatic cysts. The\ngallbladder is unremarkable. A hypodense soft tissue mass is again identified\nin the pancreatic body encasing the left adrenal the splenic artery and\nobliterating the splenic vein. The mass measures 4.4 x 5.6 cm in the axial\nplane which is decreased from the prior study at which point it measured 6.2 x\n5.2 cm. There is no retroperitoneal or mesenteric lymphadenopathy. The\nvisualized portions of the GI tract are unremarkable. Both kidneys are normal\nin size. No focal renal lesions are present. The right adrenal is normal.\n\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 2 new focal hepatic lesions are identified highly suggestive for metastatic\ndisease. 2. Interval decrease in the size of the pancreatic body neoplasm.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:15 ___, 20 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Please see chest CT scan report from same date.\n\nABDOMEN:\n\nHEPATOBILIARY: There is increase in size and number of the metastases in the\nliver. Most notably the lesion in segment 6 is increased in size from 25 mm\nto 35 mm. Separately at least 1 small cyst is noted in the right lobe of the\nliver, this is stable. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is moderately distended but otherwise\nwithin normal limits.\n\nPANCREAS: The large hyperdense mass in the body/ tail of the pancreas is\nwithout significant change, it at currently measures 41 x 60 mm compared to\nthe previous measurements of 44 x 57 mm. The tumor encases/attenuates and\nobscures midportion of the the splenic vein. Fiducial seeds are noted in the\narea. The tumor encases the common hepatic artery and the splenic artery. It\nalso invades the left adrenal.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No change in size of the mass in the pancreatic tail/body.\n2. Increase in size and number of liver metastases.\n3. No change in encasement of the common hepatic artery and the splenic artery\nand obliteration of the splenic vein midportion." }, { "input": "LOWER CHEST: Again demonstrated are multiple lung nodules bilaterally which\nare better characterized on the CT of the chest exam performed on ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The segment II of the liver is hyper attenuating compare to the\nrest of the parenchyma and has multiple foci of hypodensities largest\nmeasuring up to 1.7 x 1.3 cm (series 2 image 14 and 16). There is intrahepatic\nduct dilatation surrounding the hypodense lesions in segment II concerning for\nmass in the area. Patient is status post cholecystectomy. The common bile\nduct is up to 10 mm. The nodes around the porta hepatis have increased in\nsize, heterogeneously enhancing and are now confluent forming masslike lesion\nmeasuring up to 2.3 by 8.6 cm (series 2, image 20 and series 601, image 30).\nThe portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again noted is a 16 mm cyst in the mid pole of the right kidney with\ncalcification, unchanged from prior exams (series 2, image 28). Other lesions\nin the kidneys are too small to characterize by CT. The patient is status\npost left partial nephrectomy. The postsurgical changes are stable in\nappearance without evidence of local recurrence. There is no evidence of\nstones,or hydronephrosis. There are no urothelial lesions in the kidneys or\nureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy. There is a previously\ndescribed defect in the left flank abdominal wall through which a loop of\ncolon is seen without evidence of obstruction or strangulation.\n\nRETROPERITONEUM: There are new multiple heterogeneously enhancing\nretroperitoneal lymph nodes that are confluent and appearing has a para-aortic\nmass measuring up to 2.5 x 3.2 cm (series 2, image 26).\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.\nAbdominal and pelvic wall is within normal limits. There is age-related\ndegenerative changes and large osteophytes in the spine.", "output": "1. Disease progression. Hyperenhancement of the liver parenchyma, hypodense\nlesions and intrahepatic bile duct dilatation in segment II of the liver\nconcerning for a metastasis. New para-aortic lymph nodes and enlarged\nportacaval lymph node.\n2. Stable appearing right renal cysts.\n3. Incisional hernia containing a loop of large bowel without evidence of\nobstruction or strangulation.\n4. Numerous lung nodules bilaterally which are better characterized on CT of\nthe chest obtained on ___." }, { "input": "Lung bases: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusions seen.\n\nAbdomen: A tiny hypodensity within segment 3 of the liver is unchanged and too\nsmall to characterize. Otherwise, no discrete liver lesion. Main portal vein\nis patent. No biliary ductal dilation. The gallbladder is normal. The\npancreas enhances normally. The spleen is normal in size. Adrenals are\nnormal. Kidneys enhance symmetrically. No hydronephrosis. The abdominal\naorta is normal in course and caliber without appreciable atherosclerotic\ncalcification. No adenopathy, free air or free fluid. The stomach and\nduodenum appear normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is not definitively visualized though there are no secondary signs of\nappendicitis. The colon contains a mild fecal load. No signs of colitis or\npericolonic inflammation. Prostate and seminal vesicles are normal. Urinary\nbladder is only partially distended though appears normal. No pelvic sidewall\nor inguinal adenopathy.\n\nBones: Unremarkable.\n\nSoft tissues: There is a supraumbilical fat containing ventral hernia with a\nhernia neck measuring approximately 8 x 9 mm, similar to that seen on prior. \nThere is no associated fat stranding to suggest incarceration. There is no\numbilical hernia.", "output": "Small supraumbilical fat containing ventral hernia without evidence of\nincarceration with hernia neck measuring approximately 8 x 9 mm.\nOtherwise unremarkable exam." }, { "input": "LOWER CHEST: Bibasilar atelectasis has not significantly changed from prior. \nThere are aortic valvular calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen demonstrates punctate calcification, unchanged from prior.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA right upper pole renal cyst measuring 3.7 x 3.4 cm is unchanged. Additional\nhypodensity in the interpolar aspect of the left kidney is too small to fully\ncharacterize, likely a cyst. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Stomach is decompressed. \nSmall bowel is normal in caliber without focal wall thickening. There is\ndiverticulosis of the sigmoid colon without evidence of diverticulitis. There\nis no colonic dilation or wall thickening. The appendix is not visualized but\nthere are no secondary signs of appendicitis the right lower quadrant. There\nis no intra-abdominal free fluid or free air.\n\nPELVIS: A Foley catheter is seen within a partially distended bladder. \nUnchanged, probable calcified dropped gallstones in the left pelvis. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is absent. A left adnexal cyst measures 15\nmm, unchanged. No right adnexal masses are seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. An IVC filter is in place.\n\nBONES: There is a severe levoscoliosis of the lumbar spine with multilevel\ndegenerative changes. There are severe degenerative changes of the bilateral\nhips with unchanged superior subluxation of the left femoral head. There is\npersistent calcification of an extruded disc at L5/S1 resulting in severe\ncanal narrowing.\n\nSOFT TISSUES: Calcified injection granulomas are noted within the soft tissues\noverlying the gluteal musculature.", "output": "1. Within the limitations of a noncontrast study. No acute intra-abdominal\nprocess.\n2. Chronic changes of diverticulosis, renal cysts, and severe levoscoliosis.\n3. Unchanged left adnexal 1.5 cm cyst. Given the patient's postmenopausal\nstatus, ___ year follow-up pelvic ultrasound is recommended if clinically\nindicated.\n\nRECOMMENDATION(S):\n1. Unchanged left adnexal 1.5 cm cyst. Given the patient's postmenopausal\nstatus, ___ year follow-up pelvic ultrasound is recommended if clinically\nindicated." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Aortic valve calcifications\nnoted. The heart is mildly enlarged. Mediastinal and hilar lymph node\ncalcifications likely represent sequela of prior granulomatous disease.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is not visualized.\n\nPANCREAS: The pancreas is diffusely atrophy but otherwise normal attenuation\nthroughout, without evidence of focal lesions within the limitations of an\nunenhanced scan. There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: Atrophic spleen contains punctate calcifications reflective of prior\ngranulomas disease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Multiple cysts are\nnoted in both kidneys the largest measuring 3.9 cm in the upper pole of the\nright kidney. There is no hydronephrosis. There is no nephrolithiasis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. In the region of the terminal\nileum, at the ileocecal valve, there is fat stranding centered around a\ndiverticulum which appears to be located in the terminal ileum rather than the\ncecum, similar to the prior study. A small focus of air appears to be\nextraluminal likely representing micro perforation, similar to the prior\nstudy. No fluid collection is noted. No evidence of small-bowel obstruction.\nDiverticulosis of the colon is noted, without evidence of wall thickening and\nfat stranding. The appendix is normal. Left-sided calcifications adjacent to\nthe rectum likely represent drop stones, similar to the prior study.\n\nPELVIS: The urinary bladder contains air within the lumen may be secondary to\nrecent instrumentation. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. A left-sided adnexal cyst\nmeasuring up to 1.8 cm is again noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is tortuous. Moderate atherosclerotic disease\nis noted. An IVC filter is again noted in the infrarenal IVC, similar in\nposition to prior.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate levoconvex thoracolumbar scoliosis is noted. Severe degenerative\nchanges are present within the left hip joint with superior subluxation of the\nfemoral head. Moderate degenerative changes are noted in the right hip joint.\nSevere degenerative changes of the thoracolumbar spine noted.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted. Injection\ngranulomas are again noted within the subcutaneous tissues overlying the\ngluteus musculature.", "output": "1. Fat stranding centered around a diverticulum which appears to be located in\nthe terminal ileum rather than the cecum, at the ileocecal valve, similar to\nthe prior study, consistent with diverticulitis of the terminal ileum. \nMicroperforation is likely present, similar to the prior study. No focal\nfluid collection.\n2. Left adnexal cyst measuring 1.8 cm. If not already performed,\nnonemergent ultrasound would be warranted in a patient of postmenopausal\nstatus.\n3. The urinary bladder contains air within the lumen which may be secondary to\nrecent instrumentation. Clinical correlation recommended as infection of the\nbladder may have a similar appearance.\n\nRECOMMENDATION(S): Nonemergent pelvic ultrasound." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains gallstones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is bilateral renal cortical atrophy and scarring (left greater\nthan right). The left kidney is slightly smaller than the right. Multiple\nhypodense lesions in both kidneys are consistent with renal cysts. There is\nno evidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Sigmoid colonic\nwall thickening is likely due to diverticulosis (3:104). There is no evidence\nof acute diverticulitis. Normal appearance of the appendix.\n\nPELVIS: There is marked circumferential wall thickening of the bladder with\nassociated mucosal hyperenhancement. Associated perivesicular stranding and\nedema suggests acute inflammation. There is trace fluid along the anterior\naspect of the bladder (3:124). There is mild nonspecific presacral edema.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is severe atherosclerosis throughout the abdominal aorta and\nbilateral iliac branches. Celiac artery is patent. Superior mesenteric\nartery is patent. There is mild/moderate atherosclerotic narrowing of the\nleft renal artery (3:60). Right renal artery is patent.\n\nBONES: There are severe multilevel degenerative changes of the lumbar spine. \nThere is no acute fracture. Lumbar laminectomy changes are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Marked circumferential bladder wall thickening with mucosal\nhyperenhancement and perivesicular stranding/free fluid, consistent with acute\ncystitis.\n2. No evidence of emphysematous cystitis or pyelonephritis.\n3. Interval resolution of bilateral hydronephrosis.\n4. Cholelithiasis.\n5. Severe atherosclerosis with mild/moderate narrowing of the left renal\nartery." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is status post remote liver transplant. The\ntransplanted liver demonstrates homogeneous attenuation without any focal\nconcerning mass. A chronic subcapsular hematoma in the posterior aspect of\nsegment VII is consistent with expected postoperative changes. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen measures up to 13.5 cm and demonstrates normal attenuation\nwithout evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThe 1.0 x 0.9 cm exophytic hypodensity arising from the interpolar aspect of\nthe right kidney is unchanged and likely represents a simple renal cyst. \nThere is no evidence of focal concerning renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. A small duodenal\ndiverticulum is seen (5:133). Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nLYMPH NODES: Partially imaged soft tissue nodule within the left greater\nomentum is again seen, measuring up to 5 mm (3:56), stable since at least ___. Small retroperitoneal lymph nodes are unchanged. There is no\nmesenteric lymphadenopathy.\n\nVASCULAR: Hepatic arterial and venous vasculature are widely patent, as well\nas the the main portal vein and its intrahepatic portions. Paraesophageal and\ngastric varices, as well as splenic hilar varices, are grossly unchanged. A\nsplenorenal shunt is present, as evidenced by a prominent left renal vein. A\nprominent left gonadal vein likely supplies a varix in the pelvis, which is\nnot imaged on this abdomen-only study. There is no abdominal aortic aneurysm. \nModerate atherosclerotic disease is noted.\n\nBONES: Moderate degenerative change involving the upper lumbar spine with\ndisc height loss and vacuum disc phenomena. No compression fractures\nidentified. There is no lytic or sclerotic lesion concerning for malignancy.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of pancreatitis.\n2. Status post remote liver transplant without evidence of focal hepatic mass.\n3. Unchanged paraesophageal, gastric and splenic hilar varices." }, { "input": "LOWER CHEST: A 1.5 cm epicardial lymph node is unchanged in size or character\nfrom the prior exam (3A: 6 the heart and pericardium are within normal limits.\nThere is minimal bibasilar atelectasis as well as a small right pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver shows a nodular contour, similar in appearance to the\nprior study consistent with a known history of cirrhosis. There is no\narterially enhancing lesion identified within the liver. Re- demonstrated\nwithin segment II is a 4 mm area of hypoenhancement seen on the portal venous\nand delayed phases of enhancement, which is unchanged in appearance dating\nback to ___ (3B: 111). There is no intra or extrahepatic biliary\nductal dilatation. The main portal vein is patent, however there is very mild\nnarrowing at the portal confluence (3B: 139) and a small area of\nhypoattenuation, which is likely residual thrombus, not significantly changed\nfrom the prior examination. As before, the anterior branch of the right\nportal vein is attenuated as it courses through the hepatic parenchyma. \nMultiple enlarged varices are re- demonstrated in the left upper quadrant\nconsistent with a splenorenal shunt. Cholecystectomy clips are present. \nMultiple gastrohepatic and portacaval lymph nodes are identified unchanged in\nsize from the prior examination, the largest measuring 13 x 13 mm (3A: 34). \nThere is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring up to 16.6 cm\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Foci of calcification seen in the deep pelvis\nanterior to the rectum may reflect dropped gallstones.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple periaortic and aortocaval lymph nodes are again noted,\nunchanged in size from the prior examination. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: No suspicious osseous lesions are seen. There is stable anterior\nendplate compression deformity of T12\n\nSOFT TISSUES: Multiple fat containing abdominal wall hernias are re-\ndemonstrated, the largest just above the umbilicus.", "output": "1. Cirrhosis and the sequela of portal hypertension including splenomegaly and\nintra-abdominal varices. No ascites. No evidence of HCC.\n2. 4 mm hypodense lesion within segment II is unchanged from ___ and\nis too small to characterize on CT but is statistically benign." }, { "input": "LOWER CHEST: Small nonhemorrhagic right pleural effusion with associated\natelectasis. No focal consolidations. No pericardial effusion. Multiple\ncalcified hilar lymph nodes are visualized.\n\nABDOMEN:\nHEPATOBILIARY: The liver is cirrhotic in appearance with central fibrosis,\nbetter evaluated on the recent multiphasic CT. Subcentimeter hypodensity\nwithin the left lobe is stable, statistically likely to represent a cyst or\nbiliary hamartoma (series 2, image 25). No new focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged measuring 14.6 cm. No focal lesions. Extremely\nlarge splenic varices are re- demonstrated with a splenorenal shunt.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is circumferential thickening of the bladder wall, which may be\ndue to underdistention. There is no free fluid in the pelvis. Calcific\ndensities within the pelvis likely represent dropped gallstones.\n\nREPRODUCTIVE ORGANS: Central calcifications are seen within a non-enlarged\nprostate. A right hydrocele is visualized.\n\nLYMPH NODES: Numerous prominent gastrohepatic, aortocaval, and periaortic\nlymph nodes are visualized, unchanged since ___, likely relating to\nunderlying liver disease. No new mesenteric or retroperitoneal\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable anterior wedging of the T12 vertebral body compared to ___.\n\nSOFT TISSUES: Multiple small fat containing ventral hernias. Stranding within\nthe lower midline anterior abdominal wall is likely due to prior surgery.", "output": "1. No acute traumatic injury within the abdomen or pelvis. No free fluid. \nSmall non-hemorrhagic right pleural effusion.\n2. Cirrhotic appearing liver with sequela of portal hypertension including\nlarge splenic varices, a splenorenal shunt, and splenomegaly.\n3. Circumferential thickening of the bladder wall, which may be due to\nunder-distention but correlate with urinalysis.\n4. Stable anterior wedging of the T12 vertebral body." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Morphologic changes of cirrhosis with a nodular liver contour.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is absent\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Mildly enlarged spleen. The spleen shows normal size and attenuation\nthroughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof hydronephrosis. There is no perinephric abnormality. There is no\nurolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable\nnoting prostate calcification.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. splenorenal shunt and perisplenic varices are noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable mild compression fracture of T12 is noted.\n\nSOFT TISSUES: Midline surgical changes of the anterior abdominal wall below\nthe umbilicus. Superior to the umbilicus there are multiple midline ventral\nhernias containing fat with some fat stranding within the abdominal fat within\nthe hernias. No evidence of swelling of the mons pubis as clinically\nquestioned", "output": "1. No evidence of swelling of the mons pubis. No cause for left flank or\ngroin pain is identified. Specifically, no kidney or ureteral stone.\n2. Cirrhosis with evidence of portal hypertension.\n\n3. Superior to the umbilicus there are multiple small fat containing abdominal\nwall hernias, with mild stranding." }, { "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver density is within normal limits. There is no focal hepatic lesion. \nThere is no intra or extrahepatic bile duct dilation. The gallbladder is\nnormal. No radiopaque ductal stones are detected.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal mass.\n\nThe spleen is mildly enlarged, measuring 14.1 cm (series 601, image 45 close).\nA bandlike area of hypo density across the upper pole of the spleen is\nsuggestive of an infarct (series 601, image 44). There is no focal splenic\nlesion.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis. Subcentimeter hypodense lesions within the right kidney are\ntoo small to characterize, but are statistically likely tiny cysts (series\n601, image 34, 32).\n\nA nasointestinal tube extends to the junction of the second and third portions\nof the duodenum (series 2, image 74). There is mild distention of the small\nbowel, measuring up to 2.6 cm, with fecalization in the distal ileum (series\n2, image 106), with a transition point at the terminal ileum, approximately 15\ncm from the ileocecal valve (series 2, image 98). There is no pneumatosis or\nfree air. A rectal tube is present.\n\nThere is mild ascites and mesenteric edema. There is no abdominopelvic fluid\ncollection.\n\nExtensive calcifications are seen throughout the splenic artery (series 2,\nimage 59). The abdominal aorta, celiac trunk, SMA, renal arteries, and iliac\nbranches are normal in caliber, without dissection. There are extensive\natherosclerotic calcifications throughout the abdominal aorta and iliac\nbranches, without flow limiting stenosis. A right femoral venous central line\nis appropriately positioned (series 2, image 107).\n\nThe bladder is collapsed, and appears grossly normal. The prostate is normal\nin size.\n\nA small fat containing right inguinal hernia is present (series 2, image 111).\nThere is mild stranding along the right mid abdominal subcutaneous fat (series\n2, image 95).\n\nThere are no osseous lesions concerning for malignancy or infection.", "output": "1. Normal gallbladder. No CT evidence for cholecystitis. No radiopaque ductal\nstones or duct dilation.\n2. Moderate small bowel distention with a transition point approximately 15 cm\nfrom the ileocecal valve, with fecalization, suggestive of partial or\nlow-grade small bowel obstruction. No pneumatosis or free air.\n3. Mild splenomegaly. Bandlike hypodensity along the superior aspect of the\nspleen is suggestive of infarct.\n4. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n5. Mild ascites and mesenteric edema. No abdominopelvic fluid collection.\n6. Small fat containing right inguinal hernia." }, { "input": "LOWER CHEST: The chest Findings will be reported separately.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is minimal periportal edema. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits. A small amount of ascites is present,\ndecreasing comparisons to the previous study. There is a subxiphoid loculated\nfluid collection measuring 4.7 x 1.3 by 5.5 cm, without surrounding\ninflammatory changes. This likely represents a postoperative seroma.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Stable non enhancement of the upper pole of the spleen, compatible\nwith a previous infarct.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple wedge-shaped foci of hypo/non enhancement of the\nright renal parenchyma, new since the previous study. There is a mild amount\nof right perinephric stranding, which is similar to previous. There is a\nstable focal hypodensity at the lower pole of the right kidney, likely a cyst.\nNonobstructive 2 mm caliceal stone at the lower pole of the right kidney. \nAtrophic changes of the bilateral kidneys, stable to previous.\n\nGASTROINTESTINAL: An enteric tube is present, with the tip at the junction of\nthe second and third stages of the duodenum. The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Trace free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Prominent atherosclerotic\ndisease is noted, more than expected for the patient's age. A right femoral\nvenous catheter is present, terminating in the right common iliac vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Fat containing right inguinal hernia.", "output": "1. Multiple new areas of wedge-shaped hypo enhancement in the right kidney,\ncompatible with infarcts. Less likely, these could represent foci of\npyelonephritis, for clinical correlation. Stable splenic infarct.\n2. Loculated subxiphoid fluid collection as described, without surrounding\ninflammatory changes, likely a postoperative seroma. Small amount of ascites,\ndecreased in comparisons to the previous study.\n3. Heavy vascular calcifications, more than expected for the patient's age.\n4. The chest Findings will be reported separately.\n\nNOTIFICATION: A preliminary report was provided by the radiology resident on\ncall on ___ at 01:10. Additional Findings were discussed with the\ntreating team on ___ at 0 900 hours." }, { "input": "LOWER CHEST: Visualized lung bases are clear. There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions within limits of noncontrast study. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation within the limits of noncontrast\nstudy. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2 mm nonobstructing stone in the mid pole of the right kidney. \nThere is no hydronephrosis. There is no perinephric abnormality. There is no\nevidence of focal renal lesions within the limits of noncontrast study. The\ndistal ureters and bladder are unremarkable.\n\nGASTROINTESTINAL: Gastric lap band is seen around the proximal stomach. A\ncatheter from the lap band is seen coursing inferiorly to the right lower\nquadrant abutting the uterus. A separate fragments of catheter is seen\nabutting the inferior edge of liver exiting to the port in the right mid\nabdominal wall. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. The\nappendix is not visualized. There are no fat stranding or fascial thickening\naround the expected location of the appendix. There is no fluid collection.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: IUD is in place.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is\na small fat containing umbilical hernia.", "output": "1. Discontinuous/ fragmented gastric lap band catheter.\n2. No secondary signs of appendicitis.\n3. 2 mm nonobstructing renal stone on the right. No hydronephrosis." }, { "input": "LOWER CHEST: 9 mm right lower lobe lung nodule (series 2, image 3), unchanged\nsince at least ___. Linear atelectasis at the left lung base. No pleural\neffusion.\n\nABDOMEN: Mild central intrahepatic biliary dilatation is unchanged, likely\npost cholecystectomy. Scattered calcified hepatic and splenic granulomata. \nThe pancreas is unremarkable side for a few punctate calcifications which are\nlikely vascular. Multiple hypodensities are seen throughout the kidneys\nbilaterally, some which are compatible with cysts, and others which are too\nsmall to characterize. two lesions at the lower pole of the right kidney\nappear hyperdense, likely represent proteinaceous/hemorrhagic cysts, unchanged\ncompared to prior (series 601, image 26, 27). No hydronephrosis. The\nadrenals are unremarkable bilaterally.\n\nGASTROINTESTINAL: Again seen is a small bowel anastomosis. No free air,\nascites or bowel obstruction. The appendix is unremarkable.\n\nPELVIS: 1.8 cm cystic left adnexal structure has decreased in size compared to\nprior (series 2, image 57). The uterus and right adnexa are unremarkable for\nage. The hyperdensity around the urethra is unchanged and may be related to\nprior injections.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes are visualized.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: Posttreatment seroma within the right\nbreast measuring approximately 5.4 x 4.3 cm (series 2, image 1). Calcified\ninjection granulomas in the gluteal regions are again seen. Compression\ndeformity of the L1 vertebral body is unchanged. No aggressive osseous\nlesions.", "output": "1. No CT findings to explain abdominal pain.\n2. 1.8 cm left adnexal cyst has decreased in size compared to prior and likely\nof no clinical significance at this age.\n3. Partially seen posttreatment seroma within the right breast measuring up to\n5.4 cm." }, { "input": "CTA: There is an area of active arterial extravasation seen just distal to\nthe hepatic flexure, in the region supplied by the superior mesenteric artery\n(4A:57 -65). Multiple, noninflamed diverticuli are seen in this location. The\nsuperior mesenteric artery is slightly narrowed by calcifications at its\norigin, however, it remains patent.\n\nThere is a moderate amount of atherosclerosis with a ulcerated plaque seen\ninferior to the SMA (4A:38). There is no abdominal aortic aneurysm. There is\nsevere stenosis of the celiac artery (4A:38). The renal arteries are normal\ncaliber. The inferior mesenteric artery is occluded. The iliac arteries and\ndistal branches are patent.\n\nCT ABDOMEN AND PELVIS: Smooth cylindrical bronchiectasis is partially image\nthe left lower lobe. There is no pleural effusion or pneumothorax. The\nincluded portion of the heart is normal size and there is no pericardial\neffusion. Calcification seen in the region of the left ventricle papillary\nmuscle.\n\nThe liver enhances homogeneously without focal lesions. The gallbladder is\nsurgically absent and there is no intrahepatic biliary ductal dilation.\nCalcifications are seen throughout otherwise normal spleen and liver,\nindicative of prior granulomatous disease. The adrenal glands and pancreas are\nnormal. The kidneys are mildly atrophic and enhance symmetrically, excreting\ncontrast without hydronephrosis. Bilateral renal hypodensities, most of which\nare too small to characterize are presumably simple cysts; the largest in the\nright kidney measures 3.7 cm, compatible with a cyst.\n\nThe stomach and small bowel are normal. Sutures are seen in the mid abdomen,\nunderlying an area of subcutaneous scarring from prior surgery (4b:270). There\nis a subtle amount of fat stranding involving the descending colon with\nthickening of the lateral conal fascia which may indicate early diverticulitis\n(___: 47). There is suggestion of prior partial colectomy, likely\nsigmoidectomy. Small adjacent mesenteric lymph nodes are reactive. There is\nno bowel obstruction. There is no free air or free fluid.\n\nA Foley catheter is in place. The uterus and right adnexa are unremarkable. A\n2.4 cm left ovarian cyst is noted (4B:295) unchanged since ___. There is\nno free pelvic fluid. There is no inguinal or pelvic sidewall lymphadenopathy.\n\nThere are no lytic or blastic osseous lesions. There is a severe compression\ndeformity of L1, slightly progressed since ___, with 3mm of retropulsion\nsuperiorly, unchanged. A slow flow vascular malformation (hemangioma) is again\nseen in S1. Partial lumbarization of the S1 vertebral body is again\nappreciated. Injection granulomas are seen within the buttocks.", "output": "1. Active arterial extravasation, probably diverticular in origin, just distal\nto the hepatic flexure, in the region of the superior mesenteric artery. The\nsuperior mesenteric artery is minimally narrowed from atherosclerosis.\n2. Moderate atherosclerosis of the abdominal aorta with severe celiac artery\nstenosis and occlusion of the inferior mesenteric artery.\n3. Vague fat stranding surrounding the descending colon may reflect early\ndiverticulitis.\n4. Stable left adnexal cyst from ___ for which a nonemergent pelvic\nultrasound can be performed if clinically necessary, if not already performed.\n5. Progression of the compression deformity of L1 without increased\nretropulsion since ___.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\ntelephone on ___ at 11:23 AM, 30 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: There is a 11 x 7 mm right lower lobe lung nodule (series 2,\nimage 3). Mild dependent atelectasis bilaterally. No focal consolidations. \nNo pleural or pericardial effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous calcified granulomas are seen within the liver. \nOtherwise, the liver demonstrates homogenous attenuation throughout. There is\nno evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Numerous calcified granulomas are seen within the spleen. Otherwise,\nthe spleen shows normal size and attenuation throughout, without evidence of\nfocal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Numerous hypodensities are seen within the kidneys bilaterally, some\nof which are too small to characterize, others are consistent with simple\ncysts. Otherwise, the kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of solid renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. An ileal\nanastomosis is seen within the right lower quadrant. Extensive diverticulosis\nof the sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. There is moderate wall thickening and mild fat stranding\nsurrounding multiple colonic diverticula along a segment of transverse and\nproximal descending colon. The inflammatory findings have improved compared\nto ___, without significant adjacent fat stranding, likely\nrepresenting chronic. There is no focal fat stranding around the single\ndiverticula to suggest diverticulitis. No evidence of bowel obstruction. The\nlarge bowel enhances normally throughout. The appendix is normal.\n\nPELVIS: A tiny focus of air within the bladder lumen should be correlated with\nany recent catheterization. Otherwise, the urinary bladder and distal ureters\nare unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is normal in appearance. There is a 2.5 x 2.0\ncystic left adnexal structure (series 2, image 54), which is stable since\n___.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Severe compression deformity of the L1 vertebral body is unchanged\nsince ___. There is no evidence of worrisome osseous lesions or\nacute fracture. Moderate levoscoliosis of the lumbar spine.\n\nSOFT TISSUES: The 2.7 x 1.8 cm asymmetric soft tissue density within the right\nbreast (series 2, image 5), should be correlated with any recent dedicated\nbreast imaging. A small focus of fat stranding within the right anterior\nabdominal wall is likely due to intervention. , stable. Calcified injection\ngranulomas are seen overlying the gluteal muscles bilaterally.", "output": "1. Resolution of active colitis from the transverse colon to the proximal\ndescending colon with chronic diverticular changes. Diverticulosis without\nevidence of diverticulitis.\n2. Tiny focus of air within the bladder lumen should be correlated with any\nhistory of recent catheterization.\n3. 11 mm right lower lobe lung nodule, stable since ___.\n4. Stable 2.5 cm cystic left adnexal structure since ___.\n5. 2.7 cm asymmetric soft tissue density within the right breast, stable\ncompared to the mammogram dated ___.\n6. Stable severe L1 vertebral body compression deformity." }, { "input": "LOWER CHEST: Visualized lung fields are notable for minimal bibasilar\natelectasis. There is no evidence of pleural or pericardial effusion. There\nis mild hypoattenuation of the blood pool relative to the cardiac musculature\nsuggesting anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits. Trace perihepatic free\nfluid is unchanged.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again seen is moderate right and mild left renal atrophy, similar to\nprior examination. No evidence of focal renal lesions within the limitations\nof an unenhanced scan. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. No peritoneal nodularity or\nthickening.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Peritoneal dialysis catheter is seen entering peritoneum in the\nleft lower quadrant coiled in the central pelvis. No fluid collection noted\nin association with this catheter. The abdominal and pelvic wall is otherwise\nwithin normal limits.", "output": "1. Left lower quadrant peritoneal dialysis catheter coiled in the central\npelvis. No organized fluid collection. No acute findings given confines of a\nnoncontrast exam.\n2. Small volume free pelvic fluid around the peritoneal dialysis catheter.\n3. Moderate right and mild left renal atrophy, unchanged since prior.\n4. Findings suggestive of anemia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are scattered small locules of pneumoperitoneum, most\nprominent over the dome of the liver. The liver demonstrates homogenous\nattenuation throughout. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 1.6 x 0.9 cm locule of fluid adjacent\nto the spleen of without peripheral enhancement.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic, but with normal nephrogram. There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is not visualized. \nSmall amount of free fluid is present.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. A peritoneal\ndialysis catheter is coiled in the pelvis with adjacent free fluid.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted and unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is minimal retrolisthesis of L5 on S1\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits, noting a\nperitoneal dialysis catheter which courses through the anterior abdominal wall\njust left of midline.", "output": "1. No evidence of diverticulitis or other significant enteric abnormalities.\n2. Small locules of pneumoperitoneum and free fluid are likely the sequela of\nperitoneal dialysis catheter use." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\nThere are scattered foci of pneumoperitoneum throughout the abdominal cavity,\nlikely due to the patient's peritoneal dialysis catheter, which appears\nunchanged in position within the pelvis.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are mildly atrophic bilaterally. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid within the pelvis surrounding the dialysis\ncatheter.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is small umbilical hernia containing locules of air. \nCalcifications within the right gluteal muscles are likely due to prior trauma\n(series 2, image 74).", "output": "1. No acute abnormalities within the abdomen or pelvis.\n2. Peritoneal dialysis catheter within the pelvis, unchanged in position. \nSmall amount of free fluid surrounding the catheter, also unchanged. \nScattered foci of pneumoperitoneum throughout the abdominal cavity, likely due\nto catheter usage." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. A small nodule in the right\nlower lobe is unchanged from ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple benign-appearing hypodense liver lesions, some of which are\nof fluid density, consistent with cysts, others are too small to characterize.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nScoliosis is noted. There is a focal lace-like pattern of trabeculation\nwithin the T12 vertebral body, representing an osseous hemangioma.\n\nSOFT TISSUES: There is a moderate-sized fat-containing ventral hernia (series\n2, image 48) with a 1 cm fascial defect, associated with mild fat stranding.", "output": "1. No CT findings correlating to the reported history of microhematuria. No\nconcerning renal, urteral, or bladder mass.\n2. Mildly-inflammed moderate-sized fat-containing ventral hernia with a 1 cm\nfascial defect." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is an 8 mm hypoattenuating lesion anteriorly in the midpole of the right\nkidney, too small to completely characterize. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\nLOWER CHEST: 1 mm nodule noted in the right middle lobe (image 1, series 5).", "output": "1. 8mm hypoattenuating lesion in the midpole of the right kidney anteriorly,\ntoo small to completely characterize. Ultrasound is recommended for further\nevaluation.\n2. 1 mm nodule in the right middle lobe. If patient has a significant smoking\nhistory or other risk factors for primary lung cancer, ___ year, low-dose\nnoncontrast CT is recommended for further evaluation.\n\nRECOMMENDATION(S):\nUltrasound is recommended for further evaluation of the 8 mm hypoattenuating\nlesion in the midpole the right kidney.\n\nIf there is any significant smoking history or other risk factors for lung\ncancer, a ___ year follow-up low-dose noncontrast CT should be obtained for\nfollow up of the incidentally detected 1 mm nodule in the right middle lobe.\n\nNOTIFICATION:\nThe impression and recommendation above was entered by Dr. ___ on\n___ at 14:38 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: Minimal bibasal atelectasis. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a subcentimeter hypodense lesion in segment VIII of\nthe liver too small to characterize on CT. The liver demonstrates homogenous\nattenuation throughout. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The dependent\nportion of gallbladder there is hyperdense material which could correspond\nwith sludge and stones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple well-circumscribed hypodensities within bilateral\nkidneys, too small to characterize but statistically cysts. Area of cortical\nscarring seen at the lower pole of the left kidney. There is a 2.0 cm simple\nrenal cyst in the upper pole of the left kidney. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\npandiverticulosis of the sigmoid, descending, transverse and descending colon\nwithout wall thickening or adjacent fat stranding. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable. The seminal vesicles are\nunremarkable. Calcification of the vas deferens is noted bilaterally.\n\nLYMPH NODES: There are numerous retroperitoneal lymph nodes which are\nborderline in size measuring 1 cm in short axis in the para-aortic region, for\nexample on the left (02:38), unchanged since ___. A 1.1 cm aortocaval node\n(02:30) is also unchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite acute intra-abdominal process.\n2. Distended gallbladder with high-density internal material, potentially\nsludge and/or stones. No additional findings such as surrounding fluid or\nwall edema to suggest acute cholecystitis.\n3. Numerous retroperitoneal lymph nodes, some of which are slightly enlarged\nthough stable since ___." }, { "input": "LOWER CHEST: There is mild subsegmental atelectasis of the bilateral lower\nlobes. There is no pericardial or pleural effusion. Coronary calcifications\nare partially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: Mild circumferential wall thickening of the urinary bladder is likely\nsequelae of chronic outlet obstruction. The distal ureters are unremarkable. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged. There is hyperenhancement of\nthe right half of the prostate (05: 69), slightly crossing midline in the left\nanterior gland, presumably corresponding to known prostate cancer. The\nseminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is tortuous with extensive atherosclerotic\ndisease. There is fusiform ectasia of the infrarenal abdominal aorta,\nmeasuring up to 2.6 cm in caliber. There is approximately 50% narrowing of\nthe proximal SMA due to noncalcified plaque (08:45). The origin of the celiac\nartery and SMA also demonstrate calcified plaque. Bilateral renal arteries\nappear patent.\n\nBONES: There are moderate to severe degenerative changes of the thoracolumbar\nspine with endplate sclerosis and multiple Schmorl's nodes. There is no\nsuspicious osseous lesion, noting that degenerative changes somewhat limits\nevaluation.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen and the pelvis.\n2. Moderate degenerative changes of the thoracolumbar spine with endplate\nsclerosis somewhat limits evaluation for osseous metastatic disease. The most\nrecent bone scan did not show abnormal uptake to suggest osseus metastatic\ndisease.\n3. Enlarged prostate with hyperenhancement of the right half of the prostate\nparenchyma, presumably corresponding to known prostate cancer." }, { "input": "LOWER CHEST: There is mild dependent bibasilar atelectasis. There is\ncalcification of the coronary arteries and thoracic aorta. There is no\nevidence of pleural or pericardial effusion. A 4 mm nodule in the lingula and\na 3 mm nodule in the left lower lobe posteriorly (series 7, image 14) are\nstable stable dating back to ___ (series 7, image 4).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is mildly heterogeneous in attenuation with\nenlargement of the left hepatic lobe and nodular contour, compatible with\ncirrhosis. There are scattered sub cm hypodensities throughout the liver\nwhich are too small to characterize by any imaging modality (series 7, image\n20, image 23, image 34, image 58). No other masses are seen. The common bile\nduct measures up to 1.3 cm. The gallbladder contains gallstones without wall\nthickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged at 15.5 cm without focal lesion identified.\n\nADRENALS: The left adrenal gland is normal in size and shape. There is a\nstable right adrenal nodule.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The visualized\nportions of the colon are unremarkable.\n\nLYMPH NODES: There are an increased number of retroperitoneal and porta\nhepatis lymph nodes, some of which are mildly enlarged, measuring up to 1.4 cm\n(series 7 image 48). These findings are stable dating back to ___.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative disc disease is seen in the spine.\n\nSOFT TISSUES: The abdominal wall is within normal limits. There is bilateral\ngynecomastia.\n\n\nThis study was reviewed with Dr. ___.", "output": "1. Cirrhosis with the sequela of portal hypertension including splenomegaly,\nand an increased number and size of lymph nodes in the upper abdomen, likely\nreactive.\n2. No lesions are seen that are concerning for ___. There are a few tiny sub\ncentimeter scattered hypodensities in the liver which are nonspecific and too\nsmall to be characterized by any imaging modality. Further attention to these\nareas on follow-up imaging can be performed.\n3. The common bile duct measures up to 1.3 cm. Correlate with LFTs." }, { "input": "LOWER CHEST: Heart size is top-normal with severe coronary artery and moderate\naortic valvular calcifications. There is no significant pericardial effusion.\nThere is a small right and trace left pleural effusion. There is associated\nmild compressive atelectasis at the right lung base. The imaged lung bases\nare otherwise grossly clear.\n\nABDOMEN:\n\nHEPATOBILIARY: There is heterogeneous enhancement of the liver parenchyma with\nareas of striated hypoattenuation, most suggestive of fibrosis. There is also\na micronodular contour to the liver. The portal vein is patent. The\ngallbladder is not distended, however there is mild pericholecystic fluid,\nwhich is likely in the setting of trace perihepatic ascites. There is no\ngross focal hepatic lesion given the background of serpiginous heterogeneous\nattenuation. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There are changes from splenectomy with suture margin seen along the\nproximal stomach. No abnormal soft tissue within the splenectomy bed.\n\nADRENALS: There is a 9 mm fat density lesion of the left adrenal gland,\ncompatible with adrenal myelolipoma. The right adrenal gland is unremarkable.\n\nURINARY: There is bilateral renal atrophy with numerous bilateral renal cysts\nmeasuring up to 24 mm off the left upper pole kidney and 18 mm off the right\ninterpolar kidney. There are scattered nonobstructing right renal calculi\nmeasuring up to 6 mm in the right interpolar kidney. There are subtle\ncalcifications around 1 of the right upper pole renal cyst. There is no gross\nsolid renal lesion or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Duodenum and distal small\nbowel loops are normal caliber without evidence of obstruction. Ingested oral\ncontrast reaches the level of the transverse colon. There is prominent\nsigmoid diverticulosis with wall thickening and surrounding inflammatory\nchange compatible with sigmoid diverticulitis, without adjacent abscess or\nfree air. The remainder of the large bowel and rectum are thin-walled. The\nappendix is normal.\n\nPELVIS: Slight areas of asymmetric prominence of the right bladder dome are\nlikely due to secondary inflammation from the adjacent sigmoid diverticulosis\nas the remainder of the bladder appears spared. There is no free pelvic fluid\nor air.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged. The seminal vesicles\nare grossly unremarkable. Vas deferens calcifications are noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate lumbar degenerative changes. There also mild-to-moderate\nright and mild left hip joint degenerative changes.\n\nSOFT TISSUES: Ventral abdominal hernia repair mesh is seen. A peritoneal\ndialysis catheter enters the left hemiabdomen and terminates in the right\nlower quadrant, with a small area of surrounding fluid. There is a tiny fat\ncontaining umbilical hernia.", "output": "1. Acute uncomplicated sigmoid diverticulitis.\n2. Trace ascites, likely accounted for by the peritoneal dialysis catheter.\n3. Hepatic fibrosis.\n4. Bilateral renal atrophy with numerous cysts. 6 mm nonobstructing right\ninterpolar renal calculus.\n5. Postsurgical changes from splenectomy.\n6. Small right and trace left pleural effusions.\n7. 9 mm left adrenal adenoma lipoma.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:35 pm, 2 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Bibasilar atelectasis is noted. Moderate left and small right\npleural effusions are present. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver dome is incompletely imaged. The liver demonstrates\nhomogeneous attenuation throughout. There is no evidence of focal lesions\nwithin the limitations of an unenhanced scan. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or evidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is surgically absent, with postsurgical changes and a\nsuture margin again seen along the proximal stomach. No abnormal soft tissue\nmasses are seen in the surgical bed.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophied. Multiple bilateral renal cysts are again\nseen. A 1.3 cm cyst in the right interpolar region demonstrating a calcific\nrim (2:29) is similar to prior. A 1.0 cm round lesion in the interpolar\nregion of the left kidney demonstrating increased attenuation likely\nrepresents a hemorrhagic cyst (2:29). There is no hydronephrosis. Scattered\nright renal calculi measuring up to 7 mm in the interpolar region are again\nseen (2:33).\n\nGASTROINTESTINAL: The stomach is unremarkable. No gastrointestinal\nobstruction. Re-demonstration of extensive sigmoid diverticulosis, without\nevidence of wall thickening and fat stranding. The appendix is normal. There\nis no free intraperitoneal fluid.\n\nRETROPERITONEUM: There is asymmetric enlargement of the left psoas and\niliopsoas muscles, with heterogeneous areas of hyperdensity within and\nsurrounding the muscles, compatible with an intramuscular hemorrhage. The\narea of hemorrhage encompasses the entire left psoas muscle beginning at its\norigin (2:26) and extends down into the most inferior imaged portion of the\nleft iliopsoas muscle (2:83). Several areas of relatively high-density\nmaterial seen within and adjacent to the left psoas muscle (2: 29, 52, 55) and\nwithin the left iliopsoas muscle (2: 75, 82) likely represent more acute\nhemorrhage. Assessment for active extravasation is limited on this unenhanced\nstudy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\ngrossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes the lumbar spine are noted, worse at L3-L4.\n\nSOFT TISSUES: Herniorrhaphy tacks are seen along the anterior abdominal wall\nthere also midline incisional changes of the upper abdomen. A skin defect in\nthe left lower quadrant (2:58) corresponds to prior site of peritoneal\ndialysis catheter.", "output": "1. Intramuscular retroperitoneal hematoma involving the entire imaged portion\nof the left psoas and iliopsoas muscles. Several areas of relatively\nhigh-density material seen adjacent to or within these muscles likely reflect\nmore acute hemorrhage. Evaluation for active extravasation is limited on this\nunenhanced study.\n2. Moderate left and small right pleural effusions.\n3. Cholelithiasis without evidence of cholecystitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:35 am, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Trace left pleural effusion has decreased compared to ___. Right lower lobe nodular density measures 6 mm, maybe focal\natelectasis. Ground-glass opacities in the left lower lobe likely represent\natelectasis. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Patient is status post splenectomy.\n\nADRENALS: The right adrenal gland is normal in size and shape. 1.0 cm\nangiomyolipoma of the lateral limb of the left adrenal gland is stable.\n\nURINARY: Bilateral kidneys are atrophic with multiple cysts, unchanged from\nprior exam. For example, right interpolar region cyst with calcific rim\nmeasuring 1.3 cm is stable (02:53). Scattered right renal calculi are grossly\nunchanged, measuring up to 7 mm. There is no evidence of focal renal lesions\nwithin the limitations of an unenhanced scan. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ndescending and colon is noted. There is evidence of increased fat stranding\nand engorgement of the mesenteric vessels around the sigmoid colon (2:107),\nnew since ___. The appendix is normal (2:106). Well corticated\ncalcification anterior to the stomach is unchanged and may represent sequela\nof omental infarcts/fat necrosis from prior hernia repair.\n\nPELVIS: Mild bladder wall thickening, which is more conspicuous compared to\nprior exam may be related to under distension or reactive inflammatory\nchanges. The distal ureters are unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged and the seminal vesicles\nare unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Pre-existing anterior inferior L1 vertebral body fracture is more\nconspicuous when compared to prior exam ___. There is 3 mm\nanterior displacement of fracture fragment, previously minimally displaced. \nThere is is mild increased prevertebral swelling when compared to prior exam\non ___. There is no new vertebral body fracture.\n\nRETROPERITONEUM: When compared to ___, there has been interval\ndecrease in the size of pre-existing hematomas. For example, the\nintramuscular hematoma expanding the left psoas muscle measures 6.7 x 5.4 cm\nin the axial dimension, previously 7.8 x 4.8 cm on ___. The\nadjacent retroperitoneal hematoma measures 5.0 x 5.8 cm, previously 6.5 x 5.3\ncm. Asymmetric thickening of the left iliacus muscle has also decreased, now\nmeasuring 4.2 cm, previously 5.0 cm. In addition, pre-existing hemoperitoneum\nlayering against the peritoneal reflection has mostly resolved with trace\namount remaining overlying the distal left psoas muscle. Curvilinear\nhyperdensity between the L3 vertebral body and the left psoas muscle is\nunchanged in configuration.\n\nSOFT TISSUES: There is evidence of prior ventral hernia repair with mesh and\nmultiple tacks along the anterior abdominal wall.", "output": "1. Fat stranding around the loop of sigmoid colon, new since ___,\nconcerning for diverticulitis. No fluid collection or macro perforation.\n2. Interval decrease in left retroperitoneal and ileus psoas intramuscular\nhematomas. No new or enlarging areas of hemorrhage.\n3. Minimally increased in displacement of the anterior inferior corner\nfracture of L1 vertebral body with minimal increase in prevertebral swelling\nwhen compared to ___. Consider MRI for further evaluation of the\nanterior longitudinal ligament stability.\n\nRECOMMENDATION(S): Consider MRI for further evaluation of the anterior\nlongitudinal ligament stability." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 1.9 x 1.7 cm hypodense lesion in the left hepatic lobe with\nirregular borders, an additional subcentimeter lesion in the left hepatic\n___ represent hemangiomas (2:15, 18). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation. There is no\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Incidental note is made of\npancreatic divisum. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter cortical hypodensities bilaterally are too small to\ncharacterize, however likely represent cysts. There is mild bilateral\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are prominent\nfluid-filled loops of small bowel in the left upper quadrant measuring up to\n2.8 cm, which taper gradually, with no evidence of obstruction (2:45). \nDiverticulosis of the colon is noted, without evidence of wall thickening and\nfat stranding. The appendix is not confidently identified.\n\nPELVIS: The urinary bladder is compressed by the large uterus. The distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is massively enlarged with multiple fibroids,\nthe largest measuring 13.9 x 10.1 x 10.7 cm. Multiple exophytic fibroids are\nseen protruding from the right uterine fundus into the right lower abdomen,\nmeasuring up to 7.4 cm (3:55). There are dilated fluid-filled tubular\nstructures in the bilateral adnexa, most consistent with\nhydrosalpinx/pyosalpinx (2:51).\n\nLYMPH NODES: There is a 1.2 cm aortocaval node. There are multiple additional\nprominent retroperitoneal nodes measuring up to 9 mm in the left periaortic\nregion (2:40, 43, 46). There is a 1.2 cm para duodenal node (2:39). There is\nno pelvic or inguinal lymphadenopathy. Hazy appearance of the fat anterior to\nthe uterus is nonspecific, and may be reactive (2:59). There is no peritoneal\nor omental nodularity.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A tiny umbilical hernia containing fat is noted.", "output": "1. Dilated tubular fluid-filled structures in the bilateral adnexa are most\nconsistent with hydrosalpinx/pyosalpinx, however a concurrent small ovarian\nneoplasm can't be excluded. MRI is recommended after treatment of\nhydro/pyosalpinx for further evaluation.\n2. Massively large fibroid uterus, with the largest cervical fibroid measuring\nup to 13.9 cm.\n3. Bilateral mild hydronephrosis likely secondary to compression by the large\nfibroid uterus.\n4. Retroperitoneal lymphadenopathy is nonspecific, may be reactive.\n5. Two hepatic hypodensities measuring up to 1.9 cm may represent hemangiomas,\nhowever could be further characterized with ultrasound or MRI as clinically\nindicated.\n\nRECOMMENDATION(S): Recommend pelvic MRI after treatment." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Nodularity of the left adrenal gland measuring approximately 1.6 cm\nis unchanged in appearance from ___. The right adrenal gland is normal\nin size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral millimetric hypodensities arising exophytically from both kidneys\nare too small to characterize by CT, but statistically likely represent cysts.\nThere is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nBorderline bilateral distal external iliac lymph nodes measuring up to 8 mm on\nthe left and 8 mm on the right are nonspecific, and were not FDG avid on prior\nPET/CT. There is no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild degenerative changes of the thoracolumbar spine.\n\nSOFT TISSUES: Rectus diastasis with a small fat containing umbilical hernia is\nnoted.", "output": "1. No interval change in appearance of nonspecific nodularity of the left\nadrenal gland compared to PET study from ___ and CT of the chest from\n___.\n2. Otherwise no evidence for metastatic disease within the abdomen or pelvis.\n\nRECOMMENDATION(S): If it will change clinical management, characterization of\nthe left adrenal lesion could be performed with adrenal protocol MRI." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a hypodense\nlesion in the right interpolar region measuring 1.3 x 1.5 cm with ___ 9\nconsistent with a simple cyst. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable and contains hyperdense pills. \nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Aneurysmal dilation of the infrarenal aorta up to 2.3cm in a densely\ncalcified area. Extensive atherosclerotic disease is noted with vascular\ncalcifications throughout the abdominal aorta, the origin of the celiac axis\nand SMA, and the more distal SMA (601 B; 44).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. No\nabnormality in the visualized upper thighs.", "output": "1. No evidence of retroperitoneal or intraabdominal hematoma.\n2. Gallstones without evidence of cholecystitis.\n3. Aneurysmal dilation of the infrarenal aorta up to 2.3 cm in a densely\ncalcified area.\n4. Right renal simple cyst." }, { "input": "LOWER CHEST:\nFindings in the lower chest are described in separate report for chest CT\nperformed the same date.\n\nABDOMEN:\n\nPERITONEUM: A moderate volume of ascites has developed since the prior study.\nDiffuse omental caking and mesenteric soft tissue nodularity are also new from\nthe prior exam (3:79). An irregular 8.9 x 5.5 cm soft tissue mass at the\nmesenteric root encasing branch vessels of the superior mesenteric artery\n(3:66) has grown from a soft tissue nodule that had previously measured 2.5\ncm. A porta hepatis lymph node that was 1.1 cm in short axis now measures 2.3\nx 2.2 cm (___:55).\n\nHEPATOBILIARY: Several new hypodense lesions in the liver are consistent with\nmetastases. Representative lesions measure 1.5 x 1.3 cm in segment ___ and 1.6\ncm at the border of segments ___ (03:46). Intra and extrahepatic bile\nducts are nondilated. The gallbladder appears normal apart from mild\npericholecystic fluid, which is nonspecific in the presence of ascites.\n\nPANCREAS: The pancreas has normal attenuation without duct dilatation.\n\nSPLEEN: The spleen of normal volume with homogeneous echogenicity.\n\nADRENALS: A right adrenal metastatic lesion has enlarged, now 4.1 x 3.6 cm\n(03:55) where previously 2.4 x 2.4 cm. Two left adrenal metastases have also\ngrown with the larger now measuring 3.3 x 2.9 cm from prior 2.8 x 2.0 cm\n(03:59).\n\nURINARY: The kidneys enhance and excrete contrast symmetrically, without focal\nparenchymal lesion or hydronephrosis.\n\nGASTROINTESTINAL: There are no dilated bowel loops to suggest obstruction.\nOral contrast progresses through the rectum. A few small bowel loops in the\nright lower quadrant demonstrate irregular mural thickening suspicious for\nserosal implants (3:83).\n\nRETROPERITONEUM: Retroperitoneal lymphadenopathy is overall increased, with an\nexample left para-aortic conglomerate now measuring 4.8 x 4.7 cm from prior\n2.9 x 2.7 cm (3:62). A nodal mass closely associated with left common iliac\nartery that reportedly underwent radiation treatment is minimally smaller, 4.0\nx 3.4 cm currently from 4.5 x 3.2 cm previously (3:84).\n\nVASCULAR: The portal vein, splenic vein, and SMV are patent. The left common\niliac artery is narrowed by adjacent lymphadenopathy but not obviously\noccluded, although contrast bolus timing is not optimized for evaluation of\narterial patency. The abdominal aorta is non aneurysmal with calcified plaque\nnoted at the aortoiliac bifurcation.\n\nPELVIS:\nAscites within the pelvis demonstrates increase peripheral density likely\nreflecting tumor involvement 03:105). Some ascitic fluid tracks into bilateral\ninguinal hernias. The urinary bladder and distal ureters are unremarkable.\n\nBONES AND SOFT TISSUES:\n\nRight sacral soft tissue mass resulting in destructive changes of the bone has\ndecreased in size, 4.7 x 3.6 cm currently from 7.4 x 4.2 cm previously (3:90),\npresumably due to interval radiation treatment. Mild compression deformity of\nthe T12 vertebral body with central focal lucency are not significantly\nchanged. Lucency in the T11 vertebral is suspicious for additional metastatic\nfocus (07:38).", "output": "1. Considerably worsened metastatic disease in the abdomen and pelvis since ___, evidenced by new hepatic metastases, new omental caking, new\nascites, and probable serosal implants along the small bowel. In addition\nthere has been interval enlargement of abdominal lymphadenopathy, bilateral\nadrenal metastases, soft tissue mass at the mesenteric root, and\nretroperitoneal lymphadenopathy.\n\n2. Decreased size of a right sacral osseous metastasis and right common iliac\nlymph node conglomerate most likely secondary to radiation treatment.\n\n3. No significant change in compression deformity at T12 associated with a\nlucent lesion and additional lucency at T11, both of which may represent sites\nof osseous metastasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The visualized portions of the\nsmall bowel and colon are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "No acute intra-abdominal process to explain patient's pain." }, { "input": "Exam is moderately limited secondary to respiratory motion and minimal amount\nof intra-abdominal fat, limiting the potential visualization of inflammatory\nchange.\n\nLOWER CHEST: Visualized lung fields are within normal limits. Moderately\nenlarged heart is similar in appearance to prior studies. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThough there is some vague hyperdensity adjacent to the gallbladder fossa,\ndifficult to assess given motion. Again seen are multiple subcentimeter\nhypodensities throughout the liver parenchyma, similar in appearance to prior\nstudy and likely representing simple cysts. There is stable dilatation of the\nextrahepatic biliary duct measuring up to 1.2 cm (02:23), similar to\nmeasurement of 1.1 cm on prior study. Intrahepatic and extrahepatic biliary\ndilatation is again seen, which may be slightly worse compared to study from\n___. The gallbladder appears distended with a mild amount of\nsurrounding free fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post gastrectomy and Roux-en-Y gastric\nbypass. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder is moderately distended, though otherwise\nunremarkable. There is no trace fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcifications in the uterus could in part be due to\nfibroids or vascular. No adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild spondylolisthesis of L4 on L5 appears unchanged. Moderate multilevel\ndegenerative changes are noted throughout thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Limited exam secondary to respiratory motion and minimal amount of\nintra-abdominal fat, limiting the potential visualization of inflammatory\nchange.\n2. Distended gallbladder with mild amount of nonspecific surrounding free\nfluid. Possible hyper enhancement of the adjacent liver parenchyma. Clinical\ncorrelation with laboratory values could be considered for possibility of\nacute cholecystitis.\n3. Re-demonstration of intrahepatic and extrahepatic biliary dilatation, which\nmay be slightly worse compared to prior study from ___.\n4. No other acute intra-abdominal process, no evidence of perforation or\nobstruction.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:50 am, approximately 5\nminutes after discovery of the findings." }, { "input": "LOWER CHEST: Atelectasis visualized at the bilateral lung bases. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A percutaneous gastrostomy tube is visualized with the\nbumper seated within the subcutaneous tissues for which repositioning is\nrecommended. It is unclear whether the gastrostomy tract is patent given lack\nof enteric contrast administered through the gastrostomy tube. The visualized\nsmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The imaged portion of the colon is unremarkable\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A partially visualized VP shunt traverses the right hemithorax\nterminating in the left upper quadrant. The abdominal and pelvic wall is\nwithin normal limits.", "output": "Percutaneous gastrostomy tube is demonstrated with the bumper seated within\nthe subcutaneous tissues for which repositioning is recommended. Unclear\nwhether the gastrostomy tract is patent given lack of enteric contrast\nadministration." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA rounded hypodensity in the superior pole the left kidney is consistent with\na simple cyst. There is no evidence of focal renal lesions or hydronephrosis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not definitely visualized,\nbut there are no secondary signs of appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A nabothian cyst is incidentally noted. The reproductive\norgans are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of appendicitis or acute intra-abdominal abnormality." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size. The seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen pelvis. No\nlymphadenopathy." }, { "input": "LOWER CHEST: Known bilateral pulmonary emboli are partially visualized. \nModerate to large left pleural effusion is increased in size from prior exam. \nSmall right pleural effusion is grossly stable. Moderate pericardial effusion\nis stable from prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 6\nmm hypodense lesion left lobe of the liver stable from prior and may represent\ncyst or biliary hamartoma. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Status post splenectomy.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Status post\nrectosigmoid colectomy with anastomosis seen in the pelvis. There is moderate\nto large stool burden. The appendix is not visualized. There is ascites\nthroughout the abdomen as on prior exam, perhaps slightly increased. \nSpecifically, the amount of fluid in the left upper quadrant has increased and\nthe apparent loculation is more conspicuous on today's exam.\n\nPELVIS: Evaluation is limited by artifact from bilateral hip prosthesis. \nThere is moderate amount of ascites in the pelvis.\n\nLYMPH NODES: There are prominent retroperitoneal lymph nodes again noted, the\nlargest of which is an aortocaval lymph node which measures up to 3.3 cm\n(02:30). A large left external iliac lymph node measures up to 1.8 cm. \nEnlarged right external iliac node measures up to 1.7 cm. There are multiple\nprominent mesenteric lymph nodes (e.g. around the SMV (02:50)).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is stable appearance of narrowing of the IVC at the level of\nL3 which may be due to eccentric nonocclusive thrombus.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nFusion hardware in the lower lumbar spine spanning L3 through L5 as well as\nbilateral hip prostheses are noted.\n\nSOFT TISSUES: There is a ventral abdominal wall hernia without evidence of\nobstruction.", "output": "1. No evidence for bowel obstruction or acute intra-abdominal process. \nModerate stool burden.\n2. Slightly increased amount of intra-abdominal ascites. Specifically\nincreased amount of fluid in the left upper quadrant which is now more clearly\nloculated.\n3. Stable retroperitoneal, mesenteric, and pelvic lymphadenopathy.\n4. Slightly larger moderate to large left pleural effusion. Unchanged small\nright pleural and moderate pericardial effusion." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status total\nproctocolectomy post ileo anal anastomosis. Distal, fluid-filled loops of\nsmall bowel as well as the J-pouch are dilated to the level of the ileoanal\nanastomosis, with short segments of collapsed bowel within the right lower\nquadrant (series 601 image 24) and left lower quadrant (series 601 image 26). \nThere is no pneumatosis or free air. The bowel wall enhances uniformly\nthroughout. The appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Infrarenal IVC filter is again noted.\n\nBONES: Stabilizing plate with screws again seen fixating a chronic right\nacetabular fracture.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.", "output": "1. Post total proctocolectomy with ileoanal anastomosis. Dilated bowel with\nshort segments of collapsed bowel within the right and left lower quadrants,\nwhich could reflect areas of adhesions and/or partial small bowel obstruction.\nNo high-grade obstruction seen, as fluid and stool extends into the J-pouch\nand ileoanal anastomosis.\n2. No secondary signs of bowel ischemia. No pneumoperitoneum.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:40 am, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: No change in scattered hepatic cysts, the largest measuring 1.5\ncm in hepatic segment VII. Likely hemangioma in segment II is unchanged from\nprior. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is unremarkable except for a 9 mm likely branch-duct\nIPMN (4:78) which is unchanged.\n\nSPLEEN: The spleen is unremarkable. 3 mm splenic hypodensity too small to\ncharacterize unchanged (4:57).\n\nADRENALS: The right and left adrenal glands are unremarkable.\n\nURINARY: Again seen is bilateral cortical atrophy. Simple cortical cyst in\nthe lower right kidney is unchanged. Multiple bilateral lesions too small to\ncharacterize are unchanged.\n\nGASTROINTESTINAL: There is no bowel obstruction or ascites\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A 6.1 x 5.6 cm left adnexal cystic lesion with thin\ninternal septations is unchanged from prior imaging (4:108).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no inguinal lymphadenopathy.\n\n\nBONES: There are multiple osseous metastases and sclerotic lesions throughout\nthe bilateral iliac bones, lower lumbar vertebral bodies, the sacrum as well\nas the bilateral proximal femurs, largest measuring 1.2 cm in the left femoral\nneck (4:119), which are stable from prior.", "output": "1. Stable exam without change in osseous metastases.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: A few stable liver cysts, the largest in segment 6 measuring\n1.9 cm. No new liver lesions. The liver is unremarkable. The gallbladder is\nabsent.\n\nPANCREAS: Unremarkable. There is no peripancreatic stranding.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable except for scarring and a few stable\nbilateral renal cortical cysts.\n\nGASTROINTESTINAL: No bowel obstruction or ascites.\n\nPELVIS: There is no free fluid in the pelvis.Stability of a left adnexal cyst\nmeasuring 6.6 x 5.7 cm. The uterus and right adnexa appear unremarkable..\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: Multiple sclerotic metastatic bone lesions which appear more sclerotic,\nfor example in the lumbar spine, likely reflecting treatment response. The\nlargest metastasis is in the left femoral neck measuring 1.1 cm, unchanged.", "output": "Stable examination." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hepatic subcentimeter hypodensities are too small to\ncharacterize. The largest liver lesion measures 5 mm in segment 7(series 3,\nimage 56). The gallbladder is normal without radiopaque stones. There is no\nintra or extrahepatic biliary duct dilation.\n\nPANCREAS: The pancreas is atrophic. There are no focal pancreatic lesions.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is thickening of the superior aspect of the left adrenal\ngland. There is a 2.5 x 1.7 cm enhancing right adrenal lesion (series 6,\nimage 23).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. The\nsmall bowel is normal in caliber without focal wall thickening. A lesion\nwithin a loop of ileum measuring fatty density likely represents a lipoma\nversus ingested material (series 601b, image 24). The large bowel is also\nnormal in caliber without wall thickening. The appendix is not visualized. \nThere is no intra-abdominal free air or free fluid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are multiple enhancing masses in the uterus,\nconsistent with fibroids. The ovaries are not well seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Enhancing right adrenal lesion and thickening of the left adrenal gland,\nconcerning for metastatic disease.\n2. Multiple subcentimeter liver hypodensities are too small to characterize\nalthough statistically most likely represent simple cysts versus biliary\nhamartomas, metastatic disease however cannot be excluded.\n3. Fibroid uterus.\n4. Please see separate dictation for details on intrathoracic findings." }, { "input": "LOWER CHEST: A right-sided pleural effusion has slightly enlarged since ___ and there is a new, moderate-sized left pleural effusion. There\nis a stable 4 x 4 mm pulmonary nodule within the anterior right lower lobe\nthat appears unchanged since the CTA chest dated ___. The\nvisualized lung fields are otherwise within normal limits.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder appears absent.\n\nPANCREAS: The pancreas appears fatty replaced without evidence of focal\nlesions within the limitations of this noncontrast scan. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The obstructing stone within the proximal right ureter is unchanged. \nThe surrounding fat stranding has resolved and the upstream hydronephrosis has\nimproved. There is an additional punctate, nonobstructive stone within the\nanterior aspect of the lower pole of the right kidney. The additional,\npreviously noted stone within the right kidney is no longer clearly present,\nthough this may be obscured by the right-sided nephrostomy tube. The\nnephrostomy tube is in adequate position. The 2 previously identified,\nrelatively hyperdense, partially exophytic lesions arising from the inferior\npole of the right kidney are unchanged in size or appearance and likely\nrepresent hemorrhagic cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is marked lumbar scoliosis with associated\ndegenerative changes. There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. The obstructing right ureteral stone is stable with resolution of the\nsurrounding fat stranding and improvement of the upstream hydronephrosis.\n2. The right-sided nephrostomy tube is in adequate position.\n3. The previously identified, hyperdense lesions within the inferior pole of\nthe right kidney are unchanged in size and appearance and are likely\nhemorrhagic cysts." }, { "input": "Heart size is normal without significant pericardial fluid. Small\nleft-greater-than-right pleural effusions with associated bibasilar\natelectasis, mild on the left, trace on the right. 4 mm right lung base\nnodule is unchanged since ___. Imaged lung bases are otherwise clear.\n\nCT abdomen without contrast: Liver, spleen and adrenal glands are\nunremarkable in the context of a noncontrast examination. Pancreas is\natrophied but otherwise unremarkable. Gallbladder is not seen.\n\nRight percutaneous nephrostomy catheter in in place within the renal\ncollecting system. Punctate stone within the right lower pole kidney is\nunchanged. No hydronephrosis bilaterally. Bilateral sub cm partially\nexophytic renal lesions are unchanged and likely represent hemorrhagic or\nproteinaceous cysts. 2 adjacent 6 and 5 mm stones in the right proximal\nureter are demonstrated. These appear to be 1 stone on prior examination\n\nSmall hiatal hernia. Stomach, duodenum and small bowel loops are otherwise\nnormal caliber without evidence of obstruction. Large bowel is thin-walled\nand unremarkable without pericolonic fat stranding or fluid collection. Single\ndiverticula seen in the transverse colon.\n\nAbdominal aorta is normal caliber. Scattered mesenteric and retroperitoneal\nlymph nodes are not pathologically enlarged. Small fat containing umbilical\nhernia. No ascites or pneumoperitoneum.\n\nCT pelvis without contrast: Large fibroid uterus re- demonstrated. Bladder\nand rectum are grossly unremarkable. Ovaries not definitively seen. No free\npelvic fluid or air. No inguinal or pelvic sidewall lymphadenopathy by CT size\ncriteria.\n\nBones and soft tissues: Bones are diffusely demineralized. No suspicious focal\nbone lesion. Moderate vertebral degenerative changes. Moderate lumbar\ndextroscoliosis.", "output": "1. 2 adjacent 6 and 5 mm stones in the right proximal ureter in location of\nwhat appeared to be a single stone on prior examination. No hydronephrosis.\n2. Stable punctate nonobstructing stone in the right lower pole kidney.\n3. Fibroid uterus.\n4. Small left-greater-than-right pleural effusions.\n5. 4 mm right base lung nodule is unchanged since ___ suggesting benign\netiology." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The bladder is within normal limits. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Normal appendix. No evidence of hydronephrosis or nephrolithiasis in\neither kidney. No acute intraabdominal process." }, { "input": "CHEST:\n\nHEART AND VASCULATURE: The thoracic aorta is normal in caliber without\nevidence of acute injury. The heart, pericardium, and great vessels are\nwithin normal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass or hematoma.\n\nPLEURAL SPACES: No pneumothorax or pleural effusion.\n\nLUNGS/AIRWAYS: Relatively linear appearing areas of atelectasis are seen\nwithin both upper lobes along the fissures, as well as within the right middle\nlobe. Dependent atelectasis is also noted within both lower lobes. Minimal\nground-glass centrilobular nodular opacities are seen within the right upper\nlobe (03:35) which may reflect small airways disease. No pulmonary laceration\nor definite contusion is identified. An endotracheal tube is seen positioned\napproximately 3 cm above carina. Central airways are patent.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout. \nThere is no evidence of focal lesion or laceration. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube is seen terminating the distal esophagus. \nPatient is status post Roux-en-Y gastric bypass, without evidence of\ncomplication in the Roux or biliary limbs. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal. There is no evidence of mesenteric\ninjury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: The bladder is collapsed around a Foley balloon. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo significant atherosclerotic disease is noted.\n\nBONES: Again seen is a fracture of the left posterosuperior acetabular wall\nwith displaced fracture fragment, with associated joint effusion consistent\nwith hemarthrosis. The previously noted left femoral head dear posterior\ndislocation has been partly reduced, but the left femoral head remains\nposteriorly subluxed, with impaction of the medial posterior femoral head. \nSeveral fracture fragments are seen in the left femoroacetabular joint. \nRe-demonstration chronic appearing multiple bilateral rib fractures and left\nL2 and L3 transverse process fractures with callus formation. No focal\nsuspicious osseous abnormality. There are compression deformities involving\nmultiple lower thoracic vertebral bodies and L1 of indeterminate age, but\nlikely chronic.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Re-demonstration of left posterosuperior acetabular wall fracture with\ndisplaced fracture fragment and associated hemarthrosis.\n2. Previously noted left femoral head dislocation has been partially reduced,\nbut there is persistent posterior femoral subluxation with impaction of the\nmedial posterior femoral head and several fracture fragments noted in the left\nfemoroacetabular joint.\n3. Multiple old bilateral rib fractures and left L2 and L3 transverse process\nfractures.\n4. Compression deformities involving multiple lower thoracic vertebral bodies\nand L1, of indeterminate age, but are likely chronic.\n5. Enteric tube terminating in the distal esophagus. Recommend advancing\n10-15 cm for optimal positioning.\n6. Hepatic steatosis.\n7. Ground-glass centrilobular nodules in the right upper lobe reflect small\nairways disease, either infectious or inflammatory in etiology.\n8. Atelectasis within both upper lobes, right middle lobe, and dependent\naspects of both lower lobes." }, { "input": "LOWER CHEST:\nInterval increase in bibasilar reticular and patchy opacities likely reflects\natelectasis superimposed on a chronic interstitial abnormality. Coronary and\naortic valve calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\npunctate subcentimeter hypodensity in segment II/III is too small to\ncharacterize. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are bilateral\nsimple cortical and peripelvic cysts, as well as other subcentimeter\nhypodensities which are too small to fully characterize. Both kidneys enhance\nsymmetrically and excrete contrast normally. .\n\nGASTROINTESTINAL: Small hiatal hernia is demonstrated. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colorectal\nanastomosis appears intact without evidence of complication. Colon and rectum\notherwise are unremarkable. No evidence of obstruction or bowel wall\nthickening is demonstrated. Appendix contains air, has normal caliber without\nevidence of fat stranding. No free air or free fluid is visualized.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: The descending thoracic aorta is markedly tortuous. There is no\nabdominal aortic aneurysm. There is moderate calcium burden in the abdominal\naorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Penile prosthesis is noted. Prostate gland is\nunremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits. Moderate to severe degenerative changes are noted in the lumbar\nspine with multilevel spondylolisthesis and anterior and posterior\nosteophytosis, findings which appear unchanged from lumbar spine MR from ___.", "output": "1. No evidence of acute intra-abdominal abnormality. Specifically, no\nevidence of diverticulitis or bowel obstruction.\n2. Bibasilar opacities likely reflect atelectasis superimposed on a mild\nchronic interstitial abnormality.\n\nNOTIFICATION: An e-mail to the QA nurses was sent by Dr. ___ at 23:30\non ___ with updated findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The patient is status post\nlaparoscopic appendectomy complicated by development of abdominal pelvic\nabscesses. Since the prior exam, both drainage catheters have been removed. \nPreviously seen collection in the left anterior low pelvis has resolved with\nminimal residual fat full thickening in this site. However, there is a\npersistent fluid collection extending medially from the suture at the expected\nlevel of the appendiceal stump. This collection contains simple appearing\nfluid and measures 3.9 x 1.4 x 1.6 cm. This collection is decreased in size\nfrom prior CT exam at which time it measured 4.3 x 4.0 cm. This collection\ndoes not contain contrast material or gas. Adjacent inflammatory changes with\nbowel wall thickening noted involving the cecum. The distal large bowel is\ncollapsed.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSoft tissue thickening at the umbilicus likely reflects recent laparoscopic\nappendectomy entry site.", "output": "1. Interval removal of 2 percutaneous drainage catheters, with a residual\nright lower pelvic fluid collection which extends medially from the\nappendiceal stump. Difficult to exclude ongoing communication with the\nadjacent cecum.\n2. Resolved collection in the left anterior low pelvis.\n3. Mild thickening of the cecum likely reactive.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___ 17:30\non ___." }, { "input": "Coronary artery calcifications are present.\n\nThe patient is status post cholecystectomy. There is minimal associated\nprominence, but not substantial, involving extrahepatic biliary ducts. There\nis no intrahepatic biliary ductal dilatation. The spleen is normal in size\nand appearance. The adrenal glands appear normal. No focal liver lesions are\nidentified.\n\nThe pancreatic duct is not dilated. The pancreas shows no calcification or\ninflammatory change. Mild pancreatic atrophy is present.\n\nThere are a number of subcentimeter hypodense foci in the kidneys which are\ntoo small to characterize although unchanged. Along the right lower pole, one\nof the larger ones, measuring 15 mm in diameter, is also unchanged and can be\nexplicitly characterized as a simple cyst. Likewise, there is a simple cyst\nin the right upper pole on measuring 17 mm.\n\nThere is a small paraesophageal hiatal hernia. The small bowel is\nunremarkable. The quantity of stool in transverse colon is mildly prominent.\n\nThe cecum and ascending colon are mobile and on this study the cecum is\nreflected anteriorly and superiorly, lying anterior to the upper part of the\nliver, rather than in the right mid abdomen as it did before. This is a\ncommon incidental finding in most cases that can be associated with a on\nnon-fixated ascending colon and cecum. There is no bowel wall thickening or\ndilatation.\n\nThe bladder is full. The terus and adnexa appear within normal limits.\n\nThere is widespread moderate vascular calcification. There is probably some\ndegree of stenosis at both the origins of the superior mesenteric and celiac\narteries, probably at least moderate along the superior mesenteric artery. \nThe inferior mesenteric artery is relatively small and difficult to follow,\nbut at least it can be followed during its early course and it appears patent,\nas before.\n\nThe patient is status post right total hip replacement which obscures the\nlower part of the pelvis to some extent. Degenerative changes along the lumbar\nspine are moderate and appear unchanged. There are no suspicious lytic or\nblastic bone lesions. The bones appear demineralized.", "output": "No definite evidence of acute process. No evidence of active pancreatic\ninflammation. Mild pancreatic atrophy but no clear findings to suggest\nchronic inflammatory change. Status post cholecystectomy. Mobile cecum and\nascending colon with migration of the cecum into the right subdiaphragmatic\nregion; this is an incidental finding in most cases. Suspected a superior\nmesenteric artery stenosis, although not optimally characterized with this\ntechnique." }, { "input": "At each lung base, there is minor dependent atelectasis. The aortic valve is\nheavily calcified, including the cusps, which is often associated with aortic\nstenosis. There is also calcification about the mitral valve, frequently\nincidental, and coronary calcifications are also observed. Although the\nmostly imaged heart appears only borderline in overall size, the left atrium\nappears mild to moderately enlarged.\n\nWithin the limitations of a non-contrast examination, no focal liver lesions\nare identified. There is no biliary dilatation. The gall bladder appears\nnormal. The pancreas is also unremarkable. Spleen is normal in size. \nAdrenals appear normal. There is no evidence for stones or hydronephrosis\ninvolving either kidney. Each kidney shows mild atrophy.\n\nStomach and small bowel appear normal. Appendix is identified and also\nappears normal. There are a few scattered colonic diverticula. Quantity of\nstool along the whole colon is mildly prominent.\n Prostate appears mildly enlarged with central hypertrophy. Seminal vesicles\nappear normal. There is no lymphadenopathy or free fluid. No free air.\n\nInfrarenal abdominal aorta is mildly dilated, measuring up to 30 x 29 mm in\naxial ___ inferiorly and up to 28 mm 39 x 37 mm superiorly. The right\ncommon iliac artery measures 17 mm in diameter, and the left 15 mm. Vascular\ncalcification is moderate.\n\nBones appear demineralized. There is no evidence of fracture or dislocation\nor lysis.Although this may of been better characterized on a recent MR that is\nnot available for review, there is substantial pinal stenosis and degenerative\nchange of the lumbar spine as queried. Mild S shaped curvature is noted along\nthe thoracolumbar spine. There are no substantial spondylolisthesis.\n\nThe T10 and L1 vertebral bodies are fused both anteriorly and posteriorly with\nmild bilateral neural foraminal narrowing. The whole canal appears mildly\nnarrowed in anterior posterior dimension which is likely to some extent be a\ncongenital appearance. The L1-L2 interspace is moderately narrowed\nposteriorly with a shallow broad disc bulge. At L2-L3 moderate to severe\nstenosis is probably driven by congenital factors in addition to a shallow\nposterior disc bulge, ligamentum flavum thickening and hypertrophy of\nbilateral facet joints. There is also a left extraforaminal disc bulge at\nthat level. At L3-L4 interspace is moderate to severely narrowed. There is a\nshallow complex of disc and osteophyte. In conjunction with facet hypertrophy\nthere is at least moderate narrowing. There is probably moderate right-sided\nand milder left-sided neural foraminal narrowing. At L4-L5 there is a left\nparacentral disc bulge, narrowed anteroposterior dimension and facet\nhypertrophy that is moderate to severe. With all of these factors there is\nmoderate to severe but predominantly left-sided stenosis of the central canal.\nOn the right and left there is apparently at least moderate neural foraminal\nnarrowing. L4-L5 interspace is moderately narrowed. L5-S1 interspace is\nmildly narrowed. Each neuroforamen, especially there right appears moderately\nnarrowed and there is again moderate facet arthropathy, left greater than\nright.", "output": "1. No evidence for stones or hydronephrosis involving either kidney.\n2. Severe degenerative changes of the lumbar spine including central stenosis\nand suspected multi level neural foraminal narrowings, although these findings\ncould in all likelihood be much better assessed with MR if any prior study\nbecomes available.\n3. Small abdominal aortic aneurysms, up to 39 mm. Ultrasound follow-up is\nsuggested in 6 months." }, { "input": "LOWER CHEST: Mild basal dependent atelectasis. Aortic and mitral annular\ncalcification noted. The heart is within normal limits of size. No pleural\nor pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance and excrete normally without focal concerning\nlesion or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. Significant fecal loading of the colon is again noted. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Again identified is an infrarenal abdominal aortic aneurysm\nmeasuring 4.1 x 3.9 x 3.3 cm, not significantly changed since the most recent\nstudy. Mild focal dilatation of the right common iliac artery measuring up to\n1.9 cm is also unchanged. Moderate atherosclerotic disease is noted.\n\nBONES: Again demonstrated are significant degenerative changes in the lumbar\nspine and fusion of the T12-L1 vertebral bodies. Loss of vertebral body\nheight on L3, L4, and L5, with vacuum phenomena at L2-L3, and prominent\nanterior osteophytes at L3-L5 are chronic.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute findings in the abdomen or pelvis.\n2. Large fecal load within the colon.\n3. Stable appearance of abdominal aortic aneurysm." }, { "input": "LOWER CHEST: Aside from mild dependent atelectasis, the visualized lung fields\nare within normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. The\nliver demonstrates a nodular contour in keeping with history of cirrhosis. \nThere are multiple ill-defined, hypodense lesions measuring up to 2.4 x 3.5 cm\n(03:20) in the left hepatic lobe, although these are better evaluated on MRI\ndated ___. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder contains gallstones without wall\nthickening or adjacent fat stranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring up to 17.9 cm. The spleen has a\nnormal attenuation throughout, without evidence of focal lesions.\n\nADRENALS: Re-demonstrated is nodular thickening of the left adrenal gland\nwithout a discrete nodule. A hypodense nodule in the right adrenal gland is\nnot well visualized, was previously characterized as an adrenal adenoma.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 2.1 cm\nhypodense cyst in the left lower pole. There is no hydronephrosis. There is\nno nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. A left lower quadrant ostomy is noted without evidence\nof obstruction. Surgical sutures are noted in the right lower quadrant. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: There is high-density material within the bladder, some of which\nlayers dependently, which likely represents blood products. The distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring up to 6.9 cm in\nmaximum transverse dimension.\n\nLYMPH NODES: There are multiple prominent retroperitoneal nodes measuring up\nto 1.1 cm in the right periaortic region (03:29). Prominent external iliac\nlymph nodes measure up to 1.2 cm on the left (3:71). While nonspecific, these\nmay be reactive.\n\nVASCULAR: The aorta is mildly ectatic measuring up to 2.8 cm in diameter\n(03:43). Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel moderate degenerative changes are noted, most pronounced in the mid\nto lower lumbar spine.\n\nSOFT TISSUES: A broad-based parastomal hernia is again noted containing a loop\nof bowel.", "output": "1. High density material within the bladder, which layers dependently, may\nrepresent blood products, underlying soft tissue is not entirely excluded. \nUrology consult may be considered for further evaluation.\n2. Redemonstration of a cirrhotic appearing liver with numerous, ill-defined\nhypodensities, which were better evaluated on prior abdominal MRI. Sequela of\ncirrhosis including splenomegaly and numerous perigastric varices are \npresent. There is no ascites.\n3. Multiple prominent retroperitoneal and external iliac nodes are\nnonspecific, but may be reactive.\n4. Cholelithiasis without evidence of acute cholecystitis.\n5. Prostatomegaly." }, { "input": "CT of the abdomen with IV contrast:\n\nPreviously noted pleural effusions have resolved. There is atelectasis at the\nlung bases. There are no focal lesions in the liver are. The gallbladder is\ncontracted. The spleen is normal in size. The pancreas enhances homogeneously\nthere is no dilatation of the pancreatic duct. The adrenal glands are normal.\nThe kidneys contain subcentimeter hypodense lesions that are too small to\ncharacterize but stable in size, consistent with cysts. A 1.4 cm hypodense\nlesion in the midpole of the left kidney represents a cyst measuring 14\nHounsfield units. There is no free ___ peritoneal lymphadenopathy. The\naorta is tortuous and measures 3.1 cm in diameter the small and large bowel\nare normal. In the right psoas muscle there is a 2.6 x 1.4 cm collection the\nGT is decreased in size previously measuring 4.5 x 3.1 cm in the same\nlocation. A previously noted more inferior collection that was seen anterior\nto the right iliopsoas muscle is no longer present.\n\nCT of the pelvis with IV contrast:\n\nMultiple diverticula are seen in the sigmoid colon. There is no free fluid in\nthe pelvis. No pelvic lymphadenopathy is noted. There is severe artifact from\nbilateral hip prosthesis limiting evaluation of the true pelvis.\n\nDegenerative changes are noted in the lumbar spine. No concerning osteolytic\nor osteo-sclerotic lesions seen.", "output": "1. Decrease in size of the right ipsoas abscess. A second abscess seen\nanterior to the iliopsoas muscle has completely resolved.\n\n2. Bilateral pleural effusions have resolved." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for a description of the thoracic findings.\n\nABDOMEN:\nDetailed evaluation of the intra-abdominal organs of soft tissues is limited\nwithout the use of intravenous contrast.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. There is a tiny 4 mm non-obstructing\ngallstone (series 2, image 57). The gallbladder is otherwise normal in\nappearance without wall thickening. There is no pericholecystic fluid. There\nis no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no stone,\nfocal renal lesions or hydronephrosis. There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is no hiatal hernia. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix contains contrast and is normal in caliber without\nevidence of fat stranding. There is no free fluid collection or\npneumoperitoneum. There is no bowel obstruction.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is mild atheromatous\ncalcifications in the abdominal aorta and iliac branches.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis. Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions. Surgical\nclips or sutures in the lower anterior abdominal wall are noted.", "output": "1. No specific CT finding to explain the patient's recent weight loss.\n\n2. No evidence of malignancy on this non-contrast CT exam. Note that\nintravenous contrast is more sensitive for the detection of masses.\n\n3. Cholelithiasis without cholecystitis.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 15:40 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: There is atelectasis at the bilateral lung bases. \nAtherosclerotic calcifications of the aortic annulus as well as the coronary\narteries are noted. There is no pericardial or pleural effusion.\n\nLIVER: Extensive hypodense lesions are seen throughout the liver becoming\nmore confluent in the lower right lobe compatible with known metastatic\ndisease. There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is unremarkable and the portal vein is patent.\n\nPANCREAS: The pancreas demonstrates fatty atrophy without focal lesions or\nperipancreatic stranding or fluid collection.\n\nSPLEEN The spleen is homogeneous and normal in size.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excretion of\ncontrast. No pelvicaliceal dilatation or perinephric abnormalities are\npresent. Small 1 cm cortically based lesion in the upper pole of the right\nkidney is too small to be fully characterized, but likely represent a simple\ncyst.\n\nGI TRACT: Enteric contrast reaches to the level of the ascending colon. \nThere is a small hiatal hernia. Again seen is a ill-defined hypodense wall\nthickening along the proximal lesser curvature of the stomach measuring up to\n3.6 x 1.4 cm (02:18), better evaluated on prior MRI, consistent with gastric\nneoplasm. The duodenum and small bowel are within normal limits, without\nevidence of wall thickening or obstruction. There is distension of the\ntransverse colon measuring up to 8 cm with predominantly air without evidence\nof obstruction. The appendix is not visualized but there are no secondary\nsigns of appendicitis.\n\nVASCULAR: The aorta contains moderate atherosclerotic calcifications but is\nnormal in caliber without aneurysmal dilatation. The origins of the celiac\naxis, SMA, bilateral renal arteries, and ___ are patent.\n\nRETROPERITONEUM AND ABDOMEN: Again seen is not enlarged 1.8 cm gastrohepatic\nlymph node (02:21). An enlarged left para-aortic lymph nodes measuring up to\n10 mm is also present (02:27). No ascites, free air, or abdominal wall\nhernias are noted. No peritoneal implants is seen.\n\nPELVIC CT: The urinary bladder and distal ureters are unremarkable. No\npelvic wall or inguinal lymph node enlargement is seen. There is no pelvic\nfree fluid. There are small bilateral fat containing inguinal hernias.\n\nOSSEOUS STRUCTURES: No blastic or lytic lesions suspicious for malignancy is\npresent.", "output": "1. Gaseous distention of the large bowel, predominantly the transverse colon\nmeasuring up to 8 cm without evidence of obstruction.\n\n2. Ill-defined hypodense wall thickening along the proximal lesser curvature\nof the stomach measuring up to 3.6 x 1.4 cm compatible with known gastric\nmalignancy. This was better evaluated on prior MRI.\n\n3. Extensive hepatic metastatic disease with multiple enlarged mesenteric and\nretroperitoneal lymph nodes. Given differences in imaging modality, no\nsignificant interval change." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nCT abdomen with contrast: Underlying hepatic parenchyma is diffusely hypo\nattenuating compatible with steatosis. Several ill-defined dense hepatic\nmetastases are re- demonstrated however appearing somewhat improved compared\nto the prior examination. Some of the prior lesions are no longer seen in the\ncurrent examination and a subtle hypodense rim enhancing 17 mm lesion in\nhepatic segment V appears decreased in size compared to ___ (last\ncontrast-enhanced study) where it measured roughly 3 cm. No intrahepatic\nbiliary dilatation. Gallbladder is collapsed and unremarkable. Portal vein\nis patent.\n\nSpleen is enlarged measuring up to 14.2 mm in long axis. Pancreas is\natrophied but otherwise unremarkable. Adrenal glands are unremarkable.\n\nKidneys present symmetric nephrograms and excretion of contrast without focal\nlesion or hydronephrosis.\n\nPostsurgical changes from Nissen fundoplication. Stomach is otherwise grossly\nunremarkable. Duodenum and small bowel loops are normal caliber without\nevidence of obstruction. Large bowel is thin-walled and unremarkable without\npericolonic fat stranding or fluid collection.\n\nAbdominal aorta is normal caliber. No mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria.\n\nCT pelvis with contrast: Bladder, prostate and rectum are grossly\nunremarkable. No inguinal or pelvic sidewall lymphadenopathy by CT size\ncriteria. No free pelvic fluid or air.\n\nBones and soft tissues: No suspicious focal bone lesion.", "output": "1. Interval improvement of ill-defined hepatic metastases.\n2. No new focus of disease in the abdomen or pelvis\n3. Splenomegaly.\n4. Underlying hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Extensive hypodense liver lesions, consistent with known\nhepatic metastasis, with interval progression compared to prior exam from ___. The portal vein is patent. There is no intra or extrahepatic\nbiliary ductal dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas appears atrophic without focal lesion. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Interval increase in size of ill-defined hypodensity along\nthe lesser curvature of the stomach currently measuring 3.6 x 2.4 cm (series\n2, image 57.) Surgical clips noted from prior fundoplication procedure. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnot visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with calcifications.\n\nLYMPH NODES: Redemonstrated periportal (series 2, image 66), para-aortic\n(series 2, image 75) and gastrohepatic (series 2, image 58) lymphadenopathy is\nunchanged from prior exam. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are noted in the lumbosacral spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval increase of extensive hepatic metastasis compared to prior exam ___.\n2. Interval increase in size of ill-defined hypodensity, presumably site of\nknown gastric cancer, along the lesser curvature of the stomach measuring 3.6\nx 2.4 cm, previously 3.6 x 1.4 cm.\n3. Stable appearance of periportal, para-aortic, and gastrohepatic\nlymphadenopathy." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis. Moderate calcifications of the\nmitral valve are noted. Left atrial enlargement again noted. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular consistent with known cirrhosis. There is\nmoderate to large volume simple ascites. There is no evidence of focal\nlesions within the limitations of an unenhanced scan. There is no evidence of\nintrahepatic biliary dilatation. The common bile duct measures 1.0 cm,\nsimilar to prior. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 16.0 cm and with normal attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Subcentimeter\nhypodense lesion in the left interpolar region is too small to characterize\nbut may represent a cyst. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal. (601; 24)\nNo free intraperitoneal air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Prominent retroperitoneal lymph nodes measuring up to 0.7 cm in\nshort axis without meeting CT size criteria for lymphadenopathy. There is no\nmesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Supraumbilical hernia containing fat, mesenteric vessels, and\nascitic fluid is noted.", "output": "1. Cirrhotic liver with splenomegaly and moderate to large volume simple\nascites.\n2. No free intraperitoneal air or hemoperitoneum.\n3. Supraumbilical hernia containing mesenteric vessels, fat and ascitic fluid." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Dense mitral valvular\ncalcifications noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular in contour compatible with cirrhosis. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent. Moderate to large volume\nascites noted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 16.7 cm. A 2.4 cm splenule is\nnoted. Ill-defined wedge-shaped hypodensity within the spleen is incompletely\ncharacterized on the current study, similar in appearance to the prior study\nand potentially an infarct.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Enteric contrast is seen\ndiffusely throughout the loops of small bowel without evidence of extraluminal\ncontrast. Contrast has not reached the colon and rectum. The ascending colon\ndemonstrates mild wall thickening compatible with portal colopathy. The\nappendix is normal. There is no free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fluid and nonobstructed loops of\nbowel noted.", "output": "1. Enteric contrast is seen diffusely throughout the loops of small bowel\nwithout evidence of extraluminal contrast extravasation. There is no free\nair.\n2. Cirrhosis with moderate to large volume ascites.\n3. Ill-defined hypodensity within the spleen is incompletely characterized on\nthe current study, similar in appearance to the prior study and likely an\ninfarct." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate minimal dependent\natelectasis.. There is no evidence of pleural effusion. There is a\nair-containing structure medially in the left lung base which likely\nrepresents a subpleural air-containing bleb/bullae, seen on the prior CT from\n___ when it was smaller in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout with\nnodular contours compatible with known cirrhosis. There is no evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis surgically absent. There is moderate ascites with interval increase in\namount.\n\nPANCREAS: The pancreas is grossly unremarkable on this unenhanced study.\n\nSPLEEN: The spleen is enlarged measuring 15 cm in craniocaudal extent. Again\nseen is the focal wedge-shaped hypodensity involving the spleen (series 2,\n23). Note is made of 2 accessory spleens.\n\nADRENALS: The right and left adrenal glands are normal in size with few foci\nof punctate calcifications involving the left adrenal gland, this could be\nrelated to prior granulomatous infection..\n\nURINARY: The kidneys are of normal and symmetric size. Again seen is evidence\nof few exophytic cortical hypodensities there is no hydronephrosis. There is\nno nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Hiatus hernia, otherwise the stomach is unremarkable. Small\nbowel loops demonstrate normal caliber and wall thickness throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Noncontrast appearance of the uterus is within normal\nlimits. There is an exophytic soft tissue density in the left adnexa (series\n2, image 74) measuring 11 mm compared to the multiple prior CTs this appear\nstable, measuring 2.8 x 2.1 cm on the CT from ___.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable sclerotic foci in T9 and L5 vertebral bodies.\n\nSOFT TISSUES: Again seen is evidence of umbilical hernia containing omental\nfat and few loops of distal small bowel which are normal in caliber, compared\nto the prior studies, there has been gradual increase in size of the hernial\nsac with increase in the number/length of herniated small bowel loops. \nInterval increase in size of low-attenuation subcutaneous nodule superior to\nthe umbilicus (series 2, image 40), this likely represents herniated ascitic\nfluid from a tiny ventral hernia.", "output": "1. Hepatic cirrhosis with splenomegaly. Interval increase in the amount of\nascites.\n2. Gradual interval increase in the size of umbilical hernia now containing\nincreased length of nonobstructed small bowel loops. No evidence of bowel\nobstruction.\n3. 11 mm exophytic soft tissue density in the left adnexa, although stable\nfrom prior CT likely represents an adnexal/ovarian lesion. If this is not\npreviously evaluated, further assessment with a nonurgent pelvic ultrasound\ncan be performed." }, { "input": "LOWER CHEST: The partially imaged lower lungs are clear other than minimal\ndependent atelectasis. No evidence of a pericardial or pleural effusion. \nMitral annulus calcifications are extensive, incompletely imaged. The\nprobable bleb along the mediastinum in the left lung that loose seen on prior\nexams is not imaged on this exam. Esophageal varices are again seen.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular liver is compatible with provided history of cirrhosis.\nA 4 mm hyperenhancing focus in the right hepatic lobe is incompletely\nevaluated on this nondedicated exam but may been present on the prior contrast\nenhanced exam in ___ (series 2, image 14). Mild left intrahepatic biliary\ndilation is similar to prior exam. The common bile duct measures up to 12 mm,\nunchanged from priors. The gallbladder is surgically absent with clips in the\ngallbladder fossa. There is a small to moderate volume of ascites throughout\nthe abdomen and pelvis, similar the prior.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: Several peripheral wedge shaped hypodensities in the spleen compatible\nwith infarcts appear to been present on the prior noncontrast CT and likely\nchronic (series 2, image 11, 16, 18). The spleen remains enlarged measuring\nup to at least 15.9 cm on coronal images, previously 16.7 cm. Several\nwell-circumscribed lesions of similar enhancement to the spleen are again\ndemonstrated, consistent with accessory spleens (series 601, image 32, 29,\n25).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypodensities in the left renal cortex are unchanged, likely cysts. No\nhydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. A Dobhoff tube tip ends well\nin the proximal jejunum. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Diffuse colonic diverticulosis is\nmoderate. Internal hemorrhoids are seen within the rectum. No bowel\nobstruction. No free air.\n\nPELVIS: The urinary bladder is partially distended and unremarkable. The\ndistal ureters are unremarkable. There is free fluid in the pelvis related to\nascites setting of liver disease.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy by size\ncriteria. No pelvic or inguinal lymphadenopathy by size criteria. \nRetroperitoneal lymph nodes are prominent, likely reactive in similar to ___\n(e.g. Series 2, image 22, 33).\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic disease is\nnoted. Esophageal varices are demonstrated. Perirectal varices are also\ndemonstrated. There are internal hemorrhoids. The main portal, left portal,\nand right portal veins appear patent. There are gastrohepatic varices. The\nsplenic vein and SMV appear patent.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Multilevel\ndegenerative changes are mild.\n\nSOFT TISSUES: A fat containing ventral hernia with a small amount of fluid\nremains small in size with a neck measuring up to 3 cm (series 2, image 43). \nNo evidence of hernia complication.", "output": "1. Stable mild prominence of the left biliary intrahepatic ducts and\ndilatation of the common bile duct status post cholecystectomy. No evidence\nto suggest acute biliary obstruction.\n2. Cirrhotic appearing liver with sequelae of portal hypertension including\nsmall to moderate volume ascites, persistent splenomegaly, esophageal,\ngastrohepatic, and perirectal varices. Patent portal and splenic veins.\n3. 4-mm hyper enhanced right hepatic lobe lesion is incompletely evaluated. \nThis could be further evaluated with MRI with contrast in 3 to 6 months.\n4. Splenic infarcts appear chronic.\n5. Small fat containing ventral hernia.\n\nRECOMMENDATION(S): MRI liver with contrast in 3 to 6 months to evaluate\npossible right hepatic enhancing lesion versus perfusional abnormality." }, { "input": "LOWER CHEST: There is a small right lower lobe consolidation with few linear\natelectasis at the left lower lobe. Trace of right pleural effusion. \nParaseptal emphysematous changes are seen in the left lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic. There is no evidence of focal lesions\nwithin the limitations of an unenhanced scan. Unchanged mild intrahepatic\nbiliary duct dilatation and enlargement of the CBD measuring 12 mm. The\ngallbladder is surgically removed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Splenomegaly reaching 17.7 cm. Accessory spleen measuring 2.4 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. The previously\ndescribed cortical hypodensity in the left kidney are hardly seen. A 12 mm\ncortical cyst is seen at the interpolar of the left kidney. There is no\nhydronephrosis. There is no nephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are prominent loops of\nsmall bowel measuring up to 3.1 cm, without a transition point, most likely\nrepresenting ileus. The ascending colon is collapsed. The appendix is\nnormal.\n\nPELVIS: The urinary bladder is collapsed on a Foley catheter. Interval\nincrease of the ascites, that is now severe. No pneumoperitoneum.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Subcentimeter retroperitoneal nodes are again noted with the\ndominant one in the aortocaval area measuring 6.5 mm (series 2, image 40).\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted.\n\nBONES: There are no suspicious osseous lesions. There are moderate multilevel\ndegenerative changes of the lumbar spine.\n\nSOFT TISSUES: Bilateral uncomplicated fluid containing inguinal hernias and\nuncomplicated fat and fluid containing umbilical hernia.", "output": "1. Cirrhotic liver with signs of portal hypertension.\n2. Severe ascites, which is increased compared to prior study.\n3. Prominent loops of small bowel measuring up to 3.1 cm most likely represent\nileus. No signs of bowel obstruction. No pneumoperitoneum.\n4. Small right lower lobe consolidation, either representing atelectasis or\ninfection." }, { "input": "LOWER CHEST: Bibasilar atelectasis with trace of effusions. Please refer to\nthe separately dictated CT chest for detailed evaluation of the chest\nfindings.\n\nHEPATOBILIARY: Hepatic attenuation is homogeneous except for small area of\nhypo enhancement at the gallbladder ___ represent a small area of focal\nfatty infiltration or sparing. Portal vein and hepatic veins are patent. \nGallbladder stones are noted with no gallbladder wall thickening to suggest\nacute cholecystitis.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious masses.\n\nSPLEEN: Wedge shaped, liver hypodensity is noted along the lateral aspect of\nthe spleen, likely represents an area of infarct. There is no splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY:No hydronephrosis or suspicious renal masses noted. Scattered\nsubcentimeter renal hypodensities, too small to characterize, probably\nrepresenting cysts.\n\nGASTROINTESTINAL: There is no bowel obstruction. Status post colectomy. \nRight lower quadrant ileostomy appears unremarkable with no parastomal\nhernias.\n\nPERITONEUM: No free air, free fluid or peritoneal stranding.\n\nLYMPH NODES: Sub centimeter retroperitoneal and porta hepatis lymph nodes, do\nnot meet size criteria for adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches.\n\nPELVIS: Urinary bladder appears unremarkable. Prostate is mildly enlarged. \nSeminal vesicles are unremarkable. Rectum is under distended.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions.\nDegenerative changes of symphysis pubis. Left iliac dense sclerotic focus\nlikely bone islands.\n\nSOFT TISSUES: Soft tissues are unremarkable. Small fat containing inguinal\nhernias.", "output": "1. No acute intra-abdominal infectious process.\n2. Bibasilar atelectasis with trace bilateral pleural effusions. Please refer\nto the separately dictated CT chest.\n3. Cholelithiasis without cholecystitis.\n4. Splenic infarct." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is vicarious excretion of contrast\nin the gallbladder. No gallstones or gallbladder wall thickening.\n\nPANCREAS: Compared with outside CT torso on ___, a region of\nhypoenhancement within the pancreatic body and head is not significantly\nchanged in size, however is more well-defined, consistent with interval\nprogression of pancreatic necrosis. Again seen is peripancreatic stranding. \nPeripancreatic fluid collections abutting the stomach are slightly increased\nin size and more well-defined compared with prior. For reference, a\ncollection abutting the gastric fundus measures 8.3 x 3.0 cm, compared with\n7.7 x 2.9 cm previously (4:54). A fluid collection abutting the lesser\ncurvature measures 9.6 x 4.5 cm, compared with 8.1 x 2.4 cm previously (4:62,\n7:23). Fluid along the lateral conal spaces and tracking into the pelvis is\ndecreased from prior.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. A post pyloric enteric tube is\npresent. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. There is medial wall thickening of a segment of\ndescending colon with surrounding fat stranding, increased from prior (4:91). \nThe appendix is not visualized.\n\nPELVIS: The bladder is decompressed with a Foley catheter present. The distal\nureters are unremarkable. There is a small amount of free fluid in the\npelvis, decreased from prior.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. The portal vein, splenic vein and SMV again are attenuated near the\nconfluence, however remain patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat and a small amount of\nfluid are noted.", "output": "1. A region of hypoenhancement of the pancreatic head and body is overall not\nsignificantly changed in size, however is more well-defined compared with\nprior, consist with interval progression of pancreatic necrosis.\n2. Acute peripancreatic fluid collections are slightly increased in size and\nmore well-defined compared with prior.\n3. Wall thickening and surrounding fat stranding of the descending colon is\nnew and reactive to the adjacent pancreatitis.\n4. The portal vein, splenic vein and SMV are again attenuated near the\nconfluence, however remain patent.\n5. Interval overall decrease in ascites.\n6. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Interval improvement of the bibasilar atelectasis and bilateral\npleural effusion, currently greater on the left side.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Interval increase in volume and organization of the fluid collection\nsurrounding the pancreas and lesser curvature of the stomach and tracking down\nto the pelvis, in comparison with the prior CT from ___ (03:29, 03:26,\n03:46). The remnant body and tail are enhancing without ductal dilation. \nCentral pancreatic necrosis is again demonstrated (series 3, image 32). There\nis no gas within the collection. Again seen is moderate peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities which are too small to characterize are unchanged\nsince prior study and likely represent cysts. There is no hydronephrosis.\n\nGASTROINTESTINAL: There has been interval removal of an enteric tube. The\nstomach is unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. Fluid tracking into the anterior para-renal spaces and causing mild\npericolic edema/inflammation (greater on the left side). The appendix is not\nseen.\n\nPELVIS: Interval removal of the Foley catheter. The urinary bladder and\ndistal ureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal glands are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Porta hepatis, SMV, splenic vein are normal in caliber and patent. \nCeliac axis, SMA are patent. There is a replaced left hepatic artery arising\nfrom the left gastric (series 3, image 21).\n\nBONES: There are no osseous lesions concerning for malignancy or infection.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Necrotizing pancreatitis, with thin nonenhancing portions of the pancreatic\nneck and anterior head, and interval increase in volume of acute necrotic\ncollections abutting the lesser curvature of the stomach and tracking down to\nthe pelvis, in comparison to the prior study from ___.\n2. Patent abdominal vasculature, without thrombosis or pseudoaneurysm.\n3. Interval improvement of the bilateral pleural effusion and atelectasis." }, { "input": "LOWER CHEST: Partially visualized left lung base demonstrates consolidation\nwith bronchial impaction likely sequelae of prior aspiration. There is no\nevidence of pleural or pericardial effusion. Mild cardiomegaly is visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout\nsuggestive fatty liver disease. There is no evidence of focal lesions. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.1 cm left upper pole simple renal cyst. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is moderate hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. Rectal fecal impaction is visualized. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No intra-abdominal or pelvic injury is identified.\n2. Partially imaged consolidation at the left lung base with bronchial\nimpaction likely sequelae of prior aspiration.\n3. Diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Contrast is seen filling the small bowel. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Patient is status post sigmoid colectomy. \nAnastomosis is well visualized on CT and appears intact. There is no\nsurrounding stranding or free fluid to suggest anastomotic leak. There is no\nevidence of abscess formation. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Again seen is bilateral sclerosis of the iliac portions of the vast\nsacroiliac joints, which passed previously mentioned may represent osteitis\ncondensans ilia.\n\nSOFT TISSUES: Rectus diastases without evidence of hernia. Normal\npostsurgical changes at the umbilical incision site, without evidence of\nseroma or abscess formation.", "output": "1. The anastomosis site status post sigmoid colectomy appears intact, without\nevidence of anastomotic leak or abscess formation.\n2. Diffuse hepatic steatosis.\n\nNOTIFICATION:\nThe findings were discussed with ___ by ___, M.D. on the\ntelephone on ___ at 2:21 ___, 10 minutes after discovery of the findings." }, { "input": "LOWER CHEST: There is bilateral atelectasis at the lung bases. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits\nwith no cholelithiasis identified.\n\nPANCREAS: The pancreatic parenchyma is homogeneous though there is extensive\nadjacent fatty stranding with associated inflammatory changes of the upper\nabdomen compatible with acute interstitial pancreatitis. No associated focal\ncollections are identified.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are 2 large renal cysts in the left kidney measuring up to 7.3 cm in\nleft lower pole. Additional bilateral subcentimeter cortical renal\nhypodensities are visualized in too small to characterize though likely\nrepresent renal cysts. There is no evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No bowel obstruction or bowel wall thickening is seen. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The portal vein appears\npatent. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "Acute interstitial pancreatitis with no associated fluid collections or other\ncomplication identified." }, { "input": "VASCULAR:\n\nThere is unchanged short-segment occlusion at the origin of the left\nsubclavian artery (series 3, image 5).\n\nMild dilatation up to 3.4 cm of the main pulmonary artery, suggestive of\npulmonary hypertension.\n\nThe ascending and superior thoracic aorta are normal in size.\n\nThe patient is status post aortobi-iliac EVAR originating at the lower\nthoracic aorta. Thrombus within the graft at the level of the diaphragm is\nmoderately increased with approximately 80% of the graft being occluded (3,\n79).\n\nThere is a tiny type 1a endoleak at the superior margin of the graft (series\n3, 69), which is unchanged.\n\nThe aneurysm sac at the superior most aspect of the graft measures 7.9 x 5.9\ncm, unchanged. At the level of the origin of the celiac artery the sac\nmeasures 6.2 x 4.2 cm (previously 6.1 x 4.2 cm).\n\nChronic occlusion of the left internal iliac artery is unchanged. There is\nhigh-grade stenosis at the origin the right internal iliac artery.\n\nShort-segment irregularity of the common iliac artery on the left (3, 208) is\ncompatible with dissection.\n\nAneurysmal dilatation of the common iliacs status post stenting up to 1.6 cm\non the right and 1.9 cm on the left is unchanged.\n\nThere is nonocclusive short-segment thrombus at the proximal portion of the\nleft renal artery (series 3, image 118).\n\nThe right kidney is shrunken relative to the left and the right renal artery\nand is chronically occluded.\n\nCHEST: There is mild centrilobular emphysema. No suspicious pulmonary lesion.\nNo pulmonary embolus. Small left low-density pleural effusion. No\nsupraclavicular, axial, mediastinal or hilar lymphadenopathy. No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A 5.2 cm simple cyst arises from the right lobe of the liver. \nAdditional subcentimeter hypodensities are too small to characterize. There\nis mild central intrahepatic biliary ductal dilatation, unchanged. Portal\nveins are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: A small hypodensity in the periphery of the spleen may represent a\nsmall cyst or hemangioma. The spleen is otherwise unremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is hypoperfused, chronically and shrunken relative\nto the left. The right renal artery is not definitely seen. The left kidney\ncontains multiple simple cysts and hypodensities which are too small to\ncharacterize.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS: Calcification along the dependent portion of bladder may represent\ntiny stones or mural calcification. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Increased thrombus within the graft now occluding approximately 80% of the\ngraft lumen at the level of the diaphragm.\n2. Very small type 1a endoleak, unchanged. No increase in aneurysm sac size.\n3. Chronic short-segment left subclavian artery occlusion.\n4. Left external iliac dissection, unchanged.\n5. Calcification along the dependent portion of the urinary bladder may\nrepresent layering stones or mural calcification. Recommend nonemergent\nultrasound." }, { "input": "LOWER CHEST: There is a trace left pleural effusion. There is bibasilar\natelectasis. Heart size is enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation there is a sub\ncentimeter hypodensity in segment V which is too small to characterize. The\ngallbladder is decompressed with a percutaneous cholecystostomy tube pigtails\nwithin the gallbladder. Note that two of the side ports are located outside\nthe lumen of the gallbladder. There is no pericholecystic collection. A\ncoarse calcification along the falciform ligament is unchanged.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are notable for bilateral renal hypodensities, some\ncompatible with simple cysts. Others are too small to characterize but likely\nrepresent additional cysts. These are unchanged. There is no hydronephrosis.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. Appendix is not visualized. There\nis no intra-abdominal free fluid or free air.\n\nPELVIS: The multiple bladder diverticula are noted now containing foci of air.\nThere is no bladder wall thickening. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes.\n\nSOFT TISSUES: There is a fat containing right inguinal hernia.", "output": "1. Decompressed gallbladder containing a pigtail catheter. Note that while\ntwo side ports are located outside the gallbladder lumen, the pigtail is\nintraluminal, and no inflammatory changes are seen surrounding the\ngallbladder.\n2. Multiple bladder diverticula containing foci of air, new from prior\ncorrelate with history of instrumentation. If no history exists, recommend\nurinalysis." }, { "input": "LOWER CHEST: Limited assessment of pulmonary parenchyma due to motion and\nbreathing artifact. Stable bibasilar atelectasis compared to the recent prior\nCT chest. Bilateral small pleural effusions. Stable small pericardial\neffusion. Small paraesophageal lymph nodes measuring up to 7 mm.\n\nABDOMEN: Motion artifact degrades image quality.\n\nHEPATOBILIARY: The liver normal parenchymal morphology. There is a 2.7 x 2.5\ncm mass with peripheral hypodensity and central calcification at the hepatic\ndome in segment ___ (series 5, image 21, this has been previously\ncharacterized as a sclerosing hemangioma and has shown interval central\ncalcification over the years. Small subcentimeter hypodensities in the liver\nare too small to be characterized and are stable compared to multiple priors\nlikely representing hepatic cysts versus hamartomas.\n\nThere is mild intrahepatic and extrahepatic biliary dilatation with the CBD\nmeasuring approximately 11 mm in size a 6 mm radiopaque calculus is seen\nlargest at the distal CBD just proximal to the ampulla unchanged from the\nrecent prior CT.\n\nThere is evidence of mild-to-moderate hyperemia in the adjoining parts of\nsegment 4B and segment 3 surrounding the gallbladder fossa (series 5, image\n___. Gallbladder is decompressed and not well assessed; however, there is\nmild to-moderate wall thickening the region of the midbody. With minimal\nsurrounding stranding. Stable calculus in the gallbladder neck.\n\nThere has been interval improvement of previously seen high-density fluid\npocket in the perihepatic space with minimal linear soft tissue thickening\nseen which likely represents the tube tract. No recurrent abscess or fluid\ncollection seen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size and show evidence of\ncortical scarring. There is no evidence of hydronephrosis. Numerous\nbilateral low-attenuation renal cortical cysts are again seen. Stable left\nparapelvic cysts.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small and large bowel loops\nare normal in caliber.\n\nPELVIS: The urinary bladder shows Foley bulb in situ. There is no free fluid\nin the pelvis.There has been a prior prostatectomy with surgical clips in the\nsurgical bed. The seminal vesicles are not seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: No aggressive osseous abnormality. Degenerative disc disease again\nseen involving the lumbar spine. Multilevel vertebral body height loss seen\ninvolving the lower thoracic vertebral bodies, particularly T9 as well as\nL4-L5 vertebral bodies. No acute fracture or dislocation seen. Significant\ndegenerative changes seen involving the right hip joint.\n\nSOFT TISSUES: Bilateral small fat containing inguinal hernias..", "output": "1. Interval improvement of the previously seen high-density fluid pocket in\nthe perihepatic space with mild residual linear soft tissue thickening likely\nrepresenting tube tract. No new pericholecystic abscess or collection seen.\n2. Gallbladder is decompressed and is not well assessed on this CT however\nthere are persistent mild inflammatory changes in the gallbladder fossa. \nStable cholelithiasis. Stable choledocholithiasis with minimal upstream\nbiliary dilatation.\n3. Incidental stable calcified hemangioma in the hepatic dome." }, { "input": "LOWER CHEST: Visualization of bilateral lower lung fields is limited due to\nrespiratory motion. Within these limitations, there is bibasilar atelectasis\nwithout focal consolidation. There are trace bilateral pleural effusions. \nThere is unchanged moderate to severe cardiomegaly with extensive coronary\nartery calcifications. There is a small pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates normal parenchymal morphology. Again\nseen is a 2.6 x 2.6 cm mass with peripheral hypodensity in central\ncalcification at the hepatic dome in segment ___ (series 2; image 13), which\nwas previously characterized as a sclerosing hemangioma and appears relatively\nunchanged compared to ___. Small subcentimeter hypodensities in the\nremaining liver too small to characterize and stable compared to prior, likely\nhepatic cysts versus biliary hamartomas.\n\nAgain seen is mild intrahepatic and extrahepatic biliary dilatation with the\ncommon bile duct measuring approximately 11 mm. 3 mm radiopaque calculus is\nseen at the distal CBD, just proximal to the ampulla, relatively unchanged in\nsize from most recent prior CT.\n\nThere is evidence of mild-to-moderate hyperemia in the adjoining parts of\nsegment V in segment 3 surrounding the gallbladder fossa (series 2; images\n___. Gallbladder is decompressed and not well assessed; however, there is\nmild-to-moderate wall thickening in the region of the mid body. Patient is\nstatus post prior percutaneous cholecystostomy. There is minimal stranding\nsurrounding the gallbladder, unchanged compared to prior. Unchanged renal\ncalculus is seen in the gallbladder neck.\n\nPANCREAS: Pancreas is mildly atrophic without evidence of focal lesions or\nmain pancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are of normal and symmetric size, but do show persistent\nevidence of cortical scarring. There is no hydronephrosis. Numerous,\nbilateral low-attenuation renal cortical cysts are again seen and unchanged. \nThere are also unchanged left parapelvic cysts. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Urinary bladder shows trabeculated pattern with innumerable bladder\ndiverticula, likely due to previous chronic outlet obstruction. Patient is\nstatus post prior prostatectomy with surgical clips in the deep pelvis. \nSeminal vesicles are not seen. There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRemote rib fracture of the right tenth rib is seen. Degenerative disc disease\nis again seen involving the lumbar spine. Multilevel vertebral body height\nloss is again seen involving the lower thoracic vertebral bodies, particularly\nat T9 as well as at L4-L5 vertebral bodies. These findings are unchanged\ncompared to prior.\n\nSOFT TISSUES: Again seen are bilateral, small fat containing inguinal hernias.", "output": "1. Choledocholithiasis with minimal upstream biliary dilatation.\n2. Gallbladder is decompressed. Persistent mild inflammation at the\ngallbladder fossa. Stable cholelithiasis.\n3. Unchanged calcified hemangioma in the hepatic dome.\n4. No bowel obstruction." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is homogeneous in attenuation and normal in morphology. \nThere are multiple hepatic hypodensities, some too small to characterize other\ncompatible with simple cysts. For example, the largest cysts located in\nhepatic segment VIII measures 4.7 x 4.2 cm (series 2, image 49). Gallbladder\nis unremarkable and without radiopaque stones. There is no intra or\nextrahepatic biliary duct dilation.\n\nSPLEEN/PANCREAS: The spleen is surgically absent. Again seen, is mild fatty\natrophy of the pancreas. There is a 6 mm cystic lesion in the pancreatic\nhead, requiring no specific followup (series 2, image 75).\n\nThere is hypoattenuation of the pancreatic tail which is surrounded by and\ninterdigitates with postoperative fluid adjacent to the splenectomy bed. \nOverall amount of fluid in this region has increased and is becoming more\ndefined measuring 8.4 x 5.0 x 7.6 cm (series 2, image 77). This\nretroperitoneal fluid extends to the anterior aspect of the aneurysm sac, as\nseen previously (series 2, image 82).\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The left kidney is absent. Right kidney is notable for multiple\nsimple renal cysts measuring up to 1.5 x 1.7 cm in the right upper pole. \nAdditional subcentimeter hypodensities in the right kidney are too small to\ncharacterize, but statistically likely represent simple cysts. There is no\nhydronephrosis.\n\nGASTROINTESTINAL: A nasoenteric tube ends in the stomach. There is thickening\nof the posterior gastric wall, as seen previously. There is also thickening\nof the proximal duodenum, new from prior. There are thickening of ileal loops\nin the pelvis, unchanged from prior (series 2, image 112). There is no small\nbowel obstruction.\n\nThe patient is status post ___ procedure. Left mid abdomen ostomy\nagain seen. There is persistent wall thickening of loops of decompressed\nlarge bowel proximal to the ostomy, unchanged from prior (series 2, image 72).\nWall thickening of the cecum and ascending colon has improved. The appendix\nis unremarkable.\n\nA right lower quadrant drain tip ends in within the rectal stump. While there\nis persistent fluid in a dilated rectal pouch, there is no rectal wall\nthickening or pneumatosis. High density material along the posterior aspect\nof the rectum, seen on prior CT since ___, may represent blood product\n(series 2, image 124). Free fluid in the right paracolic gutter and pelvis is\ngrossly unchanged.\n\nPELVIS: The bladder is partially decompressed with a Foley catheter. \nThickening of the bladder wall, may reflect underdistention. Air within the\nbladder is consistent with instrumentation. There is no pelvic sidewall or\ninguinal adenopathy.\n\nREPRODUCTIVE ORGANS: The prostate contains coarse calcifications and is\notherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Postsurgical changes from abdominal aortic aneurysm repair are\npresent with a by-iliac stent graft, which is without evidence of fracture. A\nSMA stent and right renal artery stent are patent. Irregular oblong aneurysm\nsac at the level of the iliac vessels is unchanged in size measuring 6.2 x 4.6\ncm (series 2, image 88). Also unchanged is a 3.2 cm right common iliac\naneurysm. Susceptibility from clips noted in the right pelvis. The external\niliac and common femoral vessels are patent bilaterally. There is a 1.1 x 0.7\ncm pseudoaneurysm (2:83) probably arising from the splenic artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are bilateral pars defects at L5-S1 with mild anterolisthesis. There\nare multilevel degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Persistent fluid containing dilated rectal stump. No wall thickening, wall\nhypoenhancement, or pneumatosis to suggest necrosis. High density material\nlayering posteriorly in the rectum, possibly blood product, unchanged from CTs\ndating back to ___. The tip of a right lower quadrant drain extends into\nthe rectal stump.\n2. Gastric fundal thickening, similar to prior, possibly reactive in the\nsetting of adjacent postsurgical change.\n3. New duodenal thickening, suggestive of duodenitis, and may be reactive\nsecondary to the adjacent fluid collection..\n4. Persistent wall thickening of small bowel loops in the pelvis and\nlarge-bowel loops just proximal to the colostomy with improved appearance of\ncecal and ascending colon wall thickening.\n5. Continued increase in intraperitoneal and particularly retroperitoneal\nfluid. Fluid in association with the pancreatic body/tail and anterior to the\naneurysm sac has becoming defined, however, no well-formed collection is\nidentified. This increase in fluid, given its location adjacent to and\nsurrounding the upstream pancreas coupled with the heterogeneously enhancing\npancreatic parenchyma may be secondary to the pancreatitis. Correlation with\nlipase levels is recommended.\n6. Aorta bi-iliac stent graft in place. Similar size of infrarenal aortic\naneurysm sac. Patent vasculature.\n7. 1.1 x 0.7 cm pseudoaneurysm arising most likely from the splenic artery.\n The findings were discussed with ___, M.D. by ___, M.D. on\nthe telephone on ___ at 11:21 pm, 5 minutes after discovery of the\nfindings.\n\nRECOMMENDATION(S): Correlate with lipase levels." }, { "input": "LOWER CHEST: Bilateral small pleural effusions with adjacent compressive\natelectasis are noted. Please refer to separate report of CT chest performed\non the same day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\nNumerous scattered subcentimeter hypodensities are unchanged from prior exam,\nand are too small to characterize but probably represent simple cysts or\nbiliary hamartomas. A large simple cyst in hepatic segment VIII measures 4.8\ncm, unchanged (02:46). There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. Gallbladder wall edema may be related to third-spacing.\n\nPANCREAS: The pancreas is atrophic. A 6 mm hypodensity in the pancreatic tail\nis again noted. Hypoattenuation of the pancreatic tail is again noted. The\nperipancreatic fluid collection in the left upper quadrant has decreased in\ncomparison with ___, with a pigtail catheter coiled near the lateral\nedge of the collection (2:77, 78). The collection now measures approximately\n8.7 x 2.8 cm, previously up to 11.2 x 6 cm (601:23). This collection appears\nto communicate with the excluded aneurysm sac.\n\nSPLEEN: Status post splenectomy.\n\nADRENALS: The right adrenal gland is within normal limits. The left adrenal\ngland is not visualized.\n\nURINARY: The left kidney is absent. The right kidney is of normal in size\nwith normal nephrogram. Numerous subcentimeter hypodensities scattered\nthroughout the right kidney are most likely simple cysts, and are unchanged. \n2 cm cysts in the interpolar region and right lower pole are unchanged. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. A stoma is seen\nin the left upper abdomen. The rectal stump contains fluid and a percutaneous\ndrainage catheter terminates within the stump. The appearance is grossly\nunchanged in comparison with ___.\n\nModerate volume simple free fluid in the abdomen now demonstrates increased\nloculation with peritoneal hyperenhancement, particularly along the left\nabdominal wall (601:17). This partially encapsulated collection measures up\nto 5.5 x 3.6 x 15 cm and contains areas of fluid, fat and heterogenous soft\ntissue likely reflecting fat necrosis. Haziness of the mesentery most\napparent in the left abdomen is unchanged, probably related to necrotic\nmesenteric fat..\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains coarse calcifications and the\nseminal vesicles are unremarkable in appearance.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The patient is status post aortobililiac stent with right renal and\nSMA stents, which appear patent. There is a 3 cm gap between the inferior\nmargin of the aortic stent and the bilateral common iliac stents (601:23). \nThe aortic aneurysm sac is oblique in orientation and measures up to 6.2 x 4.0\ncm, grossly unchanged from prior given slight differences in measurement\ntechnique (2:85). There is continued communication of the aneurysm sac with\nthe peripancreatic collection, as described above.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMetallic fixation devices are seen along the left anterior inferior chest\nwall.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in the size of the rim enhancing fluid collection\nadjacent to the pancreatic tail with a pigtail catheter in place. The fluid\ncollection appears to communicate with the excluded infrarenal aortic aneurysm\nsac.\n2. Increased loculation of intra-abdominal fluid with peritoneal\nhyperenhancement, most pronounced along the left abdominal wall.\n3. There is approximately a 3 cm gap between the inferior margin of the aortic\ngraft and superior margin of the bilateral common iliac grafts, which is new\nin comparison with ___.\n4. The infrarenal aneurysm sac is unchanged in size, measuring 6.2 x 4.0 cm.\n5. Fluid-filled rectal stump containing a percutaneous drainage catheter is\nunchanged. There is no wall thickening.\n6. Bilateral small pleural effusions with adjacent compressive atelectasis are\nnoted. The left pleural effusion is slightly loculated. Please see the\nseparately dictated chest CT from the same date for a complete description of\nthoracic findings.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:08 pm, 30 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separately dictated CT of the chest for detailed\nassessment. Small bilateral pleural effusions with basilar atelectasis.\n\nHEPATOBILIARY: Re-demonstration of multiple hepatic hypodensities likely\nrepresenting simple cysts or hamartomas, unchanged. Mild prominence of the\nintrahepatic biliary system. Normal caliber common bile duct. Gallbladder is\nunremarkable.\n\nPANCREAS: Atrophic appearing pancreas with re-demonstration of fluid\ncollection along the tail of the pancreas as detailed below.\n\nSPLEEN: Post splenectomy.\n\nADRENALS: Right adrenal is unremarkable. Left adrenal gland is surgically\nabsent.\n\nURINARY:Post left nephrectomy. Millimetric renal cortical hypodensities\nwithin the right kidney, too small to characterize likely simple cyst. No\nhydronephrosis.\n\nGASTROINTESTINAL: Stomach is under distended. New J tube is in place. No\ndilated loops of small bowel. Left lower quadrant colostomy. Low-density\nfluid throughout the colon. Rectal stump appears unremarkable.\n\nPERITONEUM: Re-demonstration of a pigtail catheter noted along the periphery\nof the peripancreatic collection centered around the pancreatic tail. This\ncollection has minimally increased in size measuring 5 x 6.7 compared to 4 x\n6.4 cm. There is also left anterior upper abdominal collection that tracks\nposteriorly and along the left paracolic gutter. This has markedly increased\nin size compared to previously. This demonstrates rim of peritoneal\nenhancement and tiny foci gas bubbles. This communicates with the\nperipancreatic collection however, pigtail catheter does not drain this\ncollection directly. This approximately measures 11.9 x 5.5 x 14.9 cm.\n\nLYMPH NODES: Scattered reactive adenopathy.\n\nVASCULAR: Post endovascular repair with open surgical repair of endovascular\nleaks. Abdominal aorta graft appears intact with no evidence of endoleaks. \nThe ___ is not well seen, otherwise grossly the abdominal aortic branches\nopacify with contrast however, with luminal narrowing at their orifices. \nVenous structures are patent.\n\nPELVIS: Tiny foci of gas within the bladder otherwise unremarkable. Central\nprostatic calcifications. Rectal stump is intact. No pelvic adenopathy.\n\nBONES:Degenerative anterolisthesis of L5-S1 secondary to chronic pars defect\nof L5. No acute osseous abnormality. Hardware related to left anterior rib\nfractures.\n\nSOFT TISSUES: Left paramedian abdominal scar.", "output": "1. Interval increased size peripancreatic collection with the pigtail catheter\nlocated along the peripheral edges of the collection. Consider repositioning\nof the catheter.\n2. Interval marked decrease left upper abdominal collection tracking along the\nleft paracolic gutter, communicating with the peripancreatic collection\nhowever, does not drain with the pigtail catheter.\n\nNOTIFICATION: Findings were discussed with caring team 09:30, ___\nby Dr. ___ radiology fellow by phone, ___ minutes after the\ndiscovery of the findings." }, { "input": "LOWER CHEST: Limited evaluation of lung bases are notable for small bilateral\nnon hemorrhagic pleural effusions with associated atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen are multiple hepatic hypodensities, likely\nrepresenting simple cysts or biliary hamartomas, unchanged. Mild prominence\nof intrahepatic biliary system is unchanged. Common bile duct is normal in\ncaliber. Gallbladder is unremarkable. No new lesions.\n\nPANCREAS: Atrophic appearing pancreas with re-demonstration of fluid\ncollection along the tail the pancreas which has slightly decreased in size\nsince prior examination. Previously noted pigtail catheter is coiled within\nthe lateral most aspect of the collection. Collection measures approximately\n7.4 x 4.6 (previously 8.5 x 5.1 cm when remeasured) (02:45).\n\nSPLEEN: Status post splenectomy.\n\nADRENALS: Right adrenal gland is unremarkable. Left adrenal gland is\nsurgically absent.\n\nURINARY: Status post left nephrectomy. Again seen are subcentimeter renal\nhypodensities, many of which are too small to characterize and likely\nrepresent simple cysts. Largest measures 1.7 x 1.8 cm within the right upper\npole (02:37). No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Stomach is underdistended. J tube again noted. Left lower\nquadrant colostomy again noted. A new left lower quadrant pigtail catheter is\ncoiled within a loop of bowel in the left lower quadrant (2:62). Rectal stump\nis unremarkable.\n\nPELVIS: Single locule of gas within the bladder is likely due to recent\ninstrumentation. Distal ureters are unremarkable. No free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Patient is status post endovascular repair with open surgical repair\nof endovascular leaks. Abdominal aortic graft appears intact without evidence\nof gross endoleak on this nondedicated study.\n\nPERITONEUM: Interval decrease in size of left upper abdominal fluid that\ntracks posteriorly along the left pericolic gutter and is partially contained\nwith peripheral rim of enhancement. This collection contains few foci of gas\nand appears to communicate with the peripancreatic collection. Overall this\ncollection measures 9.4 x 4 (previously 11 x 5.4 cm) (2:63).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: In the left lower quadrant again seen is a sinus tract extending\nfrom the skin up to the peritoneum, unchanged since prior (2:60). Otherwise\nunremarkable.", "output": "1. Malpositioned left lower quadrant pigtail catheter within small bowel loop.\n2. Decrease in size of 9.4 cm left upper abdominal fluid collection that\ntracks posteriorly and communicates with the peripancreatic collection.\n3. Decrease in size of 7.4 cm peripancreatic fluid collection containing\npigtail catheter.\n4. Left lower quadrant sinus tract extending from skin to peritoneum.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 7:11 am, 1 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Limited evaluation of the lung bases is notable for bibasilar\natelectasis. Small bilateral non hemorrhagic pleural effusions are again\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: 3.2 x 4.6 cm segment 8 hepatic cyst is again noted, unchanged\nsince prior examination. Additional subcentimeter segment 2 and 4A hepatic\nhypodensities are not fully characterized and unchanged since prior\nexamination (02:21). No evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: Atrophic pancreas with re-demonstration of fluid collection along\nthe tail of the pancreas which is slightly decreased in size since prior\nexamination, now measuring 6.5 x 3.3 cm (previously 7.4 x 4.6 cm). The\npreviously noted pigtail catheter has been pulled back and now appears with\nthe tip just contacting the far lateral most aspect of the peripancreatic\ncollection (02:43).\n\nSPLEEN: Status post lumpectomy.\n\nADRENALS: Right adrenal gland is unremarkable. Left adrenal gland is\nsurgically absent.\n\nURINARY: Status post left nephrectomy. Again seen are subcentimeter renal\nhypodensities, many of which are too small to characterize and likely\nrepresent simple cysts. No perinephric abnormality. No hydronephrosis.\n\nGASTROINTESTINAL: Stomach is nondistended. J-tube again noted. Left lower\nquadrant colostomy is again noted. The previously malpositioned left lower\nquadrant pigtail catheter is coiled within a loop of bowel (02:50) unchanged\nin appearance since prior examination. Rectal stump is unremarkable.\n\nPELVIS: Urinary bladder is unremarkable with single locule of gas, likely from\nrecent instrumentation. Distal ureters are unremarkable. No pelvic free\nfluid.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Patient is status post endovascular repair with open surgical repair\nof endovascular leaks.\n\nPERITONEUM: No interval change in left upper abdominal fluid that tracks\nposteriorly along the left pericolic gutter and is partially contained,\nunchanged in appearance since prior examination. This collection contains few\nfoci of gas and appears to communicate with the peripancreatic collection\n(02:50). Overall this collection measures 9.5 x 4 cm (02:59) (previously 9.4\nx 4 cm).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L5 on S1 with pars defects.\n\nSOFT TISSUES: In the left lower quadrant again seen is a sinus tract extending\nfrom the skin into the peritoneum, unchanged since prior (02:50). Few locules\nof subcutaneous emphysema within the left lateral chest wall have decreased in\nconspicuity since ___. The abdominal and pelvic wall is otherwise\nwithin normal limits.", "output": "1. Malpositioned left lower quadrant pigtail catheter located within small\nbowel loop, unchanged since prior.\n2. No interval change in 9.4 cm left upper abdominal fluid that tracks\nposteriorly and communicates with peripancreatic collection. Mild decrease in\nsize of 6.5 cm peripancreatic fluid collection with pigtail catheter partially\nretracted with tip abutting the far lateral most aspect of the collection. \nCorrelate clinically to confirm that there remains drainage.\n3. Left lower quadrant sinus tract extending from skin to peritoneum." }, { "input": "LOWER CHEST: Small bilateral nonhemorrhagic pleural effusions and adjacent\natelectasis at the lung bases are similar to prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hepatic cysts measuring up to 4.5 cm at the hepatic dome are not\nsignificantly changed. Additional subcentimeter hepatic hypodensities are too\nsmall to characterize, however are not significantly changed from prior,\nlikely representing hepatic cysts or biliary hamartomas. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is atrophic. A fluid collection at the tail of the\npancreas is not significantly changed in size, measuring 6.5 x 3.6 cm,\ncompared with 6.5 x 3.6 cm previously. A drain in the is fluid collection has\nbeen repositioned, with the tip along the more medial aspect of the\ncollection.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right adrenal gland is normal in size and shape. The left\nadrenal gland is surgically absent.\n\nURINARY: Patient is status post left nephrectomy. The right kidney is normal\nin size. Few right renal cysts measuring up to 1.8 cm are not significantly\nchanged. Multiple additional subcentimeter cortical hypodensities are too\nsmall to characterize, however likely represent cysts. No hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: A right lower quadrant J-tube is not significant changed in\nposition. A left lower quadrant ostomy is again noted. A left lower quadrant\npigtail catheter is stable in position, previously seen to be interposed\nbetween small bowel loops in the left lower quadrant, with the tip not within\nthe small bowel on drain check ___. There are no abnormally dilated\nloops of bowel.\n\nThere has been interval placement of a drain in a partially contained left\npericolic gutter fluid collection containing a few foci of air which\ncommunicates with the peripancreatic collection, overall slightly decreased in\nsize, measuring approximately 6.5 x 2.1 cm along the inferior aspect, compared\nwith 8.0 x 3.0 cm previously (601:31).\n\nMultiloculated fluid rim enhancing fluid collections in the right hemiabdomen\nare slightly increased in size. For reference a right anterior fluid\ncollection measures 9.0 x 3.3 cm, compared with 8.4 x 3.2 cm previously. \nFluid tracking more medially is increased, measuring 9.5 x 2.9 cm, compared\nwith 9.2 x 2.9 cm previously (2:51, 57).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains calcification and seminal vesicles\nare normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Patient is status post endovascular repair of an abdominal aortic\naneurysm with open repair of endovascular leaks. The abdominal aortic graft\nappears intact.\n\nBONES: Grade 1 anterolisthesis of L5 on S1 with bilateral pars defects is\nagain noted. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "1. Improved positioning of a drain terminating in a peripancreatic fluid\ncollection status post repositioning.\n2. A left lower quadrant drain is stable in position, previously seen to be\ninterposed between bowel loops, and not terminating within the bowel lumen on\ndrain check on ___.\n3. Interval placement of an additional drain in a left pericolic gutter\ncollection, overall decreased in size.\n4. Interval increase in multiloculated fluid in the right hemiabdomen. Given\nthis increase in fluid in the right hemiabdomen and apparent drainage of tube\nfeeds from the newly placed drain in the left pericolic gutter fluid\ncollection; this suggests an active bowel leak, though the direct nidus of\nleak is not identified on this study without oral contrast." }, { "input": "LOWER CHEST: There is a small left and moderate right-sided pleural effusion.\nPleural effusion on the right slightly increased from prior. There is\nassociated compressive atelectasis at the bases bilaterallyPlease refer to\nseparate report of CT chest performed on the same day for description of the\nthoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Hypodense lesion measuring up to 4.8 cm in the dome of the\nliver is stable from prior and likely represents a cyst or biliary hamartoma. \nAdditional subcentimeter hypodensities of the liver too small to characterize,\nbut likely represent simple cysts. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Pancreas is atrophic. There is slight interval a decrease in size\nof a collection at the pancreatic tail measuring 6.3 x 3.5 cm containing a\ndrain in approaching from the left upper quadrant in stable position. This\ncollection appears to communicate with the infrarenal aortic aneurysm sac and\nthere are small foci of air within the aneurysm sac which are newly visualized\ncompared to prior exam.\n\nSPLEEN: Spleen is surgically absent.\n\nADRENALS: The right adrenal gland is normal in size and shape. The left\nadrenal gland is surgically absent.\n\nURINARY: The right kidney is normal size and shape. The left kidney is\nsurgically absent. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality. A 1.8 cm cyst arises\nfrom interpolar region of the right kidney. A 1.7 cm cyst arises from the\nlower pole the right kidney. Additional subcentimeter hypodensities\nbilaterally are too small to characterize but likely represent cysts.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Visualized\nportions of the colon and rectum are within normal limits.\n\nA right lower quadrant J-tube is in stable position. Left lower quadrant\nostomy is again noted. There is no evidence of bowel obstruction.\n\nThere are 2 drains in the left lower quadrant. The first is in stable\nposition and appears to be interposed between loops of small bowel. The\nsecond left lower quadrant drain appears to have been retracted slightly and\nterminates in a poorly defined collection in the left pericolic gutter\ncontaining foci of air which again appears to communicate with the\nperipancreatic collection and measures approximately 3.6 x 6.9 cm near the\nposition of the drain, and appears larger compared to prior exam.\n\nA new drain approaching from the right upper quadrant terminates in a gas\ncontaining multiloculated fluid collection in the right upper quadrant. An\nanterior component of this collection which the drain terminates in measures\n7.2 x 2.0 cm (5:90), slightly decreased from prior when it measured up to 9.0\ncm. Additional large component of this collection in the right pelvis\nmeasures up to 7.6 cm, previously up to 9.5 cm.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Status post endovascular repair of an abdominal aortic aneurysm. \nAdditional stents are noted in the right common iliac artery, SMA, and right\nrenal artery. Size of the aneurysm sac measuring up to 6.2 cm grossly stable\nfrom prior. There are new locule of air seen within the aneurysm sac (e.g. \n5:90) concerning for fistulous collection of the peripancreatic collection\nwith the aneurysm sac.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L5 on S1 with bilateral pars defects at\nthis level.\n\nSOFT TISSUES: Left upper quadrant ___ ostomy again noted. There are fat\ncontaining umbilical and left inguinal hernias noted.", "output": "1. Stable to slight interval decrease in size of a of a peripancreatic\ncollection with stable position of a left upper quadrant drain terminating\nwithin. New foci of air within the abdominal aortic aneurysm sac is\nconcerning for fistulous collection of the aneurysm sac with this collection.\n2. Interval repositioning of a left lower quadrant drain which terminates in a\npoorly defined collection along the left pericolic gutter which is slightly\nincreased in size compared to prior.\n3. Slight interval decrease in size of multiloculated fluid collections in the\nright hemiabdomen status post placement of a of a right upper quadrant drain\nterminating in an anterior component of this collection.\n4. Stable position of additional left lower quadrant drain interposed between\nbowel loops.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:59 pm, 15 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 4 mm hypoattenuating lesion in the dome of the liver, too small to\ncharacterize, likely a biliary hamartoma or cyst. There is mild intrahepatic\nbiliary ductal dilatation. The patient has undergone interval\ncholecystectomy. No extrahepatic biliary ductal dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen measures at the upper limits of normal, 12.5 cm. No focal\nsplenic lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Borderline splenomegaly.\n2. Trace free fluid in the pelvis of uncertain etiology.\n3. No evidence for intra-abdominal mass or adenopathy to explain the patient's\nsymptoms." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. Trace pericardial fluid likely\nphysiologic. There is no evidence of pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low homogenous attenuation throughout\nconsistent with fatty liver. In segment 8 of the liver, there is a hypodense\nlesion measuring 1.4 x 2.4 cm with peripheral nodular enhancement compatible\nwith a hemangioma unchanged from ___ (2; 11). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged measuring 14.6 cm (2; 18). It is normal\nin attenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis. 6 mm hypodensity at the left upper pole is too small to be\ncharacterized but is unchanged from ___ (2; 32). There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nare however scattered retroperitoneal lymph nodes which have enlarged since\n___, for example on aortocaval node measures 9 mm in short axis (02:46),\npreviously 7 mm. A 8 mm short axis right common iliac node (2:65) had\npreviously measured 5 mm. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes noted in the lower lumbar spine. 1.4 cm\nhemangioma noted in T12 vertebral body, similar to prior.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No acute intra-abdominal pathology to explain patient's abdominal pain. \nThe appendix is normal.\n2. Though not pathologically enlarged by size criteria, there has been\ninterval enlargement retroperitoneal lymph nodes since ___ of uncertain\netiology.\n3. Fatty liver.\n4. Mild splenomegaly.\n5. Small hiatal hernia." }, { "input": "Heart size is normal without significant pericardial fluid. 6 mm nodule in the\nlateral basal segment of the left lower lobe is unchanged compared to ___. Another 6 mm nodule in the posterior basal segment of the left lower\nlobe is new (07:30). Right lung base is clear.\n\nCT abdomen with and without contrast:\n\nPostsurgical changes from left hepatic lobectomy with multiple clips and\nmarkers in place. Surrounding fat stranding adjacent to the surgery bed is\nlikely postsurgical. Punctate hypodensity in the right hepatic lobe is\nunchanged, too small to fully characterize but likely representing a cyst.\nResidual right hepatic lobe enhances homogeneously without any lesion or\nbiliary dilatation. Portal vein is patent. Postsurgical changes from the\nhepatic jejunostomy without obstruction.\n\nSpleen pancreas an the adrenal glands are normal. Mild thickening of the left\nadrenal gland without frank nodularity. Several bilateral renal hypodensities\nare redemonstrated. 18 mm right interpolar renal lesion is a dense, likely\nrepresenting a hemorrhagic cyst. Additional dense lesion measuring 14 mm in\nthe left upper pole kidney also likely representing a hemorrhagic cyst. Some\nof these hypodensities are too small to fully characterize but likely\nrepresent cysts. 23 mm hypodensity in the right lower pole kidney measures\nsimple density. Kidneys otherwise present symmetric nephrograms and extrusion\nof contrast without suspicious lesion or hydronephrosis.\n\nStomach, duodenum and small bowel loops are otherwise normal caliber without\nevidence of obstruction. Large bowel is thin-walled and unremarkable without\npericolonic fat stranding or fluid collection.\n\nThe abdominal aorta is normal caliber with moderate calcified and noncalcified\natherosclerotic plaque burden. Note made of 3 renal arteries on the right. No\nascites or pneumoperitoneum. No frank ventral abdominal hernia. Scattered\nmesenteric and retroperitoneal lymph nodes are not pathologically enlarged.\n\nCT pelvis with contrast:\n\nBladder, seminal vesicles and rectum are unremarkable. Prostate is enlarged\nmeasuring 52 mm in greatest transverse dimension with fiducial markers in\nplace. No free pelvic fluid or air. Inguinal and pelvic sidewall lymph nodes\nare not pathologically enlarged.\n\nBones and soft tissues:\n\nNo suspicious focal bone lesion.", "output": "1. No evidence of abdominopelvic recurrence or metastasis.\n\n2. 6 mm nodule in the posterior basal segment of the left lower lobe,\nuncertain significance, but likely new.\n\n3. Stable 6 mm nodule in the lateral basal segment of the left lower lobe.\n\n4. Several bilateral renal cysts, some hemorrhagic, as above.\n\n5. Enlarged prostate with fiducial markers.\n\nRECOMMENDATION(S): Recommend dedicated chest CT for more detailed evaluation\nof the chest given new left lower lobe nodularity and known history of\nmalignancy." }, { "input": "CT ABDOMEN: Heart size is normal without significant pericardial fluid. 6 mm\nnodule in the lateral basal segment of the left lower lobe is unchanged\ncompared to ___. Another 6 mm nodule in the posterior basal segment of\nthe left lower lobe is stable from ___ (series 3, image 2). The\nright lung base is clear. There is no pleural effusion.\n\nPostsurgical changes from left hepatic lobectomy with multiple clips and\nmarkers in place. Punctate hypodensity in the right hepatic lobe is unchanged,\ntoo small to fully characterize but likely representing a cyst. Multiple foci\nof arterial hyper enhancement are seen throughout the right hepatic lobe,\nincluding in segment 5 (series 4, image 30), segment 6 (series 4, image 30),\nsegment 8 (series 4, image 10). These foci were not clearly seen on the prior\nexam and a equalize so on the portal venous phase. Residual right hepatic\nlobe enhances homogeneously without any lesion or biliary dilatation. Portal\nvein is patent. Postsurgical changes from the hepatic jejunostomy without\nobstruction.\n\nThe pancreas demonstrates two hypodensities in the pancreatic tail measuring 8\nand 5 mm respectively (series 6, images 30 and 33). These are not\nsignificantly changed compared with prior exam a likely represents a small\nside branch is IPMNs. The spleen and adrenal glands are normal. Mild\nthickening of the left adrenal gland without frank nodularity are stable.\nSeveral bilateral renal hypodensities are redemonstrated. 18 mm right\ninterpolar renal lesion is a dense, likely representing a hemorrhagic cyst.\nAdditional dense lesion measuring 14 mm in the left upper pole kidney also\nlikely representing a hemorrhagic cyst. Some of these hypodensities are too\nsmall to fully characterize but likely represent cysts. 23 mm hypodensity in\nthe right lower pole kidney measures simple density. Kidneys otherwise present\nsymmetric nephrograms and extrusion of contrast without suspicious lesion or\nhydronephrosis.\n\nStomach, duodenum and small bowel loops are otherwise normal caliber without\nevidence of obstruction. Large bowel is thin-walled and unremarkable without\npericolonic fat stranding or fluid collection. The abdominal aorta is normal\ncaliber with moderate calcified and noncalcified atherosclerotic plaque\nburden. 3 renal arteries are seen in the right. No ascites or\npneumoperitoneum. Although there is no frank abdominal wall hernia there is\ndiastases of the rectus sheath with presence of small bowel into the defect.\nScattered mesenteric and retroperitoneal lymph nodes are not pathologically\nenlarged.\n\nCT PELVIS: Bladder, seminal vesicles and rectum are unremarkable. Prostate is\nenlarged\nmeasuring 5.2 cm in greatest transverse dimension with fiducial markers in\nplace. No free pelvic fluid or air. Inguinal and pelvic sidewall lymph nodes\nare not pathologically enlarged.\n\nOSSEOUS STRUCTURES: No suspicious focal bone lesion.", "output": "1. Foci of arterial hyper enhancement that equalize in the portal venous\nphase are nonspecific and may represent foci of transient hepatic attenuation\ndifference. However, recurrence of disease cannot be excluded. Further\nassessment with contrast enhanced MRI is recommended.\n\n2. No evidence of distal metastasis.\n\n3. 6 mm nodules in the left lower lobe are not significantly changed from\nprior. As previously recommended, it chest CT could be perform for further\nevaluation of metastatic disease in the thorax.\n\n4. two hypodensities in the pancreatic tail measuring 8 and 5 mm respectively\n(series 6, images 30 and 33). These are not significantly changed compared\nwith prior exam a likely represents a small side branch IPMN's.\n\n5. Several bilateral renal cysts, some hemorrhagic, as above.\n\n6. Enlarged prostate with fiducial markers." }, { "input": "LOWER CHEST: Please refer to the dedicated CT chest report from the same day\nfor a description of the thoracic findings, including pulmonary nodules in the\nleft lung.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is post left hepatectomy and hepaticojejunostomy,\nwith placement of fiducial seeds. A tiny subcapsular hypodensity in the right\nlobe is too small to accurately characterize on CT but may represent a\nhemangioma or cyst, unchanged (series 6, image 130). The liver otherwise\ndemonstrates homogenous attenuation throughout all phases. No enhancing\nlesion on the delayed images. No vascular distortion or parenchymal capsular\nretraction. No evidence of concerning focal lesions. There is no\nintrahepatic bile duct dilation. No pneumobilia. The gallbladder is\nsurgically absent. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Mild thickening of the left adrenal gland is unchanged (series 6,\nimage 118). The right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nMultiple, bilateral renal cortical lesions, some of intermediate density, are\nunchanged and likely cysts and cysts with debris/hemorrhage. No concerning\nfocal renal lesions or hydronephrosis. No perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status-post hepaticojejunostomy. The stomach\nis unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. No bowel obstruction, free air, or fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate as mildly enlarged and contains fiducial\nseeds, unchanged.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic disease is\nnoted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild diastasis of the anterior abdominal wall with\nprotrusion of the entire mesenteric border of small bowel without definite\nloss of the peritoneal lining (series 6, image 125, 152). Otherwise,\nabdominal and pelvic wall is within normal limits.", "output": "1. Post left hepatectomy and hepaticojejunostomy. No evidence of local\nrecurrence or metastatic disease. No intrahepatic bile duct dilation.\n2. Mild prostatomegaly.\n3. Please refer to the dedicated CT chest report from the same day regarding\nintrathoracic findings." }, { "input": "LOWER CHEST: Partially visualized enhanced opacifications in the right lung\nbase represents atelectasis trace right pleural effusion. Mild dependent\natelectasis on the left.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular liver contour consistent with known cirrhosis. Status\npost cholecystectomy. No suspicious arterially enhancing lesion. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis surgically absent. Moderate volume ascites. There is conventional hepatic\nanatomy with early bifurcation of the proper hepatic artery resulting in a\nvery short proper hepatic artery.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly with the spleen measuring 15.8 cm. Subcentimeter\nhypodensity in the lateral aspect of the spleen is too small to characterize.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Scattered colonic\ndiverticula. The colon and rectum are within normal limits. The appendix is\nnot visualized. Fluid and fat containing right inguinal hernia.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple upper abdominal retroperitoneal lymph nodes measuring up\nto 1.2 cm are likely reactive. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Gastroesophageal, splenorenal varices are noted. Recanalized\numbilical vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cirrhotic liver morphology with sequela of portal hypertension including\nsplenomegaly, ascites, varices.\n2. Conventional hepatic anatomy with early bifurcation of the proper hepatic\nartery resulting in a very short proper hepatic artery.\n3. Subsegmental airspace opacity in the right lung base with trace right\npleural effusion represent atelectasis.\n4. Liver volumes will be calculated by the imaging lab and will be added and\nthis is an addendum." }, { "input": "LOWER CHEST: Tiny right lower lobe pulmonary nodules measure up to 4 mm\n(02:16). Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. No\nright-sided hydronephrosis. There is a 2 mm nonobstructing right lower pole\nrenal calculus (601:61). There is mild stranding about the left kidney. \nThere is mild pelviectasis of the left kidney without evidence of overt\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The bladder is collapsed limiting its evaluation. A 3 mm distal left\nureteral stone is seen near the UVJ (2:159). No convincing evidence of\nhydroureter. There is mild soft tissue stranding about the course of the left\nureter. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: 3 mm of retrolisthesis of L5 on S1 (602:82). There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 4 mm distal left ureteral stone is with upstream mild fullness of the left\ncollecting system and left ureter. Associated left perinephric and\nperiureteral stranding.\n2. Nonobstructing 2 mm right lower pole renal calculus.\n3. 4 mm right lower lobe pulmonary nodules. No further follow-up is\nrecommended, please see ___ guidelines below.\n\nRECOMMENDATION(S):\n For incidentally detected nodules smaller than 6mm in the setting of an\nincomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is mildly distended\nwithout CT evidence inflammatory change.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post esophagectomy and gastric\npull-up. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. High-density material is noted within the large bowel\nfrom previous barium ingestion during an upper GI study. There are scattered\ncolonic diverticula without evidence of acute diverticulitis.\n\nPELVIS: The urinary bladder is mildly distended. Gas within the bladder lumen\nis likely related to recent catheterization. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPars interarticularis defects at L5, bilaterally (602:36, 42)\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute process within the abdomen and pelvis. Postoperative changes as\ndescribed." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA small subcentimeter hypodensity is seen in the lower pole of the left\nkidney, too small to characterize. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post esophagectomy with gastric\npull-through. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is normal. No fistulous connection is seen between the\ngastrointestinal tract and vascular structures. A jejunostomy tube is noted\n(02:46).\n\nPELVIS: The urinary bladder is collapsed around a Foley balloon. Small free\nfluid is seen in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No fistulous connection between the gastrointestinal tract and vascular\nstructures.\n2. No acute findings in the abdomen or pelvis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. Heart size is enlarged. Note is\nmade of moderate to severe coronary artery and aortic valvular calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic with multiple calcifications. There is an\nincompletely characterized cystic lesion within the pancreatic head measuring\n2.6 x 3.6 cm. Likely additional cystic lesion noted in the uncinate process\nand body measuring approximately 1.4 x 1.6 and 1.8 x 1.8 cm respectively. \nThere is no peripancreatic abnormality.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Hypodense lesions are\nnoted in the bilateral kidneys which are consistent with simple cysts. The\nlargest is in the interpolar left kidney measuring 4.3 cm. There is no\nhydronephrosis. Nonobstructing stones are seen in the left kidney with the\nlargest in the upper pole measuring 0.3 cm. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is no hiatal hernia. There is no bowel obstruction. \nNote is made of thickening of the rectum circumferentially with surrounding\nstranding. There is diffuse diverticular disease. There is no\nintra-abdominal free air or free fluid.\n\nPELVIS: There is a Foley catheter within a partially distended urinary\nbladder. Note is made of urinary bladder wall thickening. There is no free\nfluid in the pelvis. There is nonspecific presacral edema.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is an age indeterminate compression deformity of the L3 vertebral\nbody. There are multilevel degenerative changes of the lumbar spine most\npronounced at L5-S1 where there is mild retrolisthesis. No worrisome bony\nlesion is seen. Multiple healed lower left-sided rib fractures are noted.\n\nSOFT TISSUES: There is a small amount of intermediate density ill-defined\nfluid/stranding at the level of the iliac crest on the left without\nwell-formed hematoma. Largest area of fluid measures approximately 1.9 x 2.6\ncm. Small right superficial soft tissue nodularity is likely the site of\ninjections. There is no retroperitoneal hematoma.", "output": "1. Stranding and a small amount of high density fluid in the left flank at the\nlevel of the iliac crest, which may likely represents a small amount of blood\nproduct in the setting of ecchymosis. No well-formed hematoma. No evidence\nof retroperitoneal hematoma.\n2. Circumferential thickening of the rectum with surrounding fat stranding,\nconcerning for proctitis.\n3. Mild bladder wall thickening, while findings could be due to\nunderdistention, recommend correlation with urinalysis.\n4. Incompletely characterized pancreatic cystic lesions for which non emergent\nMRCP is recommended for further evaluation if clinically indicated.\n5. Indeterminate mild compression deformity of the L3 vertebral body.\n6. Chronic left lower rib fractures.\n\nRECOMMENDATION(S): Nonemergent MRCP if clinically indicated." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Heart is mildly enlarged and\nextensive coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Spleen is borderline enlarged, but otherwise unremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape. 1.2\ncm hypodense nodule in the medial limb left adrenal gland is unchanged from\n___.\n\nURINARY: Bilateral kidneys are markedly atrophic. A 1.5 cm lesion arising\nfrom the upper pole of the left kidney has density measurements in compatible\nwith a simple cyst, and is unchanged in size compared to ___. There are\npunctate calcifications throughout both kidneys, likely tiny stones, without\nobstruction (series 2, image 42). There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. No adnexal abnormalities are\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is a fusiform infrarenal abdominal aortic aneurysm measuring\nup to 3.0 cm, unchanged. Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. No CT findings correlating to the reported history of vomiting. No bowel\nobstruction.\n3. 3.0 cm infrarenal abdominal aortic aneurysm.\n4. Cholelithiasis.\n5. Nonobstructing bilateral nephrolithiasis." }, { "input": "LOWER CHEST:\nImaged lung bases are clear aside from mild dependent atelectasis. There is a\nsub 4 mm nodule in the posterior aspect of the right lower lobe (5:5, which is\nunchanged from ___. The heart is moderately enlarged with scattered coronary\nartery calcification. No pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver is homogeneous in attenuation with 4 punctate\nhypodense lesions in hepatic segments II, III, V, VIII, which are too small to\ncharacterize but statistically likely represent cysts. The gallbladder is\nwithin normal limits, without stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen is normal in size in attenuation with a small accessory\nspleen.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The right kidney is normal in enhancement and excretion of contrast.\nThere is a simple cyst at the midpole of the right kidney with layering milk\nof calcium. No right-sided hydronephrosis. Left kidney demonstrates a delayed\nnephrogram and poor contrast enhancement compared to the right kidney, with\nmulticystic appearance of the renal pelvis in keeping with severe\nhydronephrosis. The ureter is nondilated, and this goes along with a history\nof UPJ obstruction. Since ___, the degree of urinary dilatation\nhas progressed. In comparison to the prior MRI urogram from ___, the\ndegree of the hydronephrosis has also increased.\nGASTROINTESTINAL: Distal esophagus and stomach are normal in caliber. Small\nbowel is unobstructed. The appendix is air-filled and normal. Large bowel\ndemonstrates scattered diverticula, without evidence of diverticulitis.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\nUrinary bladder is thin walled with a diverticulum posteriorly (5:90). \nProstate and seminal vesicles are normal. There is no pelvic lymphadenopathy\nor free fluid.\n\nBONES AND SOFT TISSUES:\nThere is grade 1 anterolisthesis of L5 on S1 with bilateral pars defects and\nsevere endplate sclerosis. Multilevel degenerative changes of the lumbar spine\nare noted with vacuum disc phenomenon a Schmorl's node at the superior aspect\nof the L3 vertebral body. No concerning osseous lesions are seen.", "output": "1. Since the prior genitourinary imaging from ___, interval progression of\nleft hydronephrosis as result of UPJ obstruction, previously thought to be due\nto a crossing vessel. There is thinning and asymmetrical hypoenhancement of\nthe left renal cortex, and a delayed left-sided nephrogram, all in keeping\nwith a hypofunctioning left kidney.\n2. Simple cyst at the midpole of the right kidney with layering milk of\ncalcium.\n3. Scattered hepatic hypodensities are too small to characterize, likely\nrepresenting cysts.\n4. Sub 4 mm right lower lobe pulmonary nodules unchanged from ___ and\nwarrants no further followup.\n5. Severe degenerative changes L5-S1 with grade 1 anterolisthesis and\nbilateral pars defects." }, { "input": "LOWER CHEST:\n\nModerate bilateral nonhemorrhagic pleural effusions are noted, right greater\nthan left, with adjacent passive atelectasis (2:1). Dense atherosclerotic\ncalcifications are present in the coronary arteries (2:4).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver has an unremarkable noncontrast appearance, with no\nintra or extrahepatic biliary ductal dilatation. The gallbladder contains\nmultiple tiny layering hyperdense stones (02:34), with no evidence of\ngallbladder wall thickening or pericholecystic fluid to suggest cholecystitis.\nPANCREAS: The pancreas is somewhat atrophic, but otherwise has a normal\nnoncontrast appearance.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are lobulated contour, with a small stone in the\ninterpolar right kidney (02:43). 13 mm exophytic intermediate density cysts\nextending from the lower pole of the right kidney (02:48) are unchanged,\nlikely hemorrhagic cysts.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. A large stool ball is present in the\nrectum (2:78), distending it up to 8.4 cm in axial diameter. The appendix is\nwell visualized the right lower quadrant, and is normal (02:52)\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ncalcium burden is noted in the intra-abdominal and pelvic arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. Numerous phleboliths\nare present in the pelvis. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Extensive degenerative changes are\nnoted throughout the lumbar spine. Diffuse soft tissue anasarca is present,\nbut no soft tissue defect compatible with reported stab wound is identified,\npossibly beyond the imaged field of view. Calcifications in the left gluteal\nsoft tissues are likely due to prior injections (2:70).", "output": "1. Reported left flank stab wound is not visualized, likely beyond the imaged\nfield of view. No evidence of traumatic abdominal or pelvic injury.\n2. Bilateral moderate nonhemorrhagic pleural effusions, with adjacent\natelectasis.\n3. Extensive atherosclerotic disease, including the coronary arteries, as well\nas the abdominal and pelvic arteries.\n4. Layering calcified gallstones, with no specific CT evidence of\ncholecystitis.\n5. Large stool ball in the rectum.\n6. Punctate interpolar right renal stone. Likely hemorrhagic exophytic left\nlower pole renal cysts are unchanged since ___, but could be further\nevaluated with dedicated renal ultrasound non urgently if clinically\nindicated." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged measuring 13.7 cm in SI dimension.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nSmall bowel loops are normal in caliber without focal wall thickening. There\nis moderate stool burden but no focal colonic wall thickening or dilation. \nThe appendix is well-visualized and normal. There is no intra-abdominal free\nfluid or free air.\n\nPELVIS: There is a Foley catheter in a decompressed bladder. Air within the\nbladder is likely from instrumentation. Trace pelvic free fluid is likely\nphysiologic\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Mild splenomegaly." }, { "input": "LOWER CHEST: Mild dependent bibasilar atelectasis seen. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a punctate calcification in segment 4 of the liver likely a\ngranuloma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nPatient is status post partial nephrectomy of the left kidney. There are 2\nleft kidney cysts, 1 in the interpolar region measuring 1.2 x 1.4 cm\n(previously measuring 1.0 x 0.8 cm) and the other in the lower pole measuring\n1.3 x 1.2 cm (previously measuring 1.1 x 0.7 cm). There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or pelvic findings to correlate with patient's\nsymptoms.\n2. Benign renal cysts not significantly changed compared with prior MR and CT\nimaging." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Subcentimeter\nhypodensities bilaterally too small to characterize. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Oral contrast extends the level of the\ncecum. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a vertical postsurgical incision along the anterior\nabdominal wall. Along the inferior aspect of this incision there is a gas and\nfluid containing collection that measures 1.6 x 3.0 x 4.3 cm collection which\ndoes not appear to extend intra-abdominally. Ventral abdominal wall hernia\nrepair material is noted.", "output": "1. No evidence of small-bowel obstruction.\n2. 4.3 x 3.0 x 1.6 cm subcutaneous gas and fluid collection subjacent to the\ninferior aspect of the vertical abdominal incision. No evidence of\nintra-abdominal extension." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.\n\nLOWER CHEST: Minimal atelectasis is noted in the left lung base. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a lobulated area of\nasymmetric thickening along the medial wall of the second part of the duodenum\n(series 3 image 59) which extends from the level of the ampulla, proximally\ninto the first part of the duodenum, measuring up to 1.1 cm in thickness and\nextending approximately 6 cm in length the second part of the duodenum (series\n5, image 43) with further slight extension into D1. No extramural invasion\nis seen.\nThere is a hypoattenuating nonenhancing fat density focus measuring 1.6 x 1 cm\nin the medial wall of the second part of the duodenum. (Series 3, image 51).\nThere is a small duodenal diverticulum arising from D2. Sutures are noted in\nthe mid small bowel most consistent with previous small bowel surgery.\nThe rest of the small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There are scattered colonic diverticula throughout\nthe large bowel without evidence of acute diverticulitis. The colon and\nrectum are otherwise within normal limits.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains multiple\nnonobstructing gall bladder calculi without evidence of acute cholecystitis.\n\nPANCREAS: There is mild fatty replacement of the pancreas. No evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and both ovaries appear normal however, there\nis a 2.2 cm septated cyst in the left adnexal region that is separate from the\nleft ovary. The appearance is suggestive of a paraovarian cyst, if clinically\nindicated further characterization with ultrasound is recommended.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are noted in the thoracolumbar spine\n\nSOFT TISSUES: There is a fat containing umbilical hernia. There are multiple\nsubcentimeter metallic densities within the subcutaneous tissues in the right\ngluteal region which may be a sequelae of previous injury.", "output": "1. Asymmetric thickening along the medial wall of the second part of the\nduodenum extending into the first part of the duodenum may correspond to the\nabnormality identified on the recent EGD. No evidence of extramural invasion\nor regional lymphadenopathy.\n2. Septated left paraovarian cyst. Ultrasound characterization is\nrecommended.\n3. Small fat containing umbilical hernia.\n\nRECOMMENDATION(S): Consider ultrasound of the pelvis for further\ncharacterization of the left pelvic cyst." }, { "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 3.5 cm\nLocation (head right of SMV, body left of SMV): head/neck\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent\nBiliary tree abrupt cutoff with or without upstream dilatation: absent\n\nArterial evaluation\n\nSMA involvement: present\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: Present, proximally\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: present\nSolid soft-tissue contact: >180\u00b0\nIncreased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity: present\n\nCommon hepatic artery involvement: present\nSolid soft-tissue contact: >180\u00b0\nIncreased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity: present\nExtension to celiac axis: present\nExtension to bifurcation of right/left hepatic artery: present\n\nVariant anatomy: Small accessory left hepatic artery arising from the left\ngastric artery.\nVariant vessel contact: present\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\n\nVenous evaluation\n\nMPV involvement: Present\nDegree of solid soft-tissue contact: >180\u00b0\nDegree of increased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\npresent, marked focal narrowing of the portosplenic confluence, unchanged\n\nSMV involvement: present\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein: absent\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: suspicious\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\n\nVASCULAR:\n\nNo abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries. The celiac axis, SMA, arteries\ncommon arteries are patent. There is marked focal narrowing at the confluence\nof the main portal and splenic veins. The portal vein, SMV, and splenic veins\nare patent. Gastroepiploic collaterals remain. The pancreatic mass encases\nthe celiac axis, including the common and proper hepatic artery, left gastric\nartery, and proximal splenic artery. The mass also encases the right and left\nhepatic arteries. The degree of vascular encasement is overall unchanged\ncompared to CTA of the abdomen/pelvis from ___.\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: A 12 mm hypoenhancing lesion in segment II of the liver is new\nsince the prior CTA of the abdomen/pelvis from ___, concerning for\nmetastasis and interval disease progression (series 3, image 150). A punctate\nhypodensity in the right hepatic lobe segment VIII is too small to accurately\ncharacterize and is unchanged compared to multiple prior exams (series 3,\nimage 106). No evidence of intrahepatic or extrahepatic biliary ductal\ndilation. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS: A hypoenhancing, irregular contoured mass centered in the pancreatic\nhead/neck is overall similar in size compared to the prior exam, measuring 3.5\nx 1.6 cm (series 3, image 128). The overall involvement of adjacent vessels\nis similar to the prior exam, details above in the pancreatic cancer table and\nvascular section. The upstream main pancreatic duct remains dilated up to 9\nmm with associated atrophy of the pancreatic parenchyma in the body and tail.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of stones, focal renal lesions, or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. No\nbowel obstruction.\n\nRETROPERITONEUM: No evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No evidence\nof pelvic or inguinal lymphadenopathy. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient has had prior TAH-BSO.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. The lucent\nlesion in the T9 vertebral body is unchanged from multiple prior exams.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New 12 mm left hepatic segment II hypoenhancing lesion suspicious for\nmetastasis.\n2. Overall unchanged 3.5 cm hypoenhancing pancreatic head/neck mass with\nvascular involvement as detailed above.\n\nNOTIFICATION: The findings impression were discussed with ___,\nM.D., the referring physician requesting ___, by ___, M.D. on the\ntelephone on ___ at 8:55 am, 5 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Small bilateral pleural effusions with associated atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hypodensities are seen throughout the liver, new from\nprior CT, concerning for metastatic disease, the largest of which measures 2.4\nx 2.4 x 2.4 cm in segment III (04:20). There is moderate intrahepatic biliary\ndilation. A biliary duct stent is in place. There is a small amount of\nleft-sided pneumobilia. The gallbladder is distended, without wall\nthickening. A single dependent stone is noted in the fundus. There is a\nsmall to moderate amount of ascites.\n\nPANCREAS: In ill-defined hypoenhancing mass in the pancreatic head/neck is\nagain seen, difficult to measure, though approximately 2.6 x 1.7 cm (06:13),\npreviously 2.5 x 1.6 cm. Vessel involvement is difficult to assess due to\nbolus timing, though there is apparent involvement of the main portal vein and\nSMV, with more significant narrowing compared to prior, encasement of the\nceliac axis with poor visualization of the branching vessels, and at least 180\ndegree encasement of the SMA.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The lesser sac of the stomach abuts the hepatic lesions in\nthe left lobe, with loss of fat plane. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. There is a large amount\ncolonic stool. The appendix is not visualized. Omental nodularity is noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Gastric varices are again noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Increase of ill-defined hypoenhancing lesion in the pancreatic head/mass,\ndifficult to directly compare to prior given differences in technique, though\nthere is extensive vascular involvement with increased narrowing of the main\nportal vein and SMV, and encasement of the celiac axis with attenuation of the\ncommon hepatic, left gastric, and proximal splenic arteries.\n2. Multiple hypodensities throughout the liver are new from prior, concerning\nfor metastatic disease. There is loss of fat plane between the lesser sac of\nthe stomach and a large hepatic lesion in the left lobe.\n3. Distended gallbladder, without wall thickening, as seen on prior\nultrasound. Of note, the gallbladder fundus extends down nearly to the level\nof the iliac crest, which may localize pain to the right lower quadrant.\n4. Moderate volume ascites and omental nodularity is concerning for\ncarcinomatosis.\n5. Large fecal load." }, { "input": "LOWER CHEST: Please refer to CT chest dictated separately by the thoracic\nradiology service per\n\nABDOMEN: There are multiple hypodense lesions throughout the liver some of\nwhich are compatible with metastatic disease, for example measuring 1.4 cm in\nthe right hepatic lobe and multiple smaller ones throughout the left hepatic\nlobe, all unchanged from ___. While there is diffuse metastatic\nliver disease, there are a few intrahepatic lesions that could represent\nintra-abdominal collections or biloma is given the rapid growth compared to\n___, previous cholangitis and the presence of a CBD stent (series\n4, images 64 and 58). There is expected pneumobilia.\n\nAgain seen are findings are concerning for perforated acute cholecystitis\nwithout focal contained perforation at the fundus and new peripancreatic and\nperiduodenal fluid collections measuring up to 3.4 cm, concerning for bilomas.\n\nThe pancreatic mass measuring up to 4.6 cm with similar vascular involvement\nof the celiac, common hepatic and SMA is again seen. No significant change in\nsize and appearance, previously up to 4.5 cm. Similar severe attenuation of\nthe portal splenic confluence with numerous gastroepiploic collaterals, as on\nprior.\n\nModerate splenomegaly is again seen. The apparent new hypodense lesion in the\nhilum of the spleen, compared to prior is likely due to timing of the contrast\nthrough the spleen, amenable to reassessment on routine exams.\n\nProminence of the right renal collecting system is unchanged. The kidneys and\nadrenal glands are unremarkable.\n\nGASTROINTESTINAL: No intestinal obstruction. A small amount of ascites is\nunchanged. Similar haziness of the omentum.\n\nPELVIS: Hysterectomy changes are again noted.\n\nLYMPH NODES: Stable peripancreatic and periportal adenopathy measuring up to\n1.3 cm on series 4, image 71.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: Similar well-defined lucent iliac lesions\ndating back to ___, for instance on series 4, image 92 and image 91. No\naggressive osseous lesions are seen.", "output": "1. No change in metastatic pancreatic cancer compared to ___. \nGiven the presence of the CBD stent and cholangitis, some of the lesions in\nthe liver measuring water density could represent bilomas.\n2. Evolution of perforated cholecystitis with new fluid collections, likely\nbilomas, inferior to the gallbladder and adjacent to the duodenum.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:07 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hypoattenuating lesions throughout the liver are not\nsignificantly changed from prior, and are compatible with metastatic disease. \nSome of these lesions may represent bilomas. A metallic CBD stent is again\nnoted, with pneumobilia seen, left greater than right, compatible with stent\npatency.\n\nRe-demonstration of findings concerning for perforated acute cholecystitis\noriginating from the gallbladder fundus. Several perihepatic and periduodenal\nfluid collections measure up to 4.7 cm (2:13), and are mildly bigger. These\nmay represent bilomas, however infection cannot be excluded. The large\nperiduodenal fluid collection mass effect on the adjacent second portion of\nthe duodenum, however there is no significant gastric distention to suggest\nobstruction.\n\nPANCREAS: An ill-defined pancreatic head mass is similar to prior. Its\nindistinct borders making precise measurement difficult. Vascular involvement\nof the celiac, common hepatic and superior mesenteric arteries are similar to\nprior. Again seen is severe narrowing of the portal splenic confluence and\nmain portal vein, similar to prior.\n\nSPLEEN: The spleen is top-normal in size and shows normal attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. A right extrarenal pelvis is again seen.\n\nGASTROINTESTINAL: There is no gastrointestinal obstruction. Small free\nintra-abdominal fluid and diffuse haziness of the mesenteric fat is similar to\nprior.\n\nPELVIS: The bladder is decompressed. There is small free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is post hysterectomy. No adnexal masses are\nseen.\n\nLYMPH NODES: Peripancreatic and periportal lymphadenopathy measuring up to 1.2\ncm (02:25) is unchanged. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Multiple abdominal varices are again noted.\n\nBONES: There are no aggressive appearing osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Diffuse\nanasarca is similar to prior. There is a 1.8 x 1.0 cm fluid pocket in the\nleft rectus femorals muscle (2:78), new from prior, which may represent\nhematoma or abscess.", "output": "1. Compared to ___, overall unchanged appearance of metastatic\npancreatic cancer, as detailed above.\n2. Re-demonstration of perforated cholecystitis with mildly bigger fluid\ncollections in the right upper quadrant. These may represent bilomas, however\ninfection of the collections cannot be excluded.\n3. New 1.8 cm fluid pocket in the left rectus femoris muscle may represent\nhematoma or abscess.\n4. No gastrointestinal obstruction." }, { "input": "LOWER CHEST: Small bilateral pleural effusions with adjacent compressive\natelectasis are unchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. Mild\nperiportal edema is unchanged. Compared to prior study, the gallbladder is\nincreasingly distended with persistent wall thickening. The right lateral\npercutaneous cholecystostomy drainage catheter has been withdrawn, now with\ntip curled in the hepatic parenchyma. The right hepatic lobe fluid collection\nis not well visualized on the current study, however, it appears to have\nincreased in size measuring approximately 3.8 x 1.8 cm, previously 2.7 x 1.5\ncm (04:22).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Re-demonstrated is a\n6.0 cm partially exophytic cyst arising from the left midpole, which contains\na single calcified septation. Additional hypodense cysts in the left midpole\nand lower pole are unchanged. There is no evidence of focal renal lesions\nwithin the limitations of an unenhanced scan. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Re-demonstrated is a small hiatal hernia. Visualized small\nbowel loops demonstrate normal caliber and wall thickness. The visualized\ncolon is unremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild-to-moderate multilevel degenerative changes are again noted.\n\nSOFT TISSUES: There is mild subcutaneous edema in the flanks.", "output": "1. The percutaneous cholecystostomy drain has been pulled back, now with tip\nlying in the hepatic parenchyma. There has been subsequent increase in\ngallbladder distension as well as size of the right hepatic lobe fluid\ncollection.\n2. Unchanged small bilateral pleural effusions with adjacent compressive\natelectasis.\n\nNOTIFICATION: The findings were discussed with Dr. ___, by ___\n___, M.D. on the telephone on ___ at 7:15 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple left-sided renal hypodensities are too small to characterize but\nlikely cysts. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended with gastric contents. Small bowel\nloops are normal in caliber and wall thickness, though appear diffusely\nfluid-filled. The colon and rectum are within normal limits. The appendix is\nnot discretely visualized, and suture material is noted within the right lower\nquadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Numerous loops of fluid-filled small bowel without overt dilation or focal\nwall thickness. Findings may suggest gastroenteritis.\n2. Normal gallbladder. Nonvisualized appendix with suture material in the\nright lower quadrant suggests prior appendectomy." }, { "input": "Heart size is normal. The imaged lung bases are clear.\n\nCT abdomen with contrast: The liver enhances homogeneously without focal\nlesion, intra or extrahepatic biliary ductal dilatation. There is small amount\nof intermediate density perihepatic ascites. There is no associated capsular\nhyperenhancement. The gallbladder is unremarkable. The portal vein is patent.\nThe spleen, pancreas and adrenal glands are unremarkable. The kidneys present\nsymmetric nephrograms and excretion of contrast without focal lesion,\npelvocaliceal dilatation or perinephric abnormality.\n\nThe stomach, duodenum and remainder of the small bowel is unremarkable without\nevidence of obstruction. The large bowel is mostly collapsed and grossly\nunremarkable. The appendix is not definitively visualized though there is no\nsecondary evidence for appendicitis.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment.\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size\ncriterion. There is small intermediate density ascites mainly pooling around\nthe liver with the majority of fluid within the pelvis. There is no\npneumoperitoneum or abdominal wall hernia. There is no organizing fluid\ncollection.\n\nCT pelvis with contrast: There is re-demonstration of an IUD within the uterus\nwhich was characterized as malpositioned on the same day ultrasound\nexamination. The ovaries were better characterized on CT examination. The\novaries are not definitively characterized on CT examination. The bladder and\nrectum are unremarkable. There is no inguinal or pelvic sidewall\nlymphadenopathy by CT size criterion.\n\nOsseous structures: There is no suspicious focal osseous lesion.", "output": "1. Small amount of intermediate density ascites/ free pelvic fluid with\nmajority of the fluid centered on the pelvis. Density of this fluid is\ncompatible with hemorrhage. Given negative pregnancy test, this may be\nsecondary to a ruptured corpus luteum cyst. .\n2. Malpositioned IUD within the lower uterine segment as characterized on same\nday ultrasound." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent. \nTrace free fluid is seen around the liver.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Trace free fluid is seen around the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. Multiple small foci\nat of intraperitoneal air is seen which is most likely secondary to\npostoperative changes for focal bowel perforation cannot be completely\nexcluded though no bowel edema or drainable fluid collections are seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple small foci of subcutaneous free air is seen compatible\nwith recent history of laparoscopic cholecystectomy.", "output": "Multiple small foci of subcutaneous and free intraperitoneal air, centered on\nthe right, with trace free fluid around the liver, spleen and within the\npelvis that is felt to most likely be secondary to postoperative changes\nhowever underlying bowel perforation cannot be completely excluded. No focal\nsites of bowel wall edema or drainable fluid collections are seen.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 3:34 pm, 5 minutes after discovery of\nthe findings." }, { "input": "CHEST: A small left and trace right pleural effusion are noted. The visualized\nlung bases do not have any focal consolidation or pneumothorax. The visualized\nheart is unremarkable. .\n\nABDOMEN:\n\nHEPATOBILIARY: The liver continues to have a 3.5 x 3.0 x 4.2 cm hypodensity\nwithin segment VII, similar to ___ (5:58, 7:39). Previously this\narea showed peripheral enhancement on ___, consistent with a\nhemangioma. No other focal hepatic lesions are noted. The hepatic veins and\nportal veins appear patent. The gallbladder is unremarkable. There is no\nevidence of gallstones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions or hydronephrosis.\n\nBOWEL: The stomach is minimally distended and unremarkable. The small bowel\ncontains oral contrast and distended without a transition point. The remaining\nlarge bowel contains stool and rectal contrast. No extraluminal oral or rectal\ncontrast is seen that would suggest anastomotic leak. There is a mild amount\nof intraabdominal free fluid.\n\nRETROPERITONEUM: No pathologically enlarged mesenteric or retroperitoneal\nlymph nodes are enlarged by CT size criteria. A 5.0 x 2.4 x 3.7 cm air-fluid\ncollection in the left anterior subcutaneous tissues is concerning for abscess\nformation (5:52, 8:30). This air-fluid level likely corresponds with the\nacoustic shadowing seen on ultrasound that was concerning for a synthetic\nmaterial.\n\nVASCULAR: The abdominal aorta does not have aneurysmal dilatation and its\nmajor branches are patent.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis. A\ncalcified fibroid is again noted.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.", "output": "1. 5.0 x 2.4 x 3.7 cm air-fluid collection in the left abdominal subcutaneous\ntissues c/w abscess formation.\n\n2. No evidence of anastomotic leak. Trace right and small left pleural\neffusion.\n\nNOTIFICATION: Findings were discussed with Dr. ___ by Dr. ___\ntelephone at 4:20 ___ on ___ immediately following review." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No focal consolidations. There is\nno evidence of pleural or pericardial effusion. Pacemaker leads are partially\nimaged.\n\nABDOMEN:\n\nHEPATOBILIARY: Please note the liver dome is not completely imaged. \nSubcentimeter hypodensity within the liver is too small to characterize\n(series 2, image 15), but likely represents a cyst or biliary hamartoma,\nunchanged since ___. Few calcified granulomas. Otherwise, the liver\ndemonstrates homogenous attenuation throughout. There is no evidence of solid\nlesions. The gallbladder is surgically absent. There is mild central\nintrahepatic biliary dilatation, which is likely related to post\ncholecystectomy state. There is no extrahepatic biliary dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Numerous calcified granulomas are seen within the spleen. The spleen\nshows normal size and attenuation throughout, without evidence of focal\nlesions.\n\nADRENALS: Stable left adrenal adenoma, as characterized on the CT dated ___. The right adrenal gland is normal in appearance.\n\nURINARY: Two simple cysts are seen within the left kidney measuring up to 1.5\ncm. Additional subcentimeter hypodensities within the kidneys bilaterally are\ntoo small to characterize, but also likely represent simple cysts. Otherwise,\nthe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of enhancing renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is mild wall thickening affecting the ascending and\ndescending colon diffusely, which may be due to underdistention, or may\nreflect mild colitis. There are a few colonic diverticuli, however the wall\nthickening is not focal to anyone of these. There are mildly prominent\nfluid-filled loops of small bowel with air-fluid levels, which is nonspecific,\nbut may reflect enteritis. There is no small bowel wall thickening. There is\nno evidence of obstruction. The bowel wall enhances normally throughout. \nThere is no evidence of pneumatosis or pneumoperitoneum. There are no focal\nfluid collections. The appendix is not definitively identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small volume\nfree fluid within the pelvis, likely reactive (series 601b, image 38).\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Moderate degenerative changes are seen throughout the lumbar spine with\nmoderate dextroconvex scoliosis. There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia. Otherwise, the abdominal\nand pelvic wall is within normal limits.", "output": "1. Mild wall thickening affecting the ascending and descending colon\ndiffusely, which may be due to underdistention, or may reflect mild colitis. \nThere also multiple prominent fluid-filled loops of small bowel with air-fluid\nlevels, which is nonspecific, but may reflect enteritis. These findings may\nbe inflammatory or infectious in nature. No evidence of ischemia. No\nevidence of obstruction.\n2. Small volume free fluid within the right hemipelvis, likely reactive.\n3. Stable left adrenal adenoma." }, { "input": "LOWER CHEST: Trace left pleural effusion is improved from prior exam. \nPreviously seen right pleural effusion is resolved. There is a 5 mm right\nlower lobe nodule, unchanged from prior exam. Right middle lobe granuloma is\nalso stable. There are calcifications of the right pulmonary artery. There\nis no pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nSeveral hypodense lesions throughout the liver are unchanged and likely\nrepresent cysts or biliary hamartomas. The largest in the caudate measures\n1.8 cm. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Innumerable simple\ncysts throughout bilateral kidneys are grossly stable since prior exam. This\nincludes two hyperdense cysts in the interpolar region of the left kidney and\nthe lower pole of the right kidney both stable since at least ___,\ncompatible with a hemorrhagic cyst. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L4 on L5. There are degenerative changes\nof bilateral sacroiliac joints. Right femur fracture with intramedullary nail\nis again noted. There is heterotopic calcification posteriorly and medially\naround the right hip.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is\nswelling of the muscles of the proximal left thigh. Previously seen swelling\nand fat stranding around the right thigh muscles has resolved.", "output": "1. No lymphadenopathy in the abdomen or pelvis.\n2. Swelling of the proximal left thigh muscles better evaluated on concurrent\nCT of the left lower extremity." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nNumerous cysts/biliary hamartomas are noted throughout the liver. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Multiple hypodense\nlesions are seen throughout the kidneys bilaterally previously characterized\nas cysts. There is no hydronephrosis. There is no nephrolithiasis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There has been interval improvement in upper abdominal and\nretroperitoneal lymphadenopathy compared to prior examination for example\ninteraortocaval lymph node on series 3, image 72 currently measures up to 13\nmm in short axis diameter, previously 23 mm. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nNumerous foci of osseous hypermetabolic activity seen on prior PET exam do not\nhave correlate on today's imaging.\n\nSOFT TISSUES: Embolization clips are noted in the right retroperitoneum with\nstranding related to prior hematoma.", "output": "1. No CT findings to explain patient's sepsis/bacteremia.\n2. Interval improvement in upper abdominal and retroperitoneal adenopathy when\ncompared to prior examination. Chronic findings as above.\n3. Please see to separate chest CT report for chest findings." }, { "input": "LOWER CHEST: Bilateral nonhemorrhagic pleural effusions, greater on the right\nare moderate in size, slightly decreased compared to the prior exam. \nAssociated homogeneously enhancing mild parenchymal opacities is consistent\nwith relaxation atelectasis, more pronounced on the left. Detailed evaluation\nof the parenchyma is limited secondary to respiratory and cardiac motion\nartifact. A 5-mm right lower lobe pulmonary nodule is unchanged (series 2,\nimage 5). Bilateral centrilobular ground-glass opacities with interlobular\nseptal thickening is most likely edema, similar to the prior exam. A\npericardial effusion is small. The heart is mildly enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hepatic hypodensities are too small to accurately\ncharacterize on CT, but overall appear similar in size and distribution to\nlesions characterized as cysts or biliary hamartomas on prior MR. ___ liver\nsurface contour is smooth. No evidence of concerning focal hepatic lesions. \nNo evidence of intrahepatic or extrahepatic biliary dilatation. Hyperdense\nmaterial within the gallbladder is likely stones (series 601b, image 26). No\npericholecystic fluid collections or wall thickening.\n\nPANCREAS: There is uneven lipomatosis of the pancreatic head and uncinate, a\nnormal variant. The pancreas has normal attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation. No peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNumerous bilateral renal cortical hypodensities were previously characterized\nas cysts on prior MR. ___ largest cyst in the right kidney measures up to 5 cm\nin the upper pole (series 2, image 19). The largest cyst in the left kidney\nis exophytic and measures up to 8.3 cm in the lower pole (series 601b, and\nimage 36). No concerning focal renal lesions. No obstructing renal stones. \nNo hydronephrosis. No perinephric fluid collection.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nfecalization of the terminal ileum which is nonspecific and could reflect\nileocecal valve incompetence or slow transit. No bowel obstruction. There is\nsuggestion of mild colonic wall edema and minimal mucosal hyper enhancement,\nalthough most of the large bowel is underdistended. Surrounding fat stranding\nand prominence of the pericolonic vessels is slightly more compared to the\nprior exam. These findings could suggest mild pancolitis. No pneumatosis or\nintra-abdominal fluid collection. No free air. Colonic diverticulosis is\nmost pronounced in the sigmoid colon. There is mild wall thickening and edema\nin the rectum compatible with proctitis.\n\nPELVIS: The urinary bladder is moderately distended and grossly unremarkable. \nThe distal ureters are unremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is normal in size.\n\nLYMPH NODES: No pelvic sidewall or inguinal lymphadenopathy. Scattered\nretroperitoneal lymph nodes have minimally decreased in size compared to the\nprior exam, the largest include a 1-cm aortocaval node (series 2, image 25)\nand a 7-mm left paraaortic node (series 2, image 27). An 11-mm lymph node in\nthe region of the hepatic hilum is unchanged (series 2, image 21).\n\nVASCULAR: No abdominal aortic aneurysm. Extensive atherosclerotic disease is\nnoted. The splenic artery arises directly from the abdominal aorta (series 2,\nimage 14). Embolization coils are noted within the right gonadal artery,\nunchanged.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Multilevel\ndegenerative changes of the visualized spine is moderate. Sclerotic lesion in\nthe left iliac is likely a bone island, unchanged (series 2, image 40). Mild\nanterolisthesis of L4 on L5 is unchanged, likely degenerative. Mild\nbroad-based disc bulges at L2-L3 and L3-L4 are unchanged without critical\nspinal canal stenosis.\n\nSOFT TISSUES: Embolization clips in the right retroperitoneum with stranding\nare related to prior hematoma, since treated.", "output": "1. Moderate bilateral, right greater than left nonhemorrhagic pleural\neffusions with minimal adjacent compressive atelectasis, slightly improved\nfrom the prior exam.\n2. Persistent mild pulmonary edema. No focal pneumonia.\n3. Proctitis. Possible diffuse mild colonic wall thickening and adjacent\nstranding which may reflect mild pan colitis, however findings could be\nrelated to underdistention of bowel.\n4. Colonic diverticulosis.\n5. Cholelithiasis.\n6. Retroperitoneal lymphadenopathy appears minimally decreased from the prior\nexam." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no pleural or\npericardial effusion. Moderate atherosclerotic calcifications are noted in\nthe mitral valve and coronary arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis a large duodenal diverticulum. Diverticulosis of the colon is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is an acute anterior superior endplate fracture at L1 with mild adjacent\nsoft tissue stranding (602:76). No significant loss of vertebral body height.\nNo bony retropulsion or malalignment. There is no focal hematoma.\nMild-to-moderate degenerative changes of the lower thoracic and lumbar spine\nare also present.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute compression deformity of L1, without retropulsion or malalignment.\n2. Moderate hiatal hernia.\n\nNOTIFICATION: The findings were discussed with ___, M.D. and\n___, M.D. by ___, M.D. in person on ___ at 10:30 pm,\n60 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are innumerable hypodense hepatic lesions consistent with metastases. \nCompared to the prior study the lesions have slightly decreased in size, for\nexample a lesion in hepatic segment IV previously measured 3.2 x 3.6 cm and\nnow measures 3 x 3.3 cm (4; 51), and a lesion in hepatic segment VII\npreviously measured 3.9 x 3.6 cm and now measures 3.4 by 3 cm (4; 58). There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is decompressed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 7.5 mm accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ncircumferential wall thickening of the ascending colon extending to the\niliocolic valve with surrounding mesenteric fat stranding. There is wall\nthickening of the terminal ileum, which may be secondary to infectious or\nischemic ileitis, or tumor involvement, although the colonic lesion does not\nappear to be contiguous and there is no evidence of obstruction. There is an\noblong area of stranding, less well defined on the prior study, which may\nrepresent evolving omental infarct or small focus of tumor (4; 84). The\nappendix is normal.\n\nPELVIS: The urinary bladder is decompressed. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. There is a 5.2 x\n3.3 cm left adnexal cyst and a 2.2 x 1.8 cm right adnexal cyst (4; 99, 109).\n\nLYMPH NODES: There are mildly prominent retroperitoneal nodes with some\nadjacent stranding however, these lymph nodes do not meet size criteria for\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is a 1.5 cm lucent lesion with a sclerotic rim in the right\nilium. There is a sclerotic lesion in the T6 vertebral body. There is a 1.1\ncm sclerotic lesion in the left sacrum (___). New sclerotic metas or occult\nlesions that have become more sclerotic following treatment. degenerative\nchanges are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in size of innumerable hypoattenuating hepatic\nmetastases.\n2. Interval development of osseous sclerotic lesions, which may represent\nmetastases or occult lesions that have become sclerotic following treatment.\n3. Persistent wall thickening of the ascending colon extending to the\nileocolic valve and adjacent stranding. Wall thickening of the terminal\nileum, which may be secondary to tumor involvement or an infectious or\nischemic ileitis.\n4. Stable bilateral adnexal cysts can further characterized with pelvic\nultrasound or MR.\n___. Please see the separate report from the same day CT chest for intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nInnumerable hypodense metastatic lesions are re-demonstrated though are\nsmaller when compared to prior study for example a segment IV lesion measures\n2.0 x 2.0 cm (07:19), previously measuring 3.3 x 3.0 cm, and a segment VIII\nhepatic lobe lesion measures 2.5 x 2.2 cm (07:27), previously measuring 3.0 x\n3.4 cm. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is a recanalized umbilical vein suggestive of sequelae of\nportal hypertension. The gallbladder is decompressed though contains a\ngallstone or polyp without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged measuring up to 13.7 cm, previously 13 cm, with\nnormal attenuation throughout, and without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is re-demonstration of\nfocal wall thickening of the ascending colon with heterogeneous\nhyperenhancement and adjacent soft tissue in the mesentery consistent with\nknown malignancy. Terminal ileum is now normal. The remaining small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe remaining colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. There is\nre-demonstration of right adnexal cystic lesion that measures 2.0 x 1.8 cm\n(5:109) which previously measured 2.2 x 1.8 cm, and a left adnexal cystic\nlesion that measures 5.0 x 2.8 cm (5:101), which previously measured 5.2 x 3.3\ncm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There are perigastric varices but no definite esophageal varices.\n\nBONES: Sclerotic lesions of the right ilium measuring 1.5 cm (5:102), the left\nsacrum measuring 1.2 cm 5:92), and T6 vertebral body measuring 1.2 cm, are\nless discrete but appears similar in size to prior, and may reflect treatment\nchanges. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Continued interval decrease in size of innumerable hepatic metastases with\nmultiple osseous metastases that are stable in size though less discrete on\ntoday's study, likely reflective of treatment changes.\n\nPersistent ascending colonic malignancy extending into adjacent mesentery as\nbefore. Resolution of terminal ileal abnormality.\n\nPortal hypertension is evidenced by recanalization of umbilical vein,\nperigastric varices, and splenomegaly , though no morphologic cirrhotic liver\nchanges are evident. This may be secondary to sinusoidal injury from prior\noxaliplatin therapy.\n\nUnchanged bilateral adnexal cystic lesions which can be further assessed with\npelvic ultrasound as clinically indicated.\n\nPlease refer to same-day CT chest for characterization of thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Innumerable metastatic lesions are re-demonstrated throughout\nthe hepatic parenchyma. In comparison to the prior exam there has been a mixed\nresponse as some lesions appear smaller while others are definitively larger.\nFor example, a lesion in hepatic segment VIII today measures 4.2 x 3.8 cm,\npreviously 1.5 x 1.4 cm (2:39). In addition, there is likely interval\ndevelopment of new lesions, for example in hepatic segment V (2:69). There is\nno definite evidence of intrahepatic or extrahepatic biliary dilatation. \nThere is interval development of a small volume of ascites. There is a\nrecanalized periumbilical vein, compatible with portal hypertension. The\ngallbladder is decompressed, there is likely a calcified gallstone within the\ngallbladder lumen.\n\nPANCREAS: Pancreas demonstrates normal attenuation throughout. There is no\nevidence of focal lesion or pancreatic ductal dilatation. No evidence of\nperipancreatic stranding.\n\nSPLEEN: The spleen is enlarged, measuring up to 14.2 cm, previously 13.8 cm. \nThere is normal parenchymal attenuation throughout without evidence of\nconcerning focal lesion.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: Kidneys are of normal and symmetric size. The nephrogram is\nunremarkable. There is no evidence of hydronephrosis. No evidence of\nconcerning focal renal lesion. There is no perinephric stranding. Incidental\nnote is made of a circumaortic left renal vein.\n\nGASTROINTESTINAL: The stomach is unremarkable although not well assessed on\nCT. Oral contrast is seen within the distal aspect of the small bowel as well\nas the ascending and transverse colon. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. Re-demonstrated is a focal area\nof wall thickening within the ascending colon with associated mesenteric soft\ntissue stranding, findings compatible with patient's known malignancy. There\nis thickening of the terminal ileum which may be secondary to local extension.\nThe focal thickening in the ascending colon is more conspicuous on today's\nexam in comparison to the prior which may be secondary to luminal distension\nby oral contrast. However, the degree of mesenteric stranding does appear\nintervally increased. The appendix is unremarkable.\n\nPELVIS AND REPRODUCTIVE ORGANS: The urinary bladder is decompressed. The\ndistal ureters are unremarkable. There is new simple appearing fluid within\nthe pelvis. There is an enlarged, fibroid uterus. There is a 1.6 x 1.3 cm\nright adnexal cystic lesion, previously measuring 1.8 x 2.0 cm. In addition,\nthere is a left adnexal cystic lesion measuring 5.8 x 2.8 cm, previously 5.0 x\n2.8 cm.\n\nLYMPH NODES: No evidence of retroperitoneal or mesenteric lymphadenopathy. No\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: No evidence of abdominal aortic aneurysm. Mild calcified\natherosclerotic disease is noted.\n\nBONES: A sclerotic lesion in the right ilium is larger in comparison to the\nprior exam, today measuring up to 1.0 cm, previously 0.5 cm (2:92). There is a\n1.5 cm sclerotic lesion within the right acetabular roof, similar in\nappearance in comparison to the prior exam (2:100). There is a similar\noverall appearance of the known sclerotic lesion at the level of T6.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. In comparison to the prior exam dated ___, there has been an\noverall mixed treatment response. Innumerable metastatic lesions are seen\nwithin the hepatic parenchyma, some of which are smaller in comparison to the\nprior while others are definitively larger and there is probable interval\ndevelopment of additional lesions.\n2. Focal thickening within the ascending colon with associated mesenteric\nstranding is more prominent in comparison to the prior study, although a\ncomponent of this appearance may be secondary to imaging technique.\n3. Interval growth of a sclerotic bony lesion in the right ilium.\n4. There has been interval development of a small volume of ascites. There are\nadditional signs of portal hypertension as evidenced by a recanalization of\nthe umbilical vein and splenomegaly.\n5. Stable interval appearance of bilateral adnexal cystic appearing lesions.\n6. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Innumerable hepatic metastases are again seen, some of which\nappear stable from the prior exam, for example a 2.2 cm right hepatic lobe\nlesion (4:64), previously 2.0 cm, and a 2.2 cm hepatic dome lesion (04:33),\npreviously 2.1 cm. Some metastatic lesions appear larger, for example lesions\nwithin the right hepatic lobe measuring approximately 5.5 cm (04:37),\npreviously 5.0 cm, and 3.5 cm (04:45), previously 2.8 cm. There is no\ndefinite evidence of intrahepatic or extrahepatic biliary dilatation. Ascites\nhas increased since the prior study, and is now large in volume. The\ngallbladder is decompressed.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The bilateral adrenal glands are unremarkable.\n\nURINARY: A subcentimeter hypodensity within the interpolar right kidney is too\nsmall to characterize. Otherwise, the bilateral kidneys are unremarkable.\n\nGASTROINTESTINAL: No evidence of bowel obstruction. Focal wall thickening and\nheterogeneous enhancement of the ascending colon and the terminal ileum are\nagain seen, appearing similar to prior, compatible with the patient's treated\ncolonic malignancy.\n\nPELVIS: The bladder is unremarkable. Large volume ascites, as described\nabove.\n\nREPRODUCTIVE ORGANS: The known, fibroid uterus is grossly unchanged from\nprior. A high density lesion of the left adnexa measures 4.5 x 3.5 cm\n(4:105), previously 5.8 x 2.8 cm. The right adnexa appears unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: Sclerotic lesions of the right ilium measure 1.6 cm (4:95), previously\n0.9 cm, and 1.7 cm (4:102), previously 1.5 cm. A 0.8 cm sclerotic lesion of\nthe left sacral ala appears stable. Heterogeneous, mixed sclerotic lesions of\nthe left ilium measuring up to 1.6 cm (4:88, 4:93) appear new. A 1.4 cm mixed\nsclerotic lesion of the L5 vertebral body (4:84) appears new.\n\nSOFT TISSUES: Diffuse subcutaneous edema, most prominent within the anterior\nabdominal wall.", "output": "1. Stable to mild interval worsening of innumerable hepatic metastases and\nworsening of ascites. Stable primary colonic mass without bowel obstruction.\n2. Probable worsening of osseous metastatic disease, as evidenced by new mixed\nsclerotic lesions of the left ilium and L5 vertebral body and an interval\nincrease in size of known sclerotic lesions.\n3. No significant change in a high density left adnexal lesion.\n4. Please refer to the separate report of the chest CT performed on the same\nday for intrathoracic characterization." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Enlargement of the right\ndiaphragmatic crus compared to the left with adjacent fat stranding tracking\nalong the inferior vena cava concerning for diaphragmatic injury without focal\ncollection, defect, or frank herniation.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Mild stranding about the infra hepatic inferior vena cava likely\ntracks from the diaphragmatic injury.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nWell-corticated density anterior to the superior endplate of the L4 vertebral\nbody is compatible with a congenital limbus vertebra (602; 68). Sclerotic\nfocus in the left anterior aspect of the L9 vertebral body, likely a bone\nisland.\n\nSOFT TISSUES: Bilateral small inguinal hernias containing fat are noted. \nThere is prior repair of an umbilical hernia with mesh.", "output": "1. Enlargement of the right diaphragmatic crus compared to the left with\nadjacent fat stranding concerning for right diaphragmatic injury without\ndiaphragmatic defect, fluid collection or herniation.\n2. No acute fracture in the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is 1.9 cm right hepatic lobe hypodensity which is indeterminate though\nlikely represents a hepatic cyst versus biliary hamartoma. There are several\nadditional subcentimeter hypodensities throughout the liver which are too\nsmall to characterize though likely represent hepatic cysts versus biliary\nhamartomas. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains sludge without wall thickening or\nsurrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1 cm right lower pole renal cyst. Scattered areas of cortical\nthinning likely due to scarring noted bilaterally. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening or fat\nstranding. The appendix is normal.\n\nPELVIS: Beam hardening streak artifact from right hip arthroplasty limits\nevaluation of the lower pelvis though the bladder appears within normal\nlimits. The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is a right hip hemiarthroplasty with associated surgical hardware\nand heterotopic ossification about the right hip prosthesis. There is a well\ncorticated 1.6 cm lucency in the left lateral acetabulum which likely\nrepresents cystic changes from degenerative disease of the left hip. \nMultilevel degenerative changes are visualized throughout the imaged portion\nof the thoracolumbar spine without evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.", "output": "1. No acute intra-abdominal process, no findings to explain patient's\nsymptoms.\n2. Gallbladder sludge without evidence of acute cholecystitis.\n3. Diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: Bilateral pulmonary nodules are seen in the lung bases measuring\nup to 4 mm on the left (2:13). There is a small to moderate dependent,\nlayering, nonhemorrhagic right pleural effusion with associated atelectasis. \nPatient is status post CABG.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic biliary dilatation. The common\nbile duct is prominent measuring up to 12 mm (601:29). The gallbladder is\nwithin normal limits.\n\nPANCREAS: The pancreas appears atrophic. There is a focal cystic lesion\nadjacent to the pancreatic head and neck, which is not fully characterized on\nthis exam (2:35). There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys appear atrophic. There is a 4 mm radiopaque density in\nthe left lower renal pole, likely nonobstructive renal stone (02:38). \nMultiple hypodense lesions are seen scattered over the bilateral kidneys, with\nthe largest measuring up to 4.4 cm in the left lower renal pole. \nAdditionally, there are multiple hyperdense lesions along the right kidney,\nwith the largest measuring 1.2 cm hyperdense lesion along the interpolar\nregion, which is not completely characterized on this exam (02:38). There is\nno perinephric abnormality or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Moderate fecal loading is seen\nthroughout the colon. The appendix is not well visualized. The rectum is\nunremarkable.\n\nPELVIS: The urinary bladder is significantly distended. There is no distal\nhydroureter. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Patient is status post anterior fusion of the T10 to S1 vertebral\nlevel. There are extensive degenerative changes along the visualized spine\nand bilateral hips. Cortical irregularities along the lower left ribs likely\nrepresent chronic rib fractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 4 mm radiopaque density in the left lower renal pole likely represents\nnonobstructive renal stone. No hydronephrosis.\n2. Significantly distended urinary bladder. Recommend correlation with\nclinical exam for urinary retention.\n3. 2.2 cm cystic lesion is seen abutting the pancreatic head and neck, not\ncompletely evaluated on this exam. This could represent a large side branch\nIPMN.\n4. Bilateral pulmonary nodules, measuring up to 4 mm.\n5. Small to moderate dependent, layering, nonhemorrhagic right pleural\neffusion with associated atelectasis.\n6. Multiple hyperdense lesions along the right renal cortex, measuring up to\n1.2 cm, are incompletely characterized on this exam.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nA dedicated MRCP can be obtained in 6 months if clinically desired.\nNonurgent renal ultrasound could be considered for further evaluation of renal\nlesions, which are likely hemorrhagic or proteinaceous cysts." }, { "input": "LOWER CHEST: Tiny area of scarring or atelectasis at the left base. There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are multiple,\nbilateral, well-circumscribed, fluid-attenuation lesions in the kidneys that\nlikely reflect simple cysts and are slightly increased in size compared to the\nprior examination from ___. The largest right renal cyst measures\n3.6 cm and is located in the upper pole and the largest left renal cyst\nmeasures 4.4 cm and is located in the lower pole. There is no hydronephrosis.\nThere is no nephrolithiasis or ureterolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The cecum is anterior on the right. The appendix is normal\nand is located in the right lower quadrant adjacent to a loop of bowel.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles appear unremarkable\nwithin the limitations of unenhanced CT technique.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post partial laminectomy at L1. There are mild degenerative\nchanges of the lumbar spine.\n\nSOFT TISSUES: Bilateral inguinal hernias are reidentified, with the right\ninguinal hernia containing fat and the anterior portion of a loop of small\nbowel and the left inguinal hernia containing a segment of sigmoid colon that\nextends into the scrotal sac. There is no adjacent fat stranding.", "output": "1. No evidence of nephrolithiasis, ureterolithiasis, or appendicitis. No\nother CT findings in the abdomen or pelvis to correlate with reported\nsymptoms.\n2. Bilateral inguinal hernias are reidentified. The left inguinal hernia\ncontains a short segment of sigmoid colon and the right inguinal hernia\ncontains the anterior portion of a loop of small bowel, without acute\ncomplication evident.\n3. Multiple, bilateral renal cysts.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 3:59 ___, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Rounded hypodensity in the medial\nright breast is suggestive of fat necrosis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys are markedly atrophic in keeping with long standing\nrenal failure. Patient is status post right lower quadrant renal transplant\nwithout evidence of hydronephrosis, nephrolithiasis, or focal lesion in the\ntransplanted kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post bilateral hip total arthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute process in the abdomen or pelvis." }, { "input": "LOWER CHEST: Mild basal dependent atelectasis. The imaged portion of the\nheart is unremarkable. No pleural or pericardial effusions seen.\n\nABDOMEN: Unenhanced appearance of the liver, gallbladder, pancreas, and spleen\nis normal. Adrenals are normal bilaterally. Native kidneys are markedly\natrophic. Abdominal aorta is moderately calcified and normal in caliber. No\nadenopathy, free air or free fluid. The stomach is decompressed. The\nduodenum is normal.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. No\nsecondary signs of appendicitis. The colon is unremarkable. Fecal loading is\nmild. No free air or free fluid. Transplant kidney in the right lower\nquadrant is unremarkable and better assessed on same-day renal transplant\nultrasound. Uterus is atrophic. No adnexal masses seen. Urinary bladder is\nonly partially distended though appears normal.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nBilateral total hip arthroplasties are noted without evidence of gross\ncomplication.\n\nSOFT TISSUES: A tiny fat containing supraumbilical hernia is noted.", "output": "No acute findings." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are markedly atrophic bilaterally in keeping with\nhistory of chronic renal failure. The left ureter again exits from the\nsuperior pole of the kidney with slight dilation, unchanged in appearance over\nseveral years. A right lower quadrant renal transplant is again noted. There\nis no evidence of focal renal lesions within the limitations of an unenhanced\nscan. There is no hydronephrosis. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: Evaluation of the pelvis is limited due to beam hardening artifact\nfrom adjacent bilateral hip replacements. Within these limitations, the\nvisualized portion of the urinary bladder and distal ureters are unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate multilevel degenerative changes throughout the\nthoracolumbar spine. Re-demonstrated is mild loss of height of the T10 and\nT11 vertebral bodies, similar to prior. Bilateral hip arthroplasty is again\nnoted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of nephrolithiasis. No acute intra-abdominal or intrapelvic\nprocess. Unremarkable appearance of right lower quadrant transplant kidney. \nAtrophic native kidneys, as before with slightly ectatic proximal left ureter\nstable for many years." }, { "input": "Lungs: Tiny bilateral pleural effusions are seen, slightly worse compared to\npreviously. There is associated subsegmental atelectasis.\n\nLiver: The liver is homogeneous with a smooth contour. A tiny hypodensity seen\nin segment 5, too small to characterize, but likely a cyst or biliary\nhamartoma. No suspicious liver lesion.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder is collapsed.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Small hypodensities are seen right kidney, too small to characterize,\nbut likely cortical cysts. The left kidney is unremarkable. Small caliceal\nhyperdensities are seen in both kidneys, which could be due to contrast. There\nis no hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable.\n\nGastrointestinal: The distal tip of the enteric tube terminates in the gastric\nfundus.\n\nThere is dilatation of small bowel up to 6.9 cm. There is probably a\ntransition point in the right hemiabdomen, suggestive of persistent high-grade\nobstruction.\n\nPrevious right hemicolectomy. Oral contrast, probably from a previous CT scan,\nis seen just upstream of the ileocolic anastomosis. The colon is collapsed\nafter the anastomosis. No evidence of a volvulus.\n\nVascular: There are no atherosclerotic calcifications of the abdominal aorta.\n\nThe portal vein and hepatic veins are patent.\n\nLymph nodes: There are no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion. Surgical skin\nstaples are seen midline.", "output": "1. Small bowel dilated up to 6.9 cm up to the ileocolic anastomosis, with\nprobable transition point within the right hemiabdomen, which could represent\npersistent high-grade obstruction. Recommend repeat imaging without oral and\nIV contrast to reassess progression of the oral contrast.\n\n2. Mild to moderate free fluid in the pelvis as before, with worsening\nenhancement of the peritoneum, suggestive of peritonitis.\n\n3. Tiny bilateral pleural effusions are seen, slightly worse compared to\npreviously.\n\nRECOMMENDATION(S): Recommend repeat imaging without oral and IV contrast to\nreassess progression of the oral contrast." }, { "input": "LOWER CHEST: There are bilateral pleural effusions, moderate in size. Slight\nhyperdensity of the interventricular septum implying underlying anemia. The\nleft ventricle is slightly increased in size. Heavy atherosclerotic\ncalcification of the coronary arteries.\n\nThere is atelectatic change noted at the lung bases, underlying pneumonia\ncannot be completely excluded.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is slightly nodular in appearance. This may be due\nto underlying cirrhosis, although no other findings suggestive of cirrhosis\nare identified. Clinical correlation is recommended.\n\nNo suspicious hepatic lesions seen.\n\nThe patient is status post cholecystectomy.\n\nPANCREAS: The pancreas is atrophic but otherwise unremarkable.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are shrunken and atrophic. A 1.5 cm simple cyst\nis noted arising from the left kidney.\n\nA transplant kidney seen within the right pelvis, which is almost completely\ncalcified, compatible with chronic rejection.\n\nA second transplant kidney is seen within the left lower quadrant. There is a\ntiny gas bubble noted within 1 of the renal calices. There is no significant\ninflammatory change surrounding the left pelvic transplant kidney, no other\nsigns of active inflammatory process. This may represent some refluxed air\nfrom the bladder. Emphysematous pyelonephritis is felt unlikely.\n\nGASTROINTESTINAL: High-grade small bowel obstruction is noted with transition\npoint at the mid jejunal level. A second transition point is noted at the D\n4/proximal jejunal level, which has a twisting appearance. These findings are\nconcerning for closed loop obstruction. In addition, there is inflammatory\nchange in mesenteric congestion noted surrounding the distended bowel loops,\nhighly concerning for ischemia. The distended small bowel loops also\ndemonstrate wall thickening and hyperdense appearance, although it should be\nnoted that many of the collapsed small bowel loops also demonstrates slightly\nhyperdense walls, making this finding somewhat less specific.\n\nA small hiatal hernia is noted. Uncomplicated sigmoid diverticula are also\nseen.\n\nPELVIS: Small gas bubble is seen within the bladder, likely related to prior\ninstrumentation.\n\nLarge testicular hydroceles are noted. A 1 cm hyperdense nodule is seen\nwithin the right inferior scrotum adjacent to the testicle, may represent a\nhemorrhagic epididymal cyst.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: Sclerotic bony endplate changes are noted within the\nvertebral body compatible with renal osteodystrophy. There are no suspicious\nbony lesions or fractures. The abdominal and pelvic wall is within normal\nlimits.", "output": "1. High-grade small bowel obstruction with 2 closed loop appearance and\nassociated mesenteric congestion and edema surrounding the obstructed small\nbowel; appearance is concerning for early ischemia.\n2. Slight nodular liver contour which may imply underlying cirrhosis. No\nsecondary signs of cirrhosis are identified. Recommend clinical correlation.\n3. Moderate bilateral pleural effusions.\n\nNOTIFICATION:\nFindings discussed over the telephone with Dr. ___ by Dr. ___ on ___ at 00:20, 1 minutes after they were made." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions within the limits of noncontrast study. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: Again seen are multiple cystic structures within the pancreas, the\nlargest measuring 3.2 x 3.8 cm in the pancreatic tail, consistent with\npatient's known diagnosis of VHL. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is no hydronephrosis bilaterally. Patient is status post\nright partial nephrectomy at the right lower pole since prior MRI. There is\na soft tissue density exophytic nodule with connection to the right renal\nparenchyma measuring 1.3 (AP) x 1.5 (TV) x 1.4 (SI) mm abutting the right\nnephrectomy bed, which is new since the last exam in ___. There is a\nsuggestion of hypodensity within the midpole of the left kidney measuring up\nto 1.1 cm, adjacent to the spleen, likely corresponding with the known renal\ncell carcinoma.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process, no findings to explain patient's\nsymptoms. No hydronephrosis or renal stones bilaterally.\n2. New exophytic nodule measuring up to 1.5 cm in the right nephrectomy bed,\nsuspicious for recurrence versus new renal cell carcinoma given patient's\nclinical history.\n3. Suggestion of hypodensity in the midpole of the left kidney measuring to\n1.1 cm likely corresponding with the known left renal cell carcinoma.\n4. Similar appearance of multiple cystic lesions in the pancreas, measuring up\nto 3.8 cm, consistent with patient's known diagnosis of VHL.\n\nRECOMMENDATION(S): Renal MRI for further characterization of exophytic soft\nadditional nodule on the right.\n\nNOTIFICATION: The findings and recommendations were discussed by Dr. ___\nwith Dr. ___ on the telephone." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis. No pleural effusion.\n\nABDOMEN: The liver, pancreas, spleen, adrenal glands and kidneys are\nunremarkable. There is no biliary ductal dilatation.\n\nGASTROINTESTINAL: There is a large hiatal hernia. No bowel obstruction. \nDiverticulosis of the sigmoid colon is noted with focal fatty stranding and\nwall thickening in the distal sigmoid colon compatible with acute\ndiverticulitis. The appendix is not visualized.\n\nPELVIS: There is no free fluid in the pelvis. Patient is post supracervical\nhysterectomy. No adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "Acute sigmoid diverticulitis. No abscess." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Again seen is a heterogeneously enhancing mass arising\nfrom the left ovary. This measures 7.5 cm AP by 5.9 cm transverse, not\nsignificantly changed.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "7.5 cm heterogeneously enhancing left ovarian mass, without evidence for\nmetastatic disease in the abdomen and pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The patient is status post\ncholecystectomy. ___ tube is present, extending into the left main\nbiliary duct. There is no evidence of fluid collection in the gallbladder\nfossa. Intrahepatic duct dilatation is improved. Extrahepatic bile duct\ndilatation has also slightly decreased, now measuring 17.7 mm from 20.7 mm on\n___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Scarring of the kidneys is noted bilaterally, most likely from prior\ninsult. Mild nephrocalcinosis bilaterally may be result of previous tubular\nnecrosis. Blunting of the calices bilaterally is seen. A nonobstructing\nrenal calculus is noted in the right collecting system. There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits and contain residual contrast from prior\nstudy. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. A nasobiliary tube is present, extending into the left main biliary duct.\n2. There is been interval improvement in intrahepatic bile duct dilatation. \nExtrahepatic bile duct dilatation has slightly decreased.\n3. There is no evidence of fluid collection in the gallbladder fossa.\n4. There is mild nephrocalcinosis and scarring of the kidneys bilaterally,\npossibly due to previous tubular necrosis." }, { "input": "LOWER CHEST: There are small to moderate bilateral nonhemorrhagic pleural\neffusions, which are new from ___. There is adjacent compressive\natelectasis of the bilateral lower lobes. The heart is normal in size. There\nis no pericardial effusion. There is mild to moderate calcified\natherosclerosis of the coronary arteries. No diaphragmatic defects are\ndetected.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 9\nmm hypodensity in the right lobe of the liver is too small to characterize on\nCT (series 2, image 25). An additional 6 mm hypodensity in the left lobe is\nalso too small to characterize (02:23). There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities within the left kidney are too small to\ncharacterize. No suspicious renal lesions are identified. There is no\nevidence of hydronephrosis in either kidney. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Note is made of fat in the wall of the\nappendix, which is likely due to prior inflammation. Submucosal fat involving\nthe cecum is better appreciated on the prior examination.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Fractures involving the transverse process of L1 and bilateral\ntransverse process ease of L2 through L5 are stable.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Small to moderate bilateral nonhemorrhagic and layering pleural effusions\nare new relative to prior study performed ___ associated with\ncompressive atelectasis of the bilateral lower lobes. No diaphragmatic\ndefects detected.\n2. Please see CT torso performed ___ for full description of\nfractures involving the right transverse process of L1, bilateral transverse\nprocesses of L2 through L5, and bilateral sacrum." }, { "input": "CT abdomen with contrast: Simple density hepatic cyst segment III measuring\n1.2 cm is unchanged. Mild intrahepatic and extrahepatic biliary dilatation is\nunchanged in the setting of prior cholecystectomy. Liver otherwise enhances\nhomogeneously without new lesion. Spleen, pancreas and adrenal glands are\nunremarkable.\n\nThere are 2 simple density large left lower pole renal cysts measuring 5.7 and\n5.3 cm. 6 mm hypodensity in the lateral aspect of the left interpolar kidney\nis unchanged. 8 mm hypodense lesion in the right lower pole kidney has\nintervally increased from the prior examination where it measured 6 mm\nappearing high density with possible internal septation (02:58). Other sub cm\nand parapelvic cysts appear unchanged. Kidneys otherwise present symmetric\nexcretion of contrast without hydronephrosis.\n\nStomach, duodenum and small bowel loops are normal caliber without evidence of\nobstruction. Sigmoid predominant diverticulosis is present without evidence\nof diverticulitis. Large bowel is otherwise thin-walled and unremarkable\nwithout pericolonic fat stranding or fluid collection.\n\nAbdominal aorta is normal caliber with mild to moderate atherosclerotic\ncalcification. A few mildly prominent but nonenlarged lymph nodes in the\nporta hepatis are unchanged measuring up to 8 mm in short axis. There is no\nmesenteric or retroperitoneal lymphadenopathy by CT size criteria. There is a\ntiny fat containing umbilical hernia. There is no free fluid or air.\n\nCT pelvis with contrast: Streak artifact from left hip hardware mildly limits\nevaluation. Uterus, bladder, adnexa and rectum are grossly unremarkable. \nThere is no free pelvic fluid or air. There is no inguinal or pelvic sidewall\nlymphadenopathy by CT size criteria.\n\nBones and soft tissues: Gamma nail fixation of the a left femoral neck is\npresent without evidence of hardware failure. There are severe degenerative\nchanges of the left hip joint and moderate changes of the right hip. There is\nno suspicious focal bone lesion. There is grade 1 anterolisthesis of L4 on\nL5. There are moderate multilevel degenerative changes of the thoracolumbar\nspine.", "output": "8 mm dense lesion in the right lower pole kidney has increased in size\ncompared to the prior study with increasing complexity with possible\nseptation. Given continued increase in size and complexity, this lesion is\nsuspicious.\n\nRECOMMENDATION(S): Recommend gadolinium-enhanced MR examination of the right\nrenal lesion or follow-up repeat CT examination in ___ year." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. The common bile duct is moderately dilated and measures up to the 9 mm.\nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Stable\ncalcified granulomas within the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are small\npunctate nonobstructing renal calculi in the lower pole of the left kidney and\nupper pole of the right kidney. There is no evidence of focal renal lesions\nwithin the limitations of an unenhanced scan. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post roux-en-y gastric bypass. Small\nbowel loops demonstrate normal caliber and wall thickness throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: Evaluation of the pelvis is limited by significant streak artifact\nfrom bilateral hip arthroplasty. There is asymmetry at the dome with adjacent\nfat stranding. Foci of air seen within the bladder, may be secondary to\nrecent instrumentation. There is no free fluid in the pelvis. The pelvic\norgans are difficult to visualize.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is calcified atherosclerotic disease at the origin of the\nSMA.\n\nBONES: Degenerative changes are seen in the lumbar spine. The patient is\nstatus post bilateral total hip arthroplasty. There is a stable lucent lesion\nin the right ilium. There is a healed posterior lateral ninth right rib\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Asymmetric wall thickening of the dome of the bladder with adjacent fat\nstranding is concerning for a mass. Foci of air within the bladder are most\nlikely secondary to recent instrumentation.\n2. Punctate nonobstructing renal stones in bilateral kidneys." }, { "input": "LOWER CHEST: Patchy atelectatic/consolidative changes are seen in the\nbilateral lower lobes, left greater than right. There is a loculated small\nleft pleural effusion with pleural enhancement, with a left-sided chest tube\nin place. There is a small right pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThere are numerous, ill-defined hepatic hypodensities, involving all the liver\nsegments, with a pseudo cirrhotic morphology of the liver. The largest\nconglomerate hypodensity is seen in segment 8 measuring approximately 8.3 x 5\ncm. There is no biliary duct dilatation. The gallbladder is unremarkable.\n\nThere is occlusive thrombus in the right portal vein extending into the\nportosplenic confluence.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Left-sided\nparapelvic cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. A small volume of ascites is\npresent in the abdomen and pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: 8 mm sclerotic foci in the anterior aspect of the L1 vertebral\nbody and posterior L5 vertebral body, indeterminate.", "output": "1. Diffuse hepatic hypodensities, with a pseudo cirrhotic appearance of the\nliver, compatible with metastatic disease. There is occlusive thrombus in the\nright portal vein extending into the portal splenic confluence.\n2. Small volume of ascites.\n3. Indeterminate subcentimeter sclerotic foci in the L1 and L5 vertebral\nbodies.\n4. Small bilateral pleural effusions, loculated on the left, with a pigtail in\nplace. Left pleural enhancement, which may be reactive, however a malignant\nor infectious effusion cannot be excluded and should be evaluated on a\nclinical basis." }, { "input": "LOWER CHEST: Heart size is normal without significant pericardial fluid. \nThere is a trace right-sided pleural effusion with mild-to-moderate dependent\nright lung base atelectasis and trace left lung base atelectasis. The imaged\nlung bases are otherwise grossly clear.\n\nABDOMEN:\n\nHEPATOBILIARY: Compared to the biliary catheter repositioning examination from\n___, the biliary anchor drain appears to have been retracted, with\nthe tip of the catheter sitting very peripheral in the right hepatic lobe,\nlikely not within the biliary system. There is trace subcapsular fluid at the\nlevel of the anchor drain insertion point, which is likely postprocedural. A\nsmall amount of edema and hemorrhage within the adjacent abdominal wall is\nalso likely postprocedural. Although the anchor drain appears malpositioned,\nthere is no remaining biliary dilatation. Punctate scattered hypodensities\nwithin the liver dome correspond to probable biliary hamartomas as seen on the\nprior MR examination. The liver otherwise enhances homogeneously without\nfocal mass, fluid collection, abnormal enhancement, or biliary dilatation. \nThe portal vein is patent. The gallbladder is surgically absent with clips in\nplace.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRe-identified are numerous bilateral renal cysts with numerous subcentimeter\nhypodensities too small to characterize, though likely also representing\ncysts. Some of these are high in density, compatible with proteinaceous or\nhemorrhagic cysts as verified on the prior MR exam, best seen on the coronal\nhaste images. There is no evidence of focal solid renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There are changes from Roux-en-Y gastric bypass surgery. \nThere remains contrast within the excluded portion of the stomach, suggestive\nof gastrogastric fistula. The small-bowel loops appear mildly prominent with\nair-fluid levels, though there is no evidence of obstruction, as evidenced by\ningested oral contrast reaching the level of the rectum, and this is likely\ndue to somewhat slowed motility. The large bowel is thin-walled and\nunremarkable without pericolonic fat stranding or fluid collection. There is\na double ended pigtail catheter within a jejunal or ileal loop (2:67).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is anterior wedging of a few lower thoracic vertebral bodies, which\ncould be suggestive of Scheuermann's syndrome.\n\nSOFT TISSUES: There is a small to moderate umbilical hernia containing fluid\nand irritated fat, overall unchanged.", "output": "1. Right hepatic biliary anchor drain appears to have been inadvertently\npulled back, with the tip now in a very peripheral position, likely not within\nthe biliary system, though there is no biliary dilatation, hepatic fluid\ncollection, or abnormal hepatic enhancement.\n2. Normally enhancing pancreas without fluid collection and with resolution of\npreviously seen peripancreatic fat stranding.\n3. Otherwise no acute findings in the abdomen or pelvis. Specifically no\nfluid collections.\n4. Trace right-sided pleural effusion with adjacent compressive atelectasis.\n5. Persistent contrast opacification of the excluded stomach post Roux-en-Y\nbypass, suggestive of gastrogastric fistula.\n6. Double ended pigtail catheter within a jejunal or ileal loop, likely\nrelated to prior biliary procedure.\n7. Numerous hemorrhagic and nonhemorrhagic bilateral renal cysts.\n8. Small to moderate umbilical hernia containing fluid and irritated fat." }, { "input": "LOWER CHEST: There is atelectasis the lung bases bilaterally. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild intrahepatic biliary dilation is\nlikely secondary to cholecystectomy. There is no extrahepatic biliary\ndilation. The gallbladder is surgically absent.\n\nPANCREAS: Pancreas appears edematous and has fluid around it, concerning for\npancreatitis. There is no evidence of pancreatic ductal dilation. There is\nno significant stranding around the pancreas. There is no evidence of\nassociated arterial or venous thrombosis or pseudoaneurysm. There is no\nevidence of pancreatic hypoenhancement to suggest necrosis.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There are innumerable simple cysts of\nbilateral kidneys measuring up to 4.3 cm on the right and 3.2 cm on the left. \nAdditional slightly hyperdense cyst seen exophytic off the lower pole of the\nleft kidney measures 1.5 cm (02:59). There is no perinephric abnormality.\n\nGASTROINTESTINAL: Status post Roux-en-Y gastric bypass procedure. There is\nhigh-density contrast in the excluded stomach which could represent reflux of\ncontrast through the biliary limb, however given the high-density,\ngastrogastric fistula is also possible. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Small bowel anastomosis\nnoted in the left lower quadrant. There is no evidence of obstruction. The\ncolon and rectum are within normal limits. There is a small amount of\npneumoperitoneum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Multiple small retroperitoneal lymph nodes appear slightly\nincreased in number compared to the prior exam, likely reactive. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small amount of fluid in the area of the umbilicus likely\nsecondary to recent laparoscopic procedure.", "output": "1. Acute interstitial edematous pancreatitis with small amount of surrounding\nfluid.\n2. Trace pneumoperitoneum likely related to recent laparoscopic\ncholecystectomy.\n3. Status post Roux-en-Y gastric bypass with high-density contrast within the\nexcluded portion of the stomach raising concern for gastrogastric fistula.\n4. Numerous cysts in the kidneys bilaterally which overall appear simple\nhowever there is a hyperdense cyst exophytic off the lower pole the left\nkidney, potentially hemorrhagic or proteinaceous though confirmation\nsuggested. This can be attempted by ultrasound but may not positively\nidentify this particular cyst and multi phasic exam may be necessary (MR)." }, { "input": "LOWER CHEST: There partially visualized sternal closure wires. There are 3\npericardial drainage catheters entering from a subxiphoid approach, 1 of which\nrises along the posterior pericardium. Epicardial pacing leads are also\npartially visualized. No pleural effusion is seen.\n\nPartially visualized bilateral chest tubes are also noted, both of which\nterminate above the field of view. Small residual bilateral\nhydropneumothoraces are noted bilaterally.\nConsolidation within the right middle lobe, dependently within the right lower\nlobe as well as within the lingula represent combination of relaxation\natelectasis, multifocal pneumonia, and septic emboli. Moderate partially\nvisualized consolidation within the left lower lobe with regions of\nnonenhancing parenchyma likely reflecting necrosis and developing cavitation.\n\nABDOMEN: Mild perihepatic and perisplenic ascites appear progressed in the\nupper abdomen from prior. Pelvic ascites is decreased.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder moderately distended,\ncontaining mild layering debris which may represent vicariously excreted\ncontrast versus calculi.\n\nPANCREAS: There is hypoattenuation involving the distal pancreatic body which\nmay represent edema and potentially acute pancreatitis. There is no\npancreatic ductal dilatation.\n\nSPLEEN: Demonstrates large unchanged wedge-shaped hypoattenuating infarcts. \nThere is no rim enhancement to suggest abscess development.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram,\nsuggesting improvement in prior renal infarcts. There is no evidence of focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is decompressed and contains and esophageal\nenteric catheter with its tip in the duodenal bulb. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits, and the cecum is seen within the\nmidline. The midline appendix appears normal (series 2, image 62).\n\nPELVIS: The urinary bladder is moderately distended with urine and excreted\ncontrast despite presence of a Foley catheter. The distal ureters appear\ngrossly unremarkable. Moderate free pelvic fluid is decreased from prior.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Two intraluminal filling defects within the infrarenal inferior\nvena cava and reflecting thrombi, appear progressed from prior.\n\nBONES: Postsurgical changes related to bilateral laminectomies at T11 through\nL1 and L1-2 interbody graft are seen. There is decreased postoperative\nsubcutaneous emphysema. There is unchanged mild retrolisthesis of L3 on L4\nwith mild endplate degenerative changes and subchondral cystic change. No\nevidence of osseous erosion is seen.\n\nUnchanged intraosseous hemangioma within the T12 vertebral body is noted.\n\nSOFT TISSUES: There has been interval evolution of a right psoas abscess,\nmeasuring 17 cm SI x 2.1 cm TV x 1.6 cm AP. Hyperattenuation within the right\npsoas, adjacent to the L1-2 interbody graft may reflect postoperative\nmaterial.\n\nThere is diffuse anasarca.", "output": "1. Bilateral small hydropneumothoraces (there are bilateral chest tubes) and\nmultifocal pneumonia within the visualized portions of the right middle lobe\nand both lower lobes including regions of developing cavitation in the left\nlower lobe.\n2. Multiple large splenic infarcts without presence of rim enhancing fluid\ncollections to suggest abscess formation at these sites.\n3. Evolution of right psoas abscess measuring up to 2.1 cm in maximal\nthickness.\n4. Hypoattenuation within the distal pancreatic body may represent parenchymal\nedema and/or acute pancreatitis.\n5. The known infrarenal IVC thrombus appears larger compared to the CT dated\n___, but remains nonocclusive.\n6. Distended urinary bladder despite presence of a Foley catheter. This may\nbe secondary to a clamped versus a malfunctioning catheter.\n7. Status post thoracolumbar laminectomies and interbody graft placement at\nL1-2 without evidence of complication.\n\nRECOMMENDATION(S): Correlation with laboratory studies to evaluate for acute\npancreatitis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding. Previously described hypoattenuation of the pancreatic body and\ntail is not appreciated on the current study.\n\nSPLEEN: The spleen demonstrates multiple large wedge-shaped regions of\nhypoattenuation, not appreciably changed compared to prior. There is no rim\nenhancement to suggest abscess formation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Nasoenteric tube ends in the first portion of the duodenum. \nSmall bowel is normal in caliber without focal wall thickening. There is\nedema the wall of the rectum and sigmoid colon new from ___. Remainder of\nthe large bowel is unremarkable. There is no intra-abdominal free air. The\nappendix is not visualized.\n\nThere is moderate volume intra-abdominal ascites unchanged..\n\nA pigtail catheter coils within the superior aspect of a right psoas abscess. \nOverall abscess size now measures 2.3 x 1.3 x 5.2 cm, previously 2.3 x 1.9 x\n5.7 cm. The left psoas is unremarkable.\n\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Air within\nthe bladder is likely from instrumentation. There is moderate free fluid in\nthe pelvis, unchanged. There is new high density material measuring 5.0 x 2.5\ncm adjacent to the iliac vessels on the right, consistent with intrapelvic\nhematoma.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: There are scattered retroperitoneal lymph nodes, similar to\nprior, none that are pathologically enlarged. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Focal thrombus in the infrarenal IVC has mildly decreased compared\nto prior.\n\nBONES: Postsurgical changes from bilateral laminectomies at T11 through L1\nnoted. There is in interval body spacer at L1-L2. There is postoperative\nchange including soft tissue stranding and foci of subcutaneous air near the\noperative site. Mild retrolisthesis of L3-L4 is stable. Note is made of a\nhemangioma in the T12 vertebral body. No suspicious bony lesions are seen.\n\nSOFT TISSUES: There is diffuse anasarca.", "output": "1. New small right pelvic hematoma adjacent to the iliac vessels.\n2. Stable splenic infarcts. No rim enhancing fluid collection to suggest\nsplenic abscess.\n3. Mild decrease in size of right psoas abscess. Pigtail catheter well\npositioned.\n4. Mild decrease in sizes in focal infrarenal IVC thrombus.\n5. Intra-abdominal and pelvic ascites unchanged.\n6. New edema in the rectum and sigmoid colon walls, likely related to third\nspacing, with differential including colitis.\n7. Diffuse anasarca." }, { "input": "LOWER CHEST: Atelectasis is again noted in the bilateral lobes, with interval\ndecrease in size in cavitated lung lesions in the left lower lobe. There are\nunchanged bilateral small pleural effusions, left greater than right.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is small volume ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Similar appearance of with the multiple splenic infarcts, with no\nevidence of splenic abscess.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube is again noted within the distal stomach. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits.\n\nPELVIS: There is a Foley catheter within the bladder. Gas noted within the\nbladder is secondary to instrumentation. There has been a mild interval\ndecrease in size in the moderate amount of free fluid within the cul-de-sac\nalong with enhancement of the peritoneal reflection.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: The patient is status post T12- L2 laminectomy and L1-L2 fusion due to\ndiscitis. Mild retrolisthesis grade 1 of L3 on L4 is again noted. \nHemangiomas are redemonstrated in T12 and L4 vertebral body. There are no\nenhancing fluid collection tracking from T12 to L2 vertebral body which is\nlikely postsurgical.\n\nSOFT TISSUES: A percutaneous pigtail catheter is again noted within an abscess\nin the right psoas muscle, which has slightly decreased in size since prior\nstudy, measuring 1.7 x 1.3 cm in maximal dimension (2:3), compared to 2.6 x\n2.1 cm previously.", "output": "1. Percutaneous pigtail catheter is redemonstrated in a right psoas abscess\nwhich is slightly decreased in size compared to prior.\n2. Mild interval decrease in size in moderate amount of fluid within the cul\nde sac along with mild enhancement of the peritoneum with no organized\ncollection noted.\n3. Multiple splenic infarcts are redemonstrated with no evidence of abscess.\n4. Limited evaluation of the lung bases shows mild interval decrease in size\nin cavitary lung lesions in the left lower lobe concerning for septic emboli." }, { "input": "LOWER CHEST: There is a partially visualized, at least small, right anterior\npneumothorax with a partially visualized chest tube in the pleural space. A\nright middle lobe ground-glass opacity is partially imaged. A small to\nmoderate low-density right pleural effusion is also noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates a cirrhotic morphology. Multiple\narterially enhancing lesions are scattered throughout the liver. A 2.2 cm\narterially enhancing lesion in segment 4B (series 4 image 30) demonstrates\nwashout and is compatible with a OPTN and 5B lesion.\n\nArterially hyperenhancing lesions with apparent washout but without a definite\ncapsule are seen in several locations within the liver. These include a 1.0\ncm lesion in segment 8 at the dome (series 4, image 9), 1.1 cm lesion in\nsegment 4A (series 4, image 19) and 1.3 cm lesion in segment 4B (series 4,\nimage 39). These are very suspicious but do not meet strict optn criteria.\n\nNumerous additional scattered foci of subcentimeter arterially hyperenhancing\nlesions are suspicious.\n\nThere is variant anatomy of the intrahepatic portal veins. The right\nposterior portal vein is the first branch of the main portal vein and the\nright anterior portal vein is the second branch. There is no true right\nportal vein.\n\nRecanalization of the paraumbilical vein is noted with associated upper\nanterior abdominal wall varices near midline.\n\nMild gallbladder wall thickening is likely from third-spacing of fluid. The\ngallbladder contains stones but no definite evidence of cholecystitis.\n\nPANCREAS: The visualized pancreas has normal attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is moderately enlarged measuring up to 16.2 cm without\nsuspicious focal lesion. An accessory spleen is noted along the posterior\naspect of the spleen.\n\nADRENALS: There is mild thickening the apex of the right adrenal gland without\na discrete nodule identified. The left adrenal gland is unremarkable.\n\nURINARY: There is no excretion of contrast on the 3 minute delayed phase,\nsuggesting possible renal dysfunction. No suspicious renal lesion or\nhydronephrosis.\n\nGASTROINTESTINAL: Esophageal varices are moderate. There is small volume\nascites throughout the abdomen. Mesentery is diffusely mildly edematous.\n\nLYMPH NODES: Prominent gastrohepatic, porta hepatis and retroperitoneal lymph\nnodes measure up to 8 mm.\n\nVASCULAR: There is no visualized abdominal aortic aneurysm. Mild\natherosclerotic disease is noted. Hepatic arterial anatomy is conventional.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. A 2.2 cm lesion in segment 4B meets OPTN 5B criteria for ___. At least 3\nadditional lesions greater than 1 cm in segments 8, 4A and 4B are highly\nsuspicious with arterial hyper enhancement and washout, but do not have\ncapsules and therefore do not meet strict OPTN criteria. Numerous additional\nsubcentimeter arterial hyperenhancing lesions are also suspicious.\n2. Sequelae of portal hypertension, including trace ascites, moderate\nsplenomegaly and moderate esophageal and anterior abdominal wall varices.\n3. Partially imaged right middle lobe focus of ground-glass is suspicious of\npneumonia either due to aspiration or infection.\n4. Partially imaged, at least small, right pneumothorax status post chest tube\nplacement.\n5. No contrast excretion by the kidneys at 3 minutes, could represent renal\ndysfunction." }, { "input": "LOWER CHEST: Dependent bibasilar atelectasis is noted. There are tiny\nbilateral pleural effusions. No pericardial effusion is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.7 cm heterogeneously enhancing area in the left lobe (2:46) is incompletely\ncharacterized, but may represent a hemangioma. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: There is steady replacement of the pancreatic parenchyma, without\nevidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is mildly enlarged 14.0 cm but demonstrates attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA punctate hypodensity in the right lower pole (601:81) is too small to\ncharacterize. There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia with thickening of the imaged\nlower esophageal wall. The stomach is unremarkable. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis moderate stool burden throughout the colon. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are within normal\nlimits.\n\nLYMPH NODES: There is no abdominal, pelvic or inguinal lymphadenopathy by CT\nsize criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is moderate scoliosis of the lower lumbar spine with associated moderate\ndegenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute findings in the abdomen pelvis.\n2. 1.7 cm heterogeneous enhancing focus in the left lobe of the liver is\nincompletely characterized, but may represent a hemangioma. Comparison with\nprior imaging would be helpful. If unavailable, and if clinically warranted,\nmay consider MRI or multiphasic CT for further evaluation.\n3. Mild splenomegaly at 14.0 cm.\n4. Small hiatal hernia with thickening of the imaged lower esophageal wall,\nwhich may represent sequela of chronic reflux." }, { "input": "LOWER CHEST: Small bilateral pleural effusions. Please see dedicated chest CT\nreport for further details of the chest.\n\nABDOMEN: The study is limited for evaluation of the parenchyma and visceral\norgans due to lack of IV contrast.\n\nHEPATOBILIARY: Unremarkable. Status post cholecystectomy.\n\nPANCREAS: The unenhanced pancreas is unremarkable, however there is new soft\ntissue stranding in the right anterior pararenal space around the head of the\npancreas, at the level of it closest proximity to the duodenum. Additionally,\nthere is a hyperdense focus on series 3, image 60 that similar to the density\nwithin the duodenal lumen which has diluted oral contrast, and therefore could\ncompatible with a duodenal diverticulum with surrounding inflammation (series\n5, image 41). Another consideration for this finding would be delayed\ninflammation from recent intervention.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable bilaterally.\n\nURINARY: Status post right nephrectomy there is a pocket of loculated fluid at\nsurgical site measuring up to 11 cm, however no gas is seen within these fluid\nto suggest superimposed infection. The unenhanced left kidney is\nunremarkable.\n\nGASTROINTESTINAL: Enteric tube terminates in the gastric antrum. No findings\nof bowel obstruction. Enteric tube ends in the distal stomach.\n\nPELVIS: Bladder is decompressed with a Foley in place. Punctate focal of in\nthe pending gas likely from iatrogenic causes.\n\nThere is interval resolution of pneumoperitoneum from recent procedure. \nSurgical clips in the pelvis.\n\nLYMPH NODES: No abdominopelvic adenopathy.\n\nBONES: No suspicious osseous lesion.\n\nSOFT TISSUES: Mild anasarca is worse. There is interval removal of cutaneous\nstaples just inferior to the level of the umbilicus with separation of the\nskin with debris or packing material within the deep incisional wound. No\nretroperitoneal hematoma demonstrated", "output": "1. Loculated pocket of fluid in the right renal fossa without gas to suggest\nsuperimposed infection.\n2. New soft tissue stranding around the right anterior pararenal space\npossibly due to acute duodenal diverticulitis. An additional consideration\nwould be mild delayed inflammation related to the adjacent surgical\nintervention.\n3. No retroperitoneal hematoma demonstrated. Right lower quadrant open skin\nincision with packing material.\n4. Additional findings above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:10 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Small bilateral pleural effusions and compressive atelectasis is\nnoted. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post right nephrectomy. Again seen is a\nlow-density retroperitoneal collection between the right psoas and descending\ncolon measuring approximately 19.7 cm (SI) x 7.1 cm (AP), previously 18.2 cm\n(SI) x 6.6 cm (AP). The collection appears slightly bigger since ___. The left kidney is normal in size with normal nephrogram. An 8 mm\nhypodensity in the lower pole of the left kidney is too small to characterize.\nA punctate nonobstructing stone is seen in the left renal collecting system. \nThere is no evidence of focal left hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Oral contrast is seen within the stomach, duodenum, and\njejunal loops. There is no convincing evidence of duodenal leak. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nAn intramural abnormality along the superior aspect of the ascending colon\nadjacent to the retroperitoneal collection (02:38) raises concern for colonic\ninjury. Colonic diverticulosis is again noted. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder is decompressed and contains a focus of air\ncompatible with catheterization. A small amount of ascites is again noted,\nsimilar to the prior study.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is an extended open skin defect along the right\nanterolateral abdominal wall extending from the right upper to the right lower\nquadrant. Diffuse anasarca is noted.", "output": "1. Retroperitoneal collection between the ascending colon and right psoas\nappears slightly increased in size since the prior study. There is no\nevidence of duodenal leak, however an intramural abnormality along the\nsuperior aspect of the ascending colon adjacent to the retroperitoneal\ncollection raises concern for colonic injury.\n2. Mild ascites, similar to the prior study.\n3. Small bilateral pleural effusions, unchanged.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:25 am, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodensity in the right hepatic lobe is too small to\ncharacterize on CT, though likely compatible with simple hepatic cyst or\nbiliary hamartoma (02:52). There is no evidence of focal lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. A duodenal diverticulum is\nincidentally noted. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Multiple\nphleboliths are noted within the pelvis. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Coarse central calcifications are seen within the\nprostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is bilateral pars interarticularis defect at L5 compatible with\nspondylolysis, with associated disc space narrowing at L5-S1, minimal loss of\nheight at the inferior endplate of L5, and mild anterolisthesis of L5 on S1,\ncompatible with degenerative change. Small sclerotic focus at the superior\nendplate of T11 is likely degenerative. Millimetric sclerotic foci in the\nbilateral femoral heads and the left greater trochanter are likely compatible\nwith bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite evidence of malignancy within the abdomen or pelvis.\n2. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day." }, { "input": "LOWER CHEST: Bibasilar atelectasis is visualized. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation.d the CBD is prominent measuring up to 0.9 cm the\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple renal cysts are visualized in the left kidney measuring up to 2.4 cm\n(02:20). There is no evidence of hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Multiple dilated air and\nfluid-filled loops of small bowel are visualized with an a focus of\nfecalization with a focal transition point in the anterior periumbilical\nregion (602: 41, 02:50, and 601:14) with twisting of the mesentery in the\n___ the dilated small bowel loops compatible with small-bowel\nobstruction concerning for closed loop. No bowel wall thickening,\npneumatosis, or portal venous gas is demonstrated. No large mass in the\nregion of the transition point is identified within limitations of an\nunenhanced scan. Extensive colonic diverticulosis is visualized without focal\nwall thickening or adjacent fatty stranding. The appendix is surgically\nabsent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted with re-demonstrated SMA and celiac artery stents in place.\n\nBONES: There is re-demonstrated mild anterolisthesis of L3 on L4 and L4 on L5.\nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple dilated air and fluid-filled loops of small bowel with focal\nfecalization and transition point in the anterior periumbilical region with\ntwisting of the mesentery central to the dilated small bowel loops concerning\nfor a closed loop obstruction, without evidence of ischemia within limitations\nof a noncontrast study. Findings may be secondary to adhesions. No large\nmass identified on this noncontrast exam.\n2. Extensive colonic diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: Mild bibasal atelectasis. Trace right pleural effusion. No\nsignificant pericardial effusion. Global cardiomegaly and multivessel\ncoronary calcifications noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is pneumobilia in the left and right lobes, also present on a\nprior study from ___ and presumably related to prior\nsphincterotomy. The patient is status post cholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\nevidence of pancreatic ductal dilation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are several left\nrenal cortical cysts, the largest measuring 2.4 cm. A punctate calcification\nin upper aspect of the right kidney is most likely vascular. There is no\nevidence of nephrolithiasis. There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are mildly prominent\nfluid-filled small bowel loops in the pelvis, but there are no findings to\nindicate acute obstruction. There is extensive colonic diverticulosis. The\nappendix is not well visualized but there is no evidence of inflammatory\nprocess in the right lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. There are celiac and SMA stents.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No urinary tract stones identified. No evidence of acute inflammatory process\nin the right abdomen.\n\nExtensive colonic diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. No obstructing stones in the lower pole of the left kidney\nmeasure up to 4 mm, similar to the prior examination. Additional punctate\ncalcifications are seen throughout the kidneys, potentially representing small\nnonobstructing stones or vascular calcifications. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal findings.\n2. Small nonobstructing stones in the left kidney, unchanged." }, { "input": "LOWER CHEST: Mild focal atelectasis is seen within the right lower lobe. \nThere is a trace left pleural effusion, new from prior. There is no\npericardial effusion. Dense coronary artery atherosclerotic calcifications\nare seen.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hypoattenuating lesions within the liver are\nconsistent with metastases, appearing overall similar to prior accounting for\ndifferences in technique. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral renal cysts are identified, measuring up to 4.3 cm in the\nleft mid kidney, with septal calcification, as well as 3.1 cm in the right\nupper pole. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops mild\ndistension with air and fluid with areas of decompressed small bowel within\nthe pelvis and left lower quadrant. No single transition point is identified.\nThe appendix is normal. The patient is status post sigmoidectomy with an and\ncolostomy exiting the left lower quadrant. Moderate diverticulosis of the\nascending and descending colons. A colostomy tube noted with its tip the\nlower descending colon.\n\nThe rectal stump is relatively decompressed, however an unchanged 3.8 cm x 1.9\ncm ovoid focus of gas is seen superior to the rectal chain sutures (series 6\nimage 37), concerning for contained leak versus less likely residual\npostoperative extraluminal gas.\n\nA right lower quadrant percutaneous drain tube with its tip posterior to the\nbladder is also identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Trace fat\nstranding within the pelvis is likely postoperative.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: Calcified retroperitoneal and periaortic lymph nodes are noted,\nreflecting sequela prior granulomatous disease exposure. No retroperitoneal\nlymphadenopathy is seen. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Moderate compression deformity of L3 as well as mild compression\ndeformity reverses Schmorl's node along the superior endplate of T11 is also\nseen.\n\nSOFT TISSUES: Postoperative gas is seen within both inguinal canals.", "output": "1. Post sigmoidectomy and end colostomy changes as described above. A 3.8 cm\nfocus of probable extraluminal gas superior to the rectal stump is concerning\nfor contained leak or less likely residual postoperative gas.\n2. Mildly dilated loops of small bowel in the left hemi abdomen which may be\nsecondary to an ileus. Continued attention on follow-up is however\nrecommended to exclude a small bowel obstruction secondary to adhesions within\nthe pelvis.\n3. New trace left pleural effusion." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nDuplex right renal collecting system with ureters merging at the proximal\nlevel. There is no evidence of focal renal lesions or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2:37).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No appendicitis or other acute process in the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colon is largely\ndecompressed throughout its course, limiting evaluation. No convincing\nevidence to suggest colitis. The appendix is in the right upper quadrant and\nappears within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Visualized prostate and seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No etiology identified for nausea, vomiting, diarrhea, or diffuse abdominal\ntenderness. Appendix is normal. Gallbladder is normal. No small bowel\nobstruction. Visualized portions of the stomach are within normal limits. \nColon is largely decompressed throughout its course, limiting evaluation." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis. Otherwise, the visualized lung\nfields are within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Pneumobilia is new in the interval. \nModerate intrahepatic and extrahepatic biliary dilatation appears similar to\nprior with the common bile duct measuring up to 15 mm. The gallbladder\nappears to be at least partially surgically resected.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. The main pancreatic duct is dilated to approximately 5 mm,\nslightly increased from prior, though node discrete obstructing lesion is\nseen. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A heterogeneous lesion with peripheral calcifications of the\ninterpolar left kidney measures 2.3 cm (02:19) and contains internal soft\ntissue density, appearing at the same site as a previously ablated lesion,\nthough changed in morphology. A subcentimeter right renal hypodensity is too\nsmall to characterize. The kidneys are of normal and symmetric size with\nnormal nephrogram. There is no evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. No evidence of\nbowel obstruction. Subtle haziness of the fat adjacent to extensive sigmoid\ndiverticula may suggest mild diverticulitis. No extraluminal air, discrete\nfluid collection or abscess. There is muscular hypertrophy of the sigmoid\ncolon likely due to chronic diverticular disease. There is moderate fecal\nloading upstream of the sigmoid colon. The appendix is normal.\n\nPELVIS: A small focus of air is within the anterior bladder (2:64) which could\nbe due to recent instrumentation. Trace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The uterus is not seen. No adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Left femoral fixation hardware is seen. There is left protrusio\nacetabuli, with a defect within the acetabular wall (2:64). A compression\ndeformity of L2 appears mildly progressed from the prior study. A deformity\nof the right inferior pubic ramus (2:74) appears chronic. Severe degenerative\nchanges of the left hip and thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Subtle fat stranding adjacent to extensive sigmoid diverticula may suggest\nmild diverticulitis. No evidence of perforation, aafluid collection, or\nabscess.\n2. Moderate fecal loading upstream of the sigmoid colon, but no evidence of\nbowel obstruction.\n3. A tiny focus of air within the bladder may be compatible with prior\ninstrumentation. Recommend clinical correlation and consider urinalysis to\nexclude infectious cystitis.\n4. 2.5 cm soft tissue density lesion with peripheral calcifications in the\ninterpolar left kidney, at the same site as a previously ablated lesion. \nGiven interval change in appearance of this area since the prior ablation in\n___, residual or recurrent neoplasm may be present. Comparison with more\nrecent prior imaging exams is recommended, and if needed, dedicated renal\nultrasound or MRI could be perforating for further assessment.\n5. Pneumobilia may be secondary to prior sphincterotomy. Recommend\ncorrelation with patient history.\n6. Moderate intrahepatic and extrahepatic biliary dilatation, similar to\nprior. Mild interval increase in main pancreatic duct dilatation, which may\nbe related to the ampullary stenosis, but no definitive pancreatic mass\nidentified.\n7. Status post left femoral fixation hardware, with left protrusio acetabuli,\nand a defect within the acetabular wall.\n8. Mild interval progression of a compression deformity of the L2 vertebral\nbody.\n\nRECOMMENDATION(S): 2.5 cm soft tissue density lesion with peripheral\ncalcifications in the interpolar left kidney, at the same site as a previously\nablated lesion. Given interval change in appearance of this area since the\nprior ablation in ___, residual or recurrent neoplasm may be present. \nComparison with more recent prior imaging exams is recommended, and if needed,\ndedicated renal ultrasound or MRI could be perforating for further assessment." }, { "input": "CHEST: Limited assessment of lung bases are clear. Visualized heart and\npericardium are unremarkable. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening. The hepatic veins, main portal\nvein, splenic vein, and SMV are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of obstructing stones or hydronephrosis. A 1.2 x 1.0 cm\n(4:67) (previously 1.0 x 0.6 cm) hypodense lesion within the upper pole of the\nleft kidney is consistent with a simple cyst. No additional renal lesions. No\nperinephric stranding or fluid collection.\n\nGI: The visualized esophagus, stomach, small bowel and colon are within normal\nlimits without mucosal hyper enhancement, fat stranding, focal mass lesion, or\nobstruction. Visualized appendix is normal without evidence of acute\nappendicitis. Few sigmoid diverticula seen without evidence of diverticulitis.\nSmall amount of fat infiltration within the wall of the terminal ileum is\nnonspecific and may be related to patient body habitus or sequela of\ninflammatory bowel disease. No evidence of active inflammation. No ascites,\nfree intraperitoneal air, or abdominal wall hernia.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric lymph\nnode enlargement.\n\nVASCULAR: The abdominal aorta is normal in caliber without aneurysmal\ndilatation. The SMA, ___, renal arteries are patent. Again noted is stable\ncompression of the patent celiac axis by the median arcuate ligament.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymph node enlargement. There is no free fluid\nin the pelvis.\n\nBONES AND SOFT TISSUES: No lytic or blastic lesions concerning for malignancy.", "output": "1. No evidence of intra-abdominal lymph node enlargement or disease recurrence\nwithin the abdomen or pelvis.\n2. Stable left renal cyst.\n3. Nonspecific mild fatty infiltration of terminal ileal wall may be related\nto patient body habitus or sequelae of inflammatory bowel disease. No evidence\nof active inflammation.\n4. Stable compression of the celiac axis by the median arcuate ligament." }, { "input": "LOWER CHEST: There is a 3 mm nodule in the left lower lobe (2:4). There is\nbibasilar atelectasis.. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic, with normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen is borderline enlarged, measuring 13 mm, with attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post partial small-bowel resection. \nThere is progressive marked dilation of the small bowel measuring up to 9.2 cm\nproximal to a likely transition point at midline (02:40). Suture material is\nnoted in the most dilated small bowel loop. There is fecalization of the more\ndistal loops of small bowel, which are normal in caliber, and there is\npneumatosis in a loop of small bowel in the left upper quadrant (02:33), with\nextension of few foci of air into the mesentery. A tubular radiodensity with\nlucent center is noted in the second portion of the duodenum, likely an\ningested foreign body. The colon and rectum are within normal limits. The\nappendix is surgically absent.\n\nPELVIS: The urinary bladder wall is thickened. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a tract containing fluid and foci of air along the\nright anterior abdominal wall to the existing opening in the skin at midline\n(02:51), likely with fistulous connection to a loop of small bowel containing\ncontrast, as evidence by contrast outside the abdominal wall.", "output": "1. Progressive marked dilation of the small-bowel dilation measuring up to 9.2\ncm proximal to a likely transition point at midline. Repeat study can be\nperformed to evaluate for passage of contrast.\n2. There is extensive fecalization of the more distal small bowel loops, which\nare not opacified, some of which demonstrate pneumatosis, not in a typical\nappearance for acute process, and more likely to represent benign pneumatosis.\nCorrelate with current medications and prior imaging.\n3. A tract along the right anterior abdominal wall containing fluid and foci\nof air extent to the existing opening in the skin at midline, likely with\nfistulous connection to a contrast containing loop of small bowel, as contrast\nis noted outside the abdominal cavity.\n4. Borderline splenomegaly.\n5. There is a 3 mm nodule in the left lower lobe.\n For incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:55 am, 2 minutes\nafter discovery of the findings." }, { "input": "Atelectasis is found in each posterior basilar lower lobe, left greater than\nright.\n\nWithin the limitations of a non-contrast examination, no focal liver lesions\nare identified. Gallbladder appears normal. There is no biliary dilatation. \nThe pancreas is unremarkable. Adrenals appear normal. There is no\nhydronephrosis in either kidney. Along the lower pole of the left kidney,\nthere is a pair very small stones, the larger measuring up to 3 mm.\n\nThe stomach is not particularly distended. Markedly dilated small-bowel loop\nin the epigastric region is less dilated, now only 6.1 cm, compared to over 9\ncm before. Contrast has passed through the area and is now concentrated in\nthe colon. On this study, site of suspected obstruction seems to have opened\nsomewhat (comparing 300:58 on the prior examination to 06:32 on the current\nexamination). However, the marked persistent flaccidity of the immediately\nupstream bowel, which contains an anastomotic suture line, suggests that this\nmay be a site of some degree of chronic partial obstruction with recent acute\nexacerbation.\n\nThere is no persistent dilatation of visualization of a definite intraluminal\nforeign body.\n\nThere are still small amounts of free air in the left upper quadrant as seen\npreviously perhaps for explain by extravasation from pneumatosis coli, as\nmentioned previously.\n\nAlong the right anterior abdominal immediately deep to the right anterior\nabdominal wall and leading up to a an umbilical defect is a small suspected\ntract with air but not well delineated. This is very similar to recent prior\nfindings.\n\nProstate, seminal vesicles and bladder appear normal. There is no\nlymphadenopathy or ascites. Aorta is normal in caliber.\n\nThere are no suspicious bone lesions.", "output": "1. Resolution of small bowel obstruction, although it may be the case that\nthere is some degree of chronic obstruction along the anterior upper abdominal\nwall with recent acute exacerbation.\n2. Possible fistula between small bowel and periumbilical region, but not\nwell assessed with this examination, with anatomy that was better assessed on\nthe recent prior contrast-enhanced study.\n3. Scattered foci of extraluminal air, very similar to the prior study and\nagain mostly localizing to the left upper quadrant in the setting of\npneumatosis coli, not increased." }, { "input": "LOWER CHEST: 3 mm left lower lobe nodule is unchanged. Bilateral streaky\nopacities have increased from prior, likely reflecting increasing atelectasis.\n\nABDOMEN: Mild splenomegaly is unchanged. The liver, pancreas, adrenal glands\nand kidneys are unremarkable.\n\nGASTROINTESTINAL: A large midabdominal loop of bowel containing fecalized\nmaterial and air measures up to 8 cm. There is a transition point in the\nright mid abdomen (2:100, 602:37, 601:44). Re-demonstrated is gas tracking\nalong a tract at the umbilicus, concerning for a enterocutaneous fistula.\n\nAdditionally, there is a relatively long segment of small bowel with wall\nedema and mucosal hyperenhancement (2:80), which may reflect a focus of active\nCrohn's disease. This is supported by interval increase in mesenteric lymph\nnodes in the adjacent mesentery (2:93). There is no pneumatosis or focal\nfluid collection. No intraperitoneal free air. The colon is distended with\nstool throughout.\n\nLYMPH NODES: Mesenteric lymph nodes as described above. Prominent superior\nretroperitoneal lymph nodes are likely reactive. Enlarged left iliac and\ninguinal lymph nodes are increased from prior.\n\nPELVIS: There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen.", "output": "1. Hyperenhancement and mural edema of small bowel in the left abdomen with\nassociated reactive mesenteric lymphadenopathy and stranding is concerning for\nactive Crohn's disease. No free air or focal fluid collection.\n2. Re-demonstrated small bowel dilation related to an anastomosis, with a\ntransition point in the right abdomen. This likely reflects a persistent\npartial obstruction.\n3. Tract along the anterior abdominal wall containing fluid and locules of gas\nis once again concerning for an enterocutaneous fistula, and is similar to the\nprior study.\n4. Stable splenomegaly.\n5. 3 mm left lower lobe nodule is unchanged." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. A right breast implant is\npartially seen.\n\nABDOMEN: The liver, spleen, pancreas, and adrenal glands are unremarkable. The\nnative kidneys are atrophic bilaterally. A failed right iliac fossa renal\ntransplant is atrophic. A left iliac fossa renal transplant is unremarkable. \nAn enteric drainage pancreatic transplant in the left mid abdomen is normally\nenhancing with patent graft vessels.\n\nGASTROINTESTINAL: There is no intestinal obstruction or ascites. The\npreviously identified mucocele has been excised, and there is no evidence of\nrecurrence.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: There is no pelvic free fluid. There is a stable elongated cystic\nlesion just posterior to the right uterus is redemonstrated measuring 3.8 x\n2.0 cm, likely representing hydrosalpinx. The uterus and ovaries are within\nnormal limits for age.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen. \nThere is rectus diastasis.", "output": "1. Status post mucocele resection without evidence recurrence or metastatic\ndisease in the abdomen or pelvis.\n2. Additional incidental findings as above." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: No focal pancreatic mass. No evidence of pancreatic duct dilation. \nAnterior aspect of the pancreatic body appears somewhat lobulated and\nprominent which may reflect a normal variation pancreatic parenchymal contour.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of concerning focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality. Incidental note is made of duplex right\nrenal pelvis. Tiny hypodensity too small to characterize at the lower pole of\nthe right kidney (series 5, image 33) is too small to characterize but\nstatistically likely a small cyst.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The sigmoid colon\nwall appears mildly thickened (series 5, image 56, 58). No significant\npericolonic fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: S-shaped scoliosis, convex to the left at the thoracolumbar spine,\nconvex to the right of the lower lumbar spine. Pelvic bones appear\ndiminutive. Spondylolysis at L5 noted bilaterally, with minimal\nanterolisthesis of L5 with respect to S1. There appears to be mild\nbroad-based disc bulging at L4-5 and L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild sigmoid colon wall thickening could reflect colitis. No evidence of\nother bowel abnormality. Small bowel appears unremarkable.\n2. Spondylolysis at L5 with mild anterolisthesis of L5 with respect to S1." }, { "input": "LOWER CHEST: Scattered dependent reticulonodular opacities at the bases,\nlikely related to atelectatic and chronic changes, but cannot exclude\naspiration or infectious process.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular consistent with cirrhosis.\nSubcentimeter scattered hepatic hypodensities are too small to accurately\ncharacterize. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Massive splenomegaly measuring up to 18.2 cm. Scattered\ncalcifications likely splenic granulomas.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a\nmoderate amount of formed stool in the rectosigmoid colon, with mild\ndistention of more proximal colon with gas fluid levels.\n\nPELVIS: The urinary bladder is collapsed with a Foley catheter, grossly\nunremarkable\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Upper abdominal varices are noted including periesophageal varices.\nLarge recannulized umbilical vein is identified. There is no abdominal aortic\naneurysm. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Diffuse\nbody wall edema. Bilateral small fluid containing inguinal hernias.\n\nSmall volume abdominal and pelvic ascites.", "output": "1. No abscess or other findings identified in the abdomen or pelvis to explain\npatient's bacteremia.\n2. Hepatic cirrhosis with signs of portal hypertension, including\nsplenomegaly, upper abdominal varices including periesophageal varices, and\nanasarca.\n3. Moderate amount of formed stool in the rectosigmoid colon, with mild\ndistention of more proximal colon with gas fluid levels. No frank obstruction.\n4. Scattered dependent reticulonodular opacities at the bases, likely related\nto atelectatic and chronic changes, but cannot exclude aspiration or\ninfectious process." }, { "input": "There is a persistent moderate effusion on the right, somewhat different in\nmorphology, probably with some degree of loculation but probably similar in\nsize. An area of mild round atelectasis appears to be forming at the right\nlung base. The heart is mildly enlarged. Calcifications are noted along the\nmitral valve.\n\nPneumobilia is present in the liver. At the site of the previously noted\narterial enhancing focus measuring 8 mm in the right lobe, on this study there\nis perhaps a minimally discernible blush at the same site but measuring only\n2-3 mm with segment VIII. Otherwise an area of prior resection in the right\nlobe appears unchanged including a fiducial marker near the hepatic hilum.\n\nA round lesion along the periphery of segment VIII, previously 17 x 17 mm in\naxial ___, is unchanged in size. On delayed imaging, however, the\nlesion shows new central hypodensity suggesting cystic change or necrosis;\nthis is probably not reflect of wash-out type kinetics since it is clearly a\nhyperenhancing lesion above background.\n\nThe gallbladder is absent. The adrenal glands and pancreas are unremarkable.\nThere is again a simple cyst in the upper pole of the left kidney. The spleen\nis again mildly enlarged measuring up to 14.5 cm in length. Patchy arterial\nvascular calcifications are present.\n\nTwo small bowel anastomoses are again visible.\n\nThere is no lymphadenopathy or ascites. The major mesenteric arteries and\nveins appear patent. Atherosclerotic changes are mild to moderate among major\narteries.\n\nThe bones are probably demineralized to some extent. The L3-L4 interspace is\npartly fused. Large posterior L1-L2 and L2-L3 osteophytes confer at least\nmoderate spinal stenosis, as before.", "output": "1. Increased degree of central hypodensity along peripheral nodule in segment\nVIII, uncertain in significance; attention in follow-up is recommended\nalthough findings are not diagnostic for hepatocellular carcinoma given lack\nof hyperenhancement.\n\n2. Less conspicuous focus of arterial enhancement along the main treatment\nsite." }, { "input": "LOWER CHEST: Moderate cardiomegaly is redemonstrated. There are moderate\ncoronary artery calcifications. There are small bilateral pleural effusions,\nwith rounded atelectasis noted in the right lower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is again noted to be nodular in contour in keeping\nwith cirrhosis. Note is made of patchy areas with hyperdense material in\nkeeping with lipiodol in the right lobe of the liver with adequate retention\nof lipiodol within the segment 7 HCC. The anterior branch of the right\nportal vein is again noted to be expanded. Mild pneumobilia is\nredemonstrated. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is in the upper limit of normal measuring 12.5 cm\ncraniocaudally.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is an unchanged\n2.8 cm hypodense lesion in the upper pole of the right kidney, previously\ncharacterized as a cyst. Note is made of excreted contrast within the\ncollecting system from prior interventional study. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Again noted is small bowel\nanastomosis within the anterior abdomen. Otherwise, the visualized small\nbowel loops are unremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Moderate\natherosclerotic disease is noted.\n\nBONES: There are severe degenerative changes throughout the lumbar spine.\n\nSOFT TISSUES: Note is made of a 2.9 x 1.4 cm fat containing lesion within the\nright lateral abdominal wall musculature in keeping with lipoma.", "output": "1. Status post chemoembolization with patchy areas containing lipiodol within\nthe right lobe of the liver along with adequate retention of lipiodol within\nthe segment 7 HCC.\n2. The anterior branch of the right portal vein is again noted to be expanded,\nwith no lipiodol noted within it.\n3. No significant interval changes in small bilateral pleural effusions with\nrounded atelectasis in the right lower lobe." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Area of wedge-shaped hypodensity within the right hepatic lobe\ncorresponding to T2 hyperintensity on prior MRCP remains stable. There is no\nevidence of focal lesions. There is mild intrahepatic biliary ductal\ndilatation which appears stable with more focal segmental dilatation involving\nsegment 3, also unchanged. There is pneumobilia involving the central biliary\ntree. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas appears diffusely atrophic. Multiple cystic lesions\narising from the pancreas are stable in comparison to prior MRCP, the largest\nmeasuring approximately 14 mm in the region of the pancreatic body. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Subcentimeter\nleft renal cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Enteroenteric\nanastomosis is noted within the right mid abdomen. Marked sigmoid\ndiverticulosis with apparent mural thickening which may be related to smooth\nmuscle hypertrophy or alternatively may be the result of chronic inflammation\ngiven history of ulcerative colitis. There is no definite inflammatory\nstranding or free fluid to suggest acute colitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Portal vein stent in situ.\n\nBONES: There are multilevel degenerative changes of the thoracolumbar spine,\nworst at L4-L5 with grade 1 anterolisthesis of L4 on L5. Mild anterior wedge\ncompression deformity of the L2 vertebral body.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of malignancy within the abdomen or pelvis. No findings to\nsuggest posttransplant lymphoproliferative disease. In particular, no hepatic\nmass, splenomegaly, or lymphadenopathy.\n2. Status post liver transplant with stable intrahepatic biliary ductal\ndilatation and wedge-shaped hypodensity within the right hepatic lobe.\n3. Diffuse mural thickening involving the sigmoid colon may be related to\nsmooth muscle hypertrophy in the context of diverticulosis or the result of\nchronic inflammation given history of ulcerative colitis.\n4. Grossly stable appearance of pancreatic cystic lesions, likely side-branch\nIPMNs.\n5. Multilevel degenerative changes of the thoracolumbar spine." }, { "input": "Lung bases: The imaged lung bases are notable for minimal subsegmental\natelectasis and minimal bronchial wall thickening.\n\nAbdomen: An NG tube is seen terminating in the proximal stomach.\nSeveral tiny hypodensities are noted within the liver which are too small to\ncharacterize. There is periportal edema which could reflect aggressive\nhydration. Main portal vein is patent. No biliary ductal dilation. The\ngallbladder is decompressed. The spleen is normal in size. Adrenal glands\nare normal bilaterally. The pancreas enhances normally. The kidneys enhance\nsymmetrically without hydronephrosis or worrisome lesion. The abdominal aorta\nis normal in course and caliber. There is no adenopathy. No free air or free\nfluid. The stomach and duodenum appear decompressed.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix not reliably visualized though there are no secondary signs of\nappendicitis. The colon is decompressed. There is no free air or free fluid.\nThe urinary bladder is decompressed around a Foley catheter. No pelvic\nsidewall or inguinal adenopathy.\n\nBones: There is significant arthritis at the right hip with prominent\nspurring, relative flattening of the right femoral head with subchondral\nsclerosis. Findings may reflect early degeneration due to prior trauma. In\naddition, there does appear to be a moderate-sized right hip joint effusion,\nthe nature which is unclear, though septic arthritis not excluded. Otherwise\nthe imaged bony structures appear unremarkable.", "output": "1. Moderate right hip joint effusion in the setting of severe osteoarthritis\nat the right hip. Drainage is advised.\n2. Periportal edema suggestive of aggressive hydration.\n3. Tiny hepatic hypodensities are not fully characterized." }, { "input": "CTA: Evaluation limited due to delay in imaging post IV contrast\nadministration due to IV failure. The imaged portion of the thoracic aorta is\nnormal in course and caliber with mild atherosclerotic calcification noted. \nThe main pulmonary artery and central branches appear grossly patent. The\nabdominal aorta is mildly calcified and normal in course and caliber. The\ncommon iliacs and branches appear normal. There is no evidence of active\nextravasation though evaluation is limited due to delay in imaging\npostcontrast administration.\n\nLOWER CHEST: The patient is intubated with the tip of the endotracheal tube\nentering the right mainstem bronchus. Endogastric tube terminates in the\nmidbody stomach. The imaged portion of the mediastinum is unremarkable. The\nheart is normal in size and shape. There is aortic valvular and coronary\nartery calcification which is moderate in extent. No pleural or pericardial\neffusion. There is mild lower lung atelectasis. Several tiny pulmonary\nnodules for example on series 3, image 250 in the right lower lobe measure\nless than 5 mm. A lingular nodule is seen on series 3, image 242 measuring 5\nmm. A prominent cardiophrenic recess node is seen on series 3, image 265\nmeasuring 9.5 mm in short axis.\n\nABDOMEN: Innumerable hypodense lesions within the liver likely represent\nextensive metastatic disease. Multiple periportal lymph nodes appear\nenlarged. There is a large volume of simple appearing ascites. Adrenals are\nnormal. There is a mass arising from the tail of the pancreas. This lesion\nis seen on series 3, image 303 measuring approximately 3.3 x 2.7 x 3.0 cm. \nThe gallbladder is not clearly visualized. Periesophageal varices are noted. \nHowever, the splenic vein and portal vein appear patent. Presence of varices\nlikely reflects portal hypertension in the setting of innumerable liver\nmetastatic lesions. There is hyperdense material filling the proximal\nstomach, concerning for acute blood products, possibly reflecting bleeding\nvarices. No signs of active arterial bleeding in this region, though\nevaluation is somewhat limited. The duodenum is unremarkable.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThere is probable mild colitis involving the ascending colon though\ndecompressed state somewhat limits assessment. The remainder of the colon is\nnotable for diverticulosis and no diverticulitis. A fibroid uterus is noted. \nNo adnexal mass is seen. Moderate volume simple free fluid extends into the\npelvis. The bladder contains a Foley catheter. No pelvic sidewall or\ninguinal adenopathy.\n\nOsseous structures: No worrisome lytic or blastic osseous lesion is seen. \nThere is a mild levoscoliosis of the lumbar spine. Mild body wall edema is\nnoted.", "output": "1. Right mainstem bronchial intubation. Please retract ETT by at least 3 cm.\n2. Extensive hepatic metastatic disease, moderate volume simple appearing\nascites, periportal prominent lymph nodes and pancreatic tail mass, consistent\nwith reported metastatic pancreatic cancer.\n3. Probable portal hypertension given ascites and presence of varices.\n4. Hyperdense material in the stomach is concerning for acute blood products. \nFindings may reflect bleeding esophageal varices. No signs of active arterial\nbleeding.\n5. Mild thickening of the right colon could reflect colitis versus portal\ncolopathy.\n6. Several sub 5 mm pulmonary nodules for which comparison with prior imaging\nstudies is advised to assess stability." }, { "input": "LOWER CHEST: Partially visualized consolidation at the right lung base may\nrepresent aspiration versus pneumonia. There is no pericardial effusion.\nPleural calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A gastrostomy tube is noted. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder is under distended and contains foci of air likely\nsecondary to Foley catheter. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate to severe scoliosis of the thoracolumbar spine is noted. Mild T12\ncompression deformity of uncertain chronicity is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or pelvic abnormality.\n2. Partially visualized consolidation at the right lung base may represent\naspiration versus pneumonia.\n3. Mild T12 compression deformity of uncertain chronicity." }, { "input": "LOWER CHEST: Please see the separate report of the CT chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 16.5 cm craniocaudal (601:34). No\nfocal splenic lesions seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is unremarkable in appearance\nin the right lower quadrant (2:97).\n\nPELVIS: The urinary bladder is mildly distended. There is eccentric fat\nstranding along the right lateral wall of the bladder, predominately\nanteriorly (601:21), with a small amount of free fluid. This is new when\ncompared to the prior study. No definite bladder wall thickening seen. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nRETROPERITONEUM AND MESENTERY: There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy. There is no\nabdominal aortic aneurysm. No calcified atherosclerotic disease is noted. \nThe mesenteric vessels appear patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 2 cm metallic density in the right paraspinal\nmusculature (2:181) consistent with a bullet. Punctate metallic densities\nalong the anterior aspect of the L5 transverse process on the right likely\nreflect additional small bullet fragments (2:196). There is asymmetric\nenlargement of the right obturator internus a possible rounded hypoenhancing\nregion with peripheral hyper enhancement (2:120). While this may reflect the\nsequelae of prior trauma, an abscess in this region cannot be excluded and\nthis area could be better evaluated with an MRI of the pelvis with without\ncontrast. The suggestion of", "output": "1. Splenomegaly.\n2. Asymmetric enlargement of the right obturator internus muscle, with\nheterogenous enhancement. While this may reflect the sequela of prior trauma,\nthis is new when compared to the prior study and the rounded area of\nhypoenhancement could potentially reflect an abscess. Recommend MRI with\nwithout contrast to better evaluate this region.\n3. Nonspecific fat stranding adjacent to the right lateral bladder wall with a\ntrace amount of free fluid. This may be related to the right obturator\ninternus process, however this is relatively remote and appears to be centered\naround the bladder wall. Recommend correlation with urinalysis.\n4. Bullet fragments as described.\n\nRECOMMENDATION(S): MRI of the pelvis with and without contrast." }, { "input": "Lungs: The visualized lung bases are within normal limits, except for\nsubsegmental atelectasis..\n\nLiver: The liver is homogeneous with a smooth contour. A stable millimetric\nhypodensity is seen in segment 3, too small to characterize, but likely\ncortical cyst, series 4, image 31. No suspicious liver lesion.\n\nBiliary: Unchanged position of the common bile duct stent, in correct\nposition. There is associated left pneumobilia, suggesting the stent is\npatent.\n\nThe gallbladder has been surgically removed.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas:\n\nThere is redemonstration of the pancreatic head mass, with soft tissue\nencasing the distal common bile duct, extending through the\npancreaticoduodenal groove, spanning 3.3 cm, similar to previously, series 4,\nimage 38. It also extends to the porta hepatis and to the gastrohepatic\nligament, unchanged compared to previously.\n\nThere is again mild prominence of the main pancreatic duct, measuring up to\n3.6 mm.\n\nAdrenal glands: Unchanged appearance with mild thickening of left adrenal\ngland.\n\nUrinary: The kidneys are unremarkable. There is no hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nThe uterus has been surgically removed.\n\nGastrointestinal: The bowel is within normal limits, except for a few colonic\ndiverticula. There is no evidence of bowel dilatation or obstruction.\n\nVascular: There are moderate atherosclerotic calcifications of the abdominal\naorta. Bilateral common iliac stents are seen.\n\nThere is again early takeoff of the right hepatic artery from the celiac\ntrunk, with soft tissue encasement, seen on series 4, images 32-33. There is\nencasement of the left proximal hepatic artery, as well as the gastroduodenal\nartery, seen on series 4, image 32.\n\nThere is persistent encasement of the main portal vein, seen on series 7,\nimage 54, without narrowing.\nThe SMA, SMV and splenic vein are patent. The hepatic veins are patent.\n\nLymph nodes: Stable prominent lymph nodes are seen in the gastrohepatic region\nsurrounding the left gastric artery.\n\nBone and soft tissues: There is no suspicious bone lesion.", "output": "1. No significant interval change of the pancreatic head mass, extending to\nthe porta hepatis, pancreaticoduodenal groove and gastrohepatic ligament, with\ncontinued encasement of the right and left hepatic arteries, the\ngastroduodenal artery and the main portal vein, without thrombosis.\n\n2. Stable prominent lymph nodes are seen in the gastrohepatic region\nsurrounding the left gastric artery." }, { "input": "VASCULAR:\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries with bilateral common iliac\nstents.\n\nThere is early takeoff of the right hepatic artery from the celiac trunk, with\nsoft tissue encasement, as well as encasement of left proximal hepatic artery\nand gastroduodenal artery.\n\nThere is persistent case meant of the main portal vein, without narrowing. \nThe SMA, SMV and splenic veins are patent. The hepatic veins are patent.\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. Dual stenting is seen in the CBD, with\nexpected pneumobilia. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is is resected.\n\nPANCREAS: There is redemonstration of the superior pancreatic head mass with\nsoft tissue encasing the distal common bile duct, extending through the\npancreaticoduodenal groove, measuring 27 mm and similar to previous.\n\nThere is mild prominence of the main pancreatic duct, measuring up to 4.5 mm\nwhile previously measuring 3.7 mm.\n\nThere is new fluid-like density surrounding the distal stomach and anterior\npancreas as well as infiltrating the porta hepatis and gall bladder fossa. \nThese changes could be relationship with pancreatitis, which could be\nsecondary to the new stent placement. Correlate clinically.\n\nThere is a gastrohepatic ligament lymph node measuring 18 x 10 mm\n(approximately 17 x 10 mm previously when measured in the same fashion). \nThere is redemonstration of soft tissue density in lymph nodes surrounding the\nceliac artery. Additionally, soft tissue density and stranding is seen on the\nleft of the mesenteric vessels, surrounding small arterial branches (series 2,\nimage 134) with seems slightly more prominent than on prior, likely due to the\npresence of fluid in the vicinity.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. There is mild colonic diverticulosis.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is new fluid in the retroperitoneum and abutting the distal stomach,\npossibly due to postprocedure pancreatitis. Correlate clinically and\nattention on follow-up.\n2. Unchanged appearance of extensive soft tissue in the superior pancreatic\nhead and porta hepatis surrounding several vessels as before. Plastic right\nbiliary stent courses through metal CBD stent without bile duct dilation. \nMinimal increase in sizes of the main pancreatic duct." }, { "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): The pancreatic head lesion within the\nporta hepatis is very difficult to measure, given the presence of a metallic\nstent within the common bile duct. It measures approximately 2.7 cm. It is\ndifficult to compare accurately compared to previous examination, but is\nprobably stable.\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nabsent\nBiliary tree abrupt cutoff with or without upstream dilatation: absent. There\nis pneumobilia, with a metallic stent seen in the common bile duct, which is\npatent. The gallbladder has been surgically removed, with a small amount of\nfluid in the gallbladder fossa. A linear structure is seen in the gallbladder\nfossa likely corresponding to a prominent cystic duct is seen.\n\nArterial evaluation\n\nSMA involvement: absent\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: There is celiac axis involvement, with a rind of\nincreased his E at attenuation/stranding, greater than 180 degrees. This\nappears stable compared to the previous examination. Left gastric artery is\nalso involved.\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: There is no common hepatic artery as the\nleft and right hepatic arteries arise directly from the celiac trunk.\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to celiac axis: absent\nExtension to bifurcation of right/left hepatic artery: Absent\n\nVariant anatomy: The left and right hepatic arteries arises from the celiac\ntrunk.\nVariant vessel contact: There is involvement of the left hepatic artery, with\nsurrounding increased hazy attenuation/stranding, greater than 180 degrees\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nVenous evaluation\n\nMPV involvement: There is involvement of the main portal vein, with\nsurrounding hazy attenuation. The portal vein is patent, with no thrombosis. \nThe left coronary vein is also involved.\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\n\nSMV involvement: absent\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein: absent\nThrombus within vein: absent; type of thrombus: None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: There is a new hyperenhancing ill-defined lesion in segment 5\nof the liver, measuring approximately 1.5 cm in maximal dimension. This could\nrepresent focal cholangitis versus a metastasis.\n\nTiny hypodensities are seen in segment 7 and segment 3, too small to\ncharacterize, but likely cysts. The liver is otherwise homogeneous with a\nsmooth contour.\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nLungs: Please see the report of the CT chest performed on the same day for\nmore details.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Small hypodensities are seen the left kidney, too small to\ncharacterize, but likely cysts. No hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nReproductive organs: The prostate and seminal vesicles are normal..\n\nGastrointestinal: Minimal diverticulosis, with no evidence of diverticulitis. \nModerate fecal loading of the colon. No evidence of bowel dilatation or\nobstruction.\n\nVascular: Moderate atherosclerotic calcifications of the abdominal aorta. An\naortobi-iliac stent seen. The hepatic veins are patent.\n\nLymph nodes: No size significant lymph nodes.\n\nBone and soft tissues: No suspicious bone lesion. Postsurgical changes are\nseen in the anterior abdominal wall. Just caudal to the scar on the right in\nthe anterior abdominal wall, there is an enhancing lesion between the right\nrectus abdominis muscle and transverse abdominis muscle, measuring 1.0 cm x\n1.5 cm, likely representing granulation tissue. Recommend attention on\nfollow-up.", "output": "1. Interval stability of the ill-defined pancreatic head mass, with stable\npancreatic duct dilatation up to 4mm. Stable celiac axis, left hepatic artery,\nmain portal vein and left coronary vein involvement as described in the body\nof the report.\n\n2. New hyperenhancing ill-defined lesion in segment 5 of the liver, measuring\napproximately 1.5 cm in maximal dimension. This could represent focal\ncholangitis versus a metastasis. Recommend MRI for further evaluation.\n\n3. Just caudal to the scar on the right in the anterior abdominal wall, there\nis an enhancing lesion between the right rectus abdominis muscle and\ntransverse abdominis muscle, measuring 1.0 cm x 1.5 cm, likely representing\ngranulation tissue. Recommend attention on follow-up.\n\nRECOMMENDATION(S): Recommend MRI for further evaluation of the segment 5\nliver lesion." }, { "input": "LOWER CHEST: There is some thickening adjacent to the pleura in the lingula\n(2:3).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney appears normal. The left kidney has extensive\nsurrounding perinephric fat stranding. There is moderate to severe left-sided\nhydronephrosis and dilatation of the renal pelvis. The left ureter is\nslightly dilated but the findings still may reflect a UPJ obstruction. There\nis a nonobstructing calculus in the renal sinus and an additional calculus\nwithin the upper pole.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. ___ air colonic diverticula\nare noted. The appendix is not definitively visualized but there is no\nsecondary evidence of appendicitis.\n\nPELVIS: There is mild stranding about the bladder consistent with cystitis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is ectasia of the abdominal aorta, measuring up to 2.5 cm\n(series 2: Image 32), without evidence of aneurysm. Extensive\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are seen in the visualized lumbosacral spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Moderately severe left-sided hydronephrosis with surrounding stranding and\nnonobstructing renal calculi. Overall the findings may reflect an UPJ\nobstruction. The surrounding stranding may reflect forniceal rupture or\ninfection. There is also evidence of mild cystitis.\n2. Mild parenchymal opacity in the region of the lingula may reflect scarring\nbut follow-up chest CT in 3 months should be performed.\n\nRECOMMENDATION(S): Correlate for any concern for pyonephrosis given the\nleft-sided renal obstruction and UTI. Urology consultation is recommended.\n\nNOTIFICATION: Change from preliminary findings discussed with Dr. ___ on\n___ @ 3:41 pm." }, { "input": "LOWER CHEST: A lingular opacity is again seen, relatively unchanged compared\nto prior study, which likely represents scarring. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is mild prominence of the right renal pelvis with no evidence\nof frank hydroureteronephrosis. There is moderate perinephric fat stranding\naround the left kidney as well as moderate to severe left-sided hydronephrosis\nwith dilation of the renal pelvis, which appears slightly improved when\ncompared to prior CT from ___. Two punctate hyperdense foci are\nnoted within the renal pelvis, similar to prior, which may represent non\nobstructing stones. There is mild scarring and asymmetric atrophy of the left\nkidney.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Scattered colonic diverticula\nare noted without evidence of acute diverticulitis. The appendix is not\nvisualized, however no secondary signs of appendicitis are present.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Ectasia of the abdominal aorta measuring up to 2.5 cm, unchanged\nfrom prior. Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes of the lumbosacral spine, worst at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Compared to prior studies, slightly improved appearance of left-sided\nmoderate to severe hydronephrosis and similar appearance of surrounding\nperinephric fat stranding, which is nonspecific and may represent infection or\nobstruction.\n2. Two punctate hyperdense foci are again seen in the left renal pelvis,\nlikely nonobstructing stones. No obstructing renal or ureteral calculi are\nidentified.\n3. Scarring and asymmetric atrophy of the left kidney.\n4. Otherwise, no acute abdominopelvic process to explain the patient's\nsymptoms." }, { "input": "LOWER CHEST: Bibasal atelectasis. Dense calcification of the mitral valve\nannulus. Moderate hiatus hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver parenchyma is unremarkable in appearance on this\nnoncontrast study. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the upper pole of the left kidney is too small to\ncharacterize, but likely represents a small cyst. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is an enteric tube with its tip in the gastric body. \nSmall to moderate size hiatus hernia. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Uncomplicated sigmoid\ndiverticulosis. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral rectus sheath hematomas with fluid-fluid (hematocrit)\nlevels, measuring 3.7 x 8.8 x 13.8 cm on the left and 5.0 x 10.7 x 15.2 cm on\nthe right.", "output": "1. Bilateral rectus sheath hematomas as described above.\n2. No evidence of intraperitoneal or retroperitoneal hemorrhage.\n3. Uncomplicated sigmoid diverticulosis." }, { "input": "CT OF THE ABDOMEN: LUNG BASES DEMONSTRATE DEPENDENT ATELECTASIS. THERE MAY BE\nA SMALL COMPONENT OF BRONCHIECTASIS AT BOTH BASES AS WELL.\n\nTHERE ARE 2 BILIARY STENTS WHICH SCREWS CROSS AND AND IN THE RIGHT AND LEFT\nDUCTS PROXIMALLY AND DISTALLY WITHIN THE DUODENUM. THERE IS EXPECTED AIR\nWITHIN THE BILIARY TREE. THE BILIARY TREE REMAINS DILATED. THERE ARE MULTIPLE\nDIFFUSE HYPODENSITIES THROUGHOUT THE LIVER. SOME CONTAIN AIR-FLUID LEVELS.\nOVERALL THESE LIKELY REPRESENT DILATED DUCTS AND OR BILOMAS. A FOCAL AREA OF\nCHOLEDOCHOLITHIASIS IS AGAIN SEEN AND PREVIOUSLY IDENTIFIED ON ULTRASOUND.\nSUPERIMPOSED INFECTION MUST BE DETERMINED CLINICALLY. THERE ARE ADJACENT\nPERICARDIAL ENLARGED LYMPH NODES. THE PORTAL VEIN IS PATENT, BRANCHES P COM\nATTENUATED HOWEVER. HEPATIC VEINS ARE NOT WELL VISUALIZED DUE TO TIMING OF\nIMAGING.\n\nTHE VISUALIZED LOOPS OF LARGE AND SMALL BOWEL APPEAR UNREMARKABLE. THE\nPANCREAS, SPLEEN AND ABDOMINAL AORTA ARE UNREMARKABLE. THERE ARE SCATTERED\nSMALL LYMPH NODES. IN THE RETROPERITONEUM HOWEVER, NONE MEET SIZE CRITERIA FOR\nPATHOLOGIC ENLARGEMENT. . HYPODENSITIES WITHIN BOTH KIDNEYS ARE TOO SMALL TO\nCHARACTERIZE LIKELY REPRESENTING SIMPLE CYSTS. AREA OF RENAL CORTICAL THINNING\nINVOLVING THE MIDPOLE OF THE RIGHT KIDNEY.\n\nCT OF THE PELVIS: VISUALIZED LOOPS OF LARGE SMALL BOWEL APPEAR UNREMARKABLE.\nNO FREE FLUID, NO PATHOLOGICALLY ENLARGED ADENOPATHY, VASCULATURE APPEARS\nUNREMARKABLE, PROSTATE IS NOT ENLARGED.\n\nBONE WINDOWS DEMONSTRATE NO SUSPICIOUS AREAS, THERE IS A FOCAL AREA OF\nSCLEROSIS. INVOLVING THE ANTERIOR ASPECT OF L3. FINDING IS NONSPECIFIC AS\nTHERE IS NO ASSOCIATED SOFT TISSUE OR DEGENERATIVE CHANGE. ATTENTION ON\nFOLLOWUP, CORRELATION WITH ANY SYMPTOMS.", "output": "1. DIFFUSE BILIARY DUCTAL DILATATION WITH ASSOCIATED EXPECTED SCATTERED\nAIR-FLUID LEVELS DUE TO BILIARY STENTING. FOCUS OF CHOLEDOCHOLITHIASIS NOTED\nAS ON PRIOR ULTRASOUND. THERE ARE LIKELY BILOMA'S AS WELL. OVERALL, THE DUCTAL\nDILATATION APPEARS TO HAVE INCREASED COMPARED TO THE PRIOR ULTRASOUND OF\n___. SUPERIMPOSED INFECTION/CHOLANGITIS MUST BE DETERMINED CLINICALLY.\n2. AREA OF ILL-DEFINED SCLEROSIS INVOLVING THE L3 VERTEBRAL BODY ANTERIORLY ,\nOF UNKNOWN SIGNIFICANCE. PLEASE CORRELATE WITH ANY SYMPTOMS, ATTENTION ON\nFOLLOWUP. REMAINDER OF THE BONES ARE UNREMARKABLE.\n3. HYPODENSITIES WITHIN BOTH KIDNEYS LIKELY REPRESENTING SIMPLE CYSTS,\nCORTICAL DEFECT ON THE RIGHT." }, { "input": "LOWER CHEST: Limited assessment of lung bases are notable for bibasilar\natelectasis. Superimposed infection cannot be excluded. The heart is normal\nin size. No pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Few locules of gas are seen within the biliary system\nconsistent with pneumobilia. Again seen is intrahepatic biliary duct\ndilatation with multiple diffuse hypodensities scattered throughout the liver\nconsistent with dilated ducts and/or bilomas. Biliary stones are noted. \nKnown choledocholithiasis are not well seen and likely radiolucent. There is\nincreased subtle hyper enhancement surrounding the dilated common bile ducts. \nThe common bile duct is mildly dilated measuring 1 cm and unchanged in\nappearance since ___. Top-normal periportal and porta hepatis lymph\nnodes are again noted. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral subcentimeter renal hypodensities are too small to\ncharacterize, largest measuring 1.9 cm in the right lower pole consistent with\na cyst. No perinephric collection. The kidneys otherwise are of normal and\nsymmetric size with normal nephrogram. There is no evidence of focal renal\nlesions or hydronephrosis.\n\nGASTROINTESTINAL: No hiatal hernia. The stomach is unremarkable Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. The appendix is not\nvisualized, however no secondary signs acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no mesenteric lymphadenopathy. Few subcentimeter\nmesenteric lymph nodes do not meet CT size criteria for enlargement. There is\nno pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Progression of bile duct hyperemia is worrisome for cholangitis in the\nappropriate clinical setting.\n2. Diffuse biliary ductal dilatation, biliary ducts stones, and bilomas with\nfew locules of pneumobilia are expected in a patient with recurrent pyogenic\ncholangitis.\n3. Bibasilar atelectasis. Superimposed infection cannot be excluded." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate few areas of subsegmental\natelectasis. Punctate 2 mm nodule in the right lung base (series 4, image\n32). There are no pleural effusions. There is a large hiatal hernia\nmeasuring 7.9 x 4.7 cm. Please refer to the separately dictated report of CT\nchest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable appearance of the subcentimeter hypodensities superiorly in segment ___\n(series 4, image 44). There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The rightadrenal gland is normal in size and shape. Stable sub cm\nleft adrenal nodule.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Large hiatus hernia as described above, otherwise the\nstomach is unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The appendix is within normal limits. \nThe patient is status post sigmoid colectomy with colostomy. Multiple colonic\ndiverticula are again seen without evidence of acute diverticulitis.\n\nPELVIS: The urinary bladder is partially distended. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is bulky and shows a large exophytic solid\nmass posteriorly measuring 6.7 x 4.6 cm. The endometrial canal is distended\nmeasuring up to 1.4 cm. Ovaries are not well seen.\n\nLYMPH NODES: There is no retroperitoneal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is evidence of thrombosis involving the right gonadal vein\nwhich is enlarged and shows central nonfilling (series 4, image 74).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild levoconvex scoliosis of the lumbar spine. Significant degenerative disc\ndisease involving the entire lumbar spine\n\nSOFT TISSUES: There is a small umbilical hernia containing fat.", "output": "1. Bulky uterus with endometrial thickening/distension, this would be better\nassessed on pelvic ultrasound/MRI. No significant retroperitoneal or pelvic\nlymphadenopathy. Right gonadal vein thrombosis, given history of known\nendometrial carcinoma, tumor involvement cannot be excluded.\n2. Stable left adrenal nodule.\n3. Stable subcentimeter segment 2 hepatic hypodensity compared to CT from\n___. No new lesions seen.\n4. Please refer to the separately dictated report of CT chest." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Unremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: Unremarkable.\n\nGASTROINTESTINAL: Moderate hiatal hernia. Otherwise, the stomach is\nunremarkable. There are postsurgical changes from reversal of right lower\nileostomy. There are postsurgical changes from reversal of prior left lower\nquadrant colostomy. Again seen is a end to side distal colonic anastomosis. \nOtherwise, the small bowel, colon and rectum are unremarkable. The appendix\nis unremarkable.\n\nPELVIS: There is no free fluid in the pelvis.The patient is status post\nhysterectomy and bilateral salpingo-oophorectomy. Similar appearance of the\nvaginal cuff.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Similar appearance of right\ngonadal vein stump.\n\nBONES: There is no evidence of worrisome osseous lesions. There are moderate\nmultilevel degenerative changes of the visualized spine and degenerative\nchanges of the bilateral SI joints, as on prior.\n\nSOFT TISSUES: There are multiple subcutaneous nodules with fat in the center\nin the anterior abdominal wall, likely related to prior injections. The\npatient is status post reversal of a right lower quadrant ileostomy with\nsurgical clips in the right lower quadrant and a 4.5 x 3.2 cm likely seroma in\nthe right lower quadrant anterior subcutaneous tissues (series 6/image 89). \nThere are small fat containing paraumbilical hernias. There are few scattered\npunctate gluteal granulomas.", "output": "1. No evidence of local recurrence or metastatic disease in the abdomen or\npelvis.\n2. Postoperative changes and multiple soft tissue nodules in the anterior\nabdominopelvic wall presumably sequela of subcutaneous injections." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is not visualized, and\nmay be contracted or surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal attenuation throughout, without evidence of\nfocal lesions. There is splenomegaly, with the spleen measuring 17 cm in\ncraniocaudal dimension.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a delayed\nnephrogram on the left and delayed excretion of contrast from the left kidney.\nBilateral subcentimeter hypodensities are too small to characterize on CT. \nThere is mild to moderate left hydronephrosis and hydroureter leading to a 2-3\nmm calculus in the distal left ureter (2:85, 601:49). Hyperdensity within the\nperirenal fat is suggestive of a forniceal or caliceal rupture.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. A 2-3 mm stone in the distal left ureter is seen, with associated mild to\nmoderate left hydroureter and hydronephrosis, a delayed left nephrogram, and\nstranding within the perirenal fat suggestive of forniceal or calyceal\nrupture.\n2. Splenomegaly" }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: Bilateral adrenal metastases has slightly increased in size since\nthe recent prior CT from ___, with a 20 x 17 mm hypo enhancing lesion\narising from the left adrenal gland (06:25), which was 19 mm in greatest\ndiameter previously. 2 discrete lesions in the right adrenal gland have also\nincreased, including a 19 x 12 mm lesion arising from the lateral limb\n(06:23), previously 16 x 13 mm. A larger, more superior adrenal lesion now\nmeasures 26 x 20 mm, previously 20 x 17 mm (06:19).\nURINARY: The left kidney is surgically absent. The right kidney demonstrates\nmultiple millimetric hypodensities, unchanged compared to the prior studies,\nincompletely characterized. The kidney otherwise enhances symmetrically, and\nexcrete contrast promptly.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. A left\ninguinal hernia contains loops of small bowel (3:125), as seen previously,\nwith no evidence of incarceration or obstruction.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nExtensive soft tissue mass involving the left aspect of the L2 through L4\nvertebral levels, at the site of prior instrumented posterior fusion\ndemonstrates heterogeneous enhancement (3:72). The extension into the\nadjacent paraspinal soft tissues on the left appears to have increased\nslightly since the prior study, although the overall measurement and\nassessment is limited due to artifact from adjacent orthopedic hardware, and\nextent of spinal canal invasion is better assessed on recent prior MRI. A\nlytic lesion with soft tissue component in the left aspect of the sacrum along\nthe sacroiliac joint (3:86) is concerning for metastasis.", "output": "1. Interval increase in size of bilateral adrenal metastases since the recent\nprior CT from ___.\n2. Soft tissue mass involving the posteriolateral left aspect of the L2\nthrough L4 vertebral levels has apparently increased in size, and involves the\nparaspinal muscles to the left. Spinal canal and neural foraminal invasion are\nbetter characterized on MRI from yesterday.\n3. Lytic lesion in the left sacrum is also concerning for metastasis, similar\nin size compared to the prior CT from ___." }, { "input": "LOWER CHEST:\n\nLeft lower lobe consolidation is again visualized with areas of collapse.\nThere is re- demonstration of 2 right middle lobe nodules (2a:10) largest\nmeasuring 11 mm. There is a 8 mm right lower lobe pulmonary nodule (2A: 15)\nand a 9 mm pleural based right lower lobe nodule (2a:9).\n\nAbdomen/Pelvis:\nThe liver is unremarkable without evidence of mass. There is no intrahepatic\nor extrahepatic biliary ductal dilatation. Gallbladder is unremarkable. Spleen\nand pancreas are within normal limits.\n\nBilateral adrenal nodules are consistent with metastases. The left kidney is\nsurgically absent. The right kidney enhances without evidence of mass or\nhydronephrosis. Urinary bladder is decompressed by indwelling catheter\n\nThere are no dilated loops of bowel. There is no evidence of bowel wall\nthickening. There are colonic diverticula without evidence of diverticulitis.\nThere is a left inguinal hernia containing loops of small bowel without\nevidence of bowel wall edema. There is no intraperitoneal free air or free\nfluid.\n\nThere is mild atherosclerotic calcification of the abdominal aorta. There is\nno evidence of abdominal aortic aneurysm. There is no evidence of contrast\nextravasation.\n\nThere is a lytic lesion in the left sacral ala (2a: 113). There are\npostsurgical changes of the lumbar spine including posterior fusion hardware\nof L1-L4 including corpectomy changes at L3. There is surgical drain within\nthe posterior aspect of the surgical bed.", "output": "1. No evidence of active extravasation or abdominal or pelvic hematoma.\n2. Left lower lobe consolidation concerning for pneumonia.\n3. Pulmonary and bilateral adrenal metastases as described above.\n4. Postsurgical changes of lumbar fusion and corpectomy.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 4:30 ___, 10 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Incidental note is made of a 1.8 cm splenule.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is fluid-filled and dilated up\nto 1.1 cm with wall thickening, hyperemia, and a moderate amount of\nperiappendiceal fat stranding. There is no drainable fluid collection or\nextraluminal gas to suggest perforation. There is mild focal thickening at\nthe base of the cecum as well, likely reactive.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute appendicitis without evidence of rupture or abscess formation." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus appears normal. A right ovarian cyst\nmeasuring 2.1 x 2.1 x 2.6 cm is better characterized on same-day pelvic\nultrasound as a simple cyst. Trace free fluid is physiologic. Left ovary is\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSchmorl's nodes noted along the L2 and L3 superior endplates.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Normal appendix.\n2. Simple right ovarian cyst measuring up to 2.6 cm, better characterized on\nsame-day pelvic ultrasound." }, { "input": "Heart size appears mildly enlarged. There is a trace left-sided pleural\neffusion with small adjacent compressive atelectasis. The imaged lung bases\nare otherwise clear.\n\nCT abdomen with contrast: The liver is nodular with geographic redistribution\ncompatible with given history of cirrhosis. There is mild, non masslike\nheterogeneous enhancement of the liver without focal mass, likely perfusional.\nThere is no intra or extrahepatic biliary ductal dilatation. The portal vein\nappears patent. There is a single calcified gallstone in otherwise\nunremarkable gallbladder.\n\nThe spleen is enlarged measuring up to 17 cm in long axis. The spleen\notherwise enhances homogeneously without focal lesion. Note is made of small\nparaesophageal and gastric varices. The pancreas and right adrenal gland are\nunremarkable. There is some thickening of the left adrenal gland without focal\nnodule. A millimetric right interpolar renal density is too small to fully\ncharacterize by CT but likely represents a cyst. The kidneys otherwise present\nsymmetric nephrograms without focal solid mass, hydronephrosis or perinephric\nabnormality.\n\nThe stomach, duodenum and remainder of the small bowel is unremarkable without\nevidence of obstruction. Patient is status post prior sigmoid resection with\nprimary colorectal anastomosis without evidence of obstruction at this point.\nThere is diffuse diverticulosis without evidence of diverticulitis.\n\nThe abdominal aorta is normal in caliber without focal aneurysmal segment.\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size\ncriterion. A few prominent but nonenlarged lymph nodes in the porta hepatis\nmay be secondary to hepatic process. There is moderate to large volume simple\ndensity ascites. There is no pneumoperitoneum more ventral abdominal hernia.\n\nCT pelvis with contrast: The bladder, seminal vesicles, prostate and rectum\nare unremarkable. There is no inguinal or pelvic sidewall lymphadenopathy by\nCT size criterion. There is no free pelvic air.\n\nOsseous structures and soft tissues. Diffuse superficial soft tissue stranding\nis compatible with anasarca.\n\nThere is no suspicious focal osseous lesion. There are mild multilevel\ndegenerative changes of the imaged thoracolumbar spine most prominent at L5-S1\nwith disc space narrowing, vacuum disc phenomenon and a posterior disc\nosteophyte complex which causes at least mild canal stenosis.", "output": "1. Cirrhotic liver with sequela of portal hypertension including splenomegaly,\nmoderate to large ascites and varices formation.\n2. Bowel hemorrhage cannot be assessed on this single phase study with\nbackground oral contrast.\n3. No focal liver lesion.\n4. Cholelithiasis.\n5. Diverticulosis.\n6. Trace left-sided pleural effusion with small adjacent compressive\natelectasis." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 5.5 x 4.9 x 4.6 cm hypodense lesion with peripheral\nenhancement that fills in on the delayed phase imaging. This likely\nrepresents a cavernous hemangioma. There is a 0.8 cm hyperdense lesion in\nsegment 6 (___), which may represent a small flash filling hemangioma. There\nis a 1.2 cm hypodense focus in segment 5 (___), which may represent focal\nfatty infiltration. There are a few punctate hyperdense lesions which do not\npersist on delayed imaging, likely representing perfusional variants. Liver\ndemonstrates homogenous attenuation throughout. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is a subcentimeter hypodense lesion in the anterior portion the\nspleen (___) of indeterminate clinical significance. The spleen otherwise\nshows normal size and attenuation throughout. There are few small\nsubcentimeter medial splenules.\n\nADRENALS: There is a 1.1 x 1.3 cm heterogeneous lesion in the right adrenal\ngland (___), incompletely characterized on this study. The left adrenal\ngland is mildly prominent without definite nodule.\n\nURINARY: There is a focus of cortical thinning of the inferior pole of the\nright kidney (___), which may represent scarring from prior infection. The\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nevidence of focal renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Small hiatus hernia. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is diverticulosis. No evidence of diverticulitis. The\ncolon and rectum are otherwise within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is heterogeneous with multiple coarse\ncalcifications, measuring 5.1 cm with involvement of the left neurovascular\nbundle. The visualized reproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There is a 0.6 cm left pelvic sidewall lymph node and a 0.5 cm\nright pelvic sidewall lymph node (___). There is no retroperitoneal or\nmesenteric lymphadenopathy. There is no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is obstructive\nthrombus in the left common iliac artery extending for approximately 5 cm,\nwhich reconstitutes at the site of bifurcation into the internal and external\niliac arteries (___). Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a 0.7 cm sclerotic focus in the right ilium (___), likely\nrepresenting a bone island. There are degenerative changes of the visualized\nspine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There are 0.6 cm left and 0.5 cm right pelvic sidewall lymph nodes. No\nother evidence of metastases in the abdomen or pelvis.\n2. The prostate is heterogeneous with multiple coarse calcifications and\nextracapsular extension on the left , better evaluated on recent MRI from ___.\n3. There is obstructive thrombus in the left common iliac artery extending for\napproximately 5 cm, with reconstitution at the left common iliac artery\nbifurcation with patent left internal and external iliac arteries.\n4. There is a segment VII hepatic 5.5 x 4.9 x 4.6 cm hypodense lesion with\nperipheral discontinuous enhancement that fills in on delayed phase imaging,\ncompatible with a hemangioma.\n5. There is a 1.1 x 1.3 cm heterogeneous lesion in the right adrenal gland,\nincompletely characterized on this study. Consider adrenal CT or MRI for\nfurther evaluation.\n\n\nRECOMMENDATION(S): Consider adrenal CT or MRI for further evaluation of the\nright adrenal nodule.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:43 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThree round, homogeneous, water-density lesions with imperceptible walls in\nthe right lobe of the liver are stable and likely reflect simple hepatic\ncysts. The largest lesion measures 1.3 cm and is in segment 8. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: Stable, diffuse fatty replacement of the pancreas, without evidence\nof focal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Stable, bilateral\nupper pole parapelvic cysts, right greater than left. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: Evaluation of the pelvic structures including the bladder and prostate\nis limited given significant streak artifact from the bilateral hip\nprostheses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nHip prostheses are intact. Stable lumbar scoliosis and degenerative changes.\n\nSOFT TISSUES: Stable inflammatory changes in the anterior abdominal wall\nwithout evidence of recurrent ventral hernia.", "output": "1. No recurrent ventral hernia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Coronary artery\ncalcifications are noted. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. A punctate nonobstructing renal stone is seen in the mid\nright kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not definitively visualized.\n\nPELVIS: The urinary bladder appears somewhat trabeculated, which may relate to\nchronic outlet obstruction. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains calcifications. The seminal\nvesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. 1 cm hazy mesenteric focus on\nseries 2, image 59, likely corresponding to finding on the prior study from ___ on series 2, image 58, may represent a small focus of fat\nnecrosis\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There are dilated pelvic veins.\n\nBONES: Degenerative changes are seen in the lumbar spine with multi level at\nleast moderate narrowing of the central canal..\n\nSOFT TISSUES: Umbilical hernia containing fat is noted. Large right and small\nleft bilateral fat containing inguinal hernias.", "output": "1. No evidence of hydronephrosis or obstructing nephrolithiasis. Punctate\nnonobstructing calculus in the right kidney.\n2. Cholelithiasis without acute cholecystitis.\n3. Narrowing of the central canal at multiple levels in the lumbar spine\nrelated to degenerative changes and short pedicles." }, { "input": "LOWER CHEST: There is left basal atelectasis.\n\nHEPATOBILIARY: Unenhanced liver appears unremarkable. There is cholelithiasis\nwithout evidence of cholecystitis.\n\nPANCREAS: Pancreas is atrophic with no discrete suspicious mass lesions\nidentified.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY:There is no hydronephrosis. There is a nonobstructing midpole\ncalculus on the right.\n\nGASTROINTESTINAL: Stomach is moderately distended as well as the duodenum and\nproximal jejunal loops. There is gradual transition from dilated and fluid\nfilled jejunum less dilated jejunum with mildly fecalized material which\nremains similar to the side to side anastomosis and nondistended distal small\nbowel where there is fecalized luminal contents,\ntransitioning smoothly to a decompressed terminal ileum (2:656). Close to\nthe anastomosis, there are short foci of wall thickening (2:67) and tethering\n(602:67) where areas of mild inflammation or adhesions, respectively, might be\npresent; though assessment of inflammation is limited without intravenous\ncontrast. More distally there is another possible focus of wall thickening\n(2:72) though again no overt adjacent fat stranding or mesenteric edema.\nTerminal ileum does not show overt signs of active inflammation. However,\nthere is submucosal fat, indicative of previous episodes of inflammation.\nThere are scattered colonic diverticulosis without diverticulitis\n\nPERITONEUM: There is no free air or free fluid. There is no peritoneal\nstranding.\n\nLYMPH NODES: There is no abdominopelvic adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with moderate atherosclerotic\ncalcifications.\n\nPELVIS: Urinary bladder is unremarkable. Prostate is enlarged with central\ncalcifications. Rectum is unremarkable.\n\nBONES:There are extensive multilevel degenerative changes of the lumbar spine\nwith no acute osseous abnormality or suspicious osseous lesions.\n\nSOFT TISSUES: There are postsurgical changes along the anterior abdominal wall\nwith multiple anterior abdominal wall scars. There is a large right direct\ninguinal hernia containing fat and a small to moderate one on the left. There\nare small incisional hernias along the midline above the level of the\numbilicus.", "output": "1. Possible partial small bowel obstruction with gradual lumen normalizing\ntowards to the region of the anastomosis site. Just beyond the anastomosis\nthere is equivocal focus of mild wall thickening (2:67) and some morphologic\nkinking, more distally there is equivocal wall thickening without overt\nmesenteric edema (2:72). It's unclear if this represents is a mechanical\nobstruction given the gradual normalization of bowel caliber along its course\nand degree of fecalization; functional obstruction related to segmental bowel\ndysmotility is possible given the history of Crohn disease and the possibly\nabnormal bowel segments as described.\n2. Note is also made that these changes are essentially new since the time of\nadmission; CT which was performed one day prior to current admission\ndemonstrated normal small bowel caliber without significant fecalization.\n3. Terminal ileum exhibits changes of prior episodes of inflammation.\n4. No gross active inflammatory changes of Crohn's disease though difficult\nassessment without intravenous contrast.\n5. Cholelithiasis.\n\nRECOMMENDATION(S): NG decompression is suggested. Contrast enhanced\nexamination may be considered if needed to evaluate bowel wall; however, it is\nnoted the patient was unable to tolerate or cooperate for MR evaluation in\n___." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis is noted. Visualized lung fields are\notherwise within normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is status post left hepatectomy and Whipple procedure. \nPneumobilia is compatible with presence of hepaticojejunostomy. The liver\ndemonstrates homogenous attenuation throughout. There is no evidence of\nconcerning focal lesions. There is stable appearance of a subcentimeter\nhypodensity within the right hepatic lobe, likely compatible with simple cyst\nor biliary hamartoma (02:24). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post Whipple procedure. The remaining distal\npancreas is mildly atrophic but has a normal attenuation throughout, without\nevidence of focal lesions. Mild pancreatic ductal prominence is unchanged,\nmeasuring up to 3 mm. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Whipple procedure with\ngastrojejunostomy noted. Tiny hiatal hernia is seen. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the colon is noted, without evidence of wall thickening and\nfat stranding. The appendix is not visualized, however there are no secondary\nsigns of inflammation noted in the right lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. Coarse\ncentral calcifications are noted within the prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative change of the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic process which would correlate with\npatient's reported symptoms. No evidence for recurrent malignancy.\n2. Status post left hepatectomy and Whipple procedure with associated\npostsurgical changes." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains gallstones without\nwall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has fatty replacement, without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis\nseen in the sigmoid colon.There is thickening in the sigmoid colon, why may\nindicate muscular hypertrophy. Otherwise, the colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder has several diverticula. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are noted in the lumbosacral spine, with grade\n1 retrolisthesis of L5-S1 level.\n\nSOFT TISSUES: A small fat containing umbilical hernia is noted", "output": "1. No evidence of malignancy within the abdomen or pelvis.\n2. Diverticulosis and mild thickening in the sigmoid colon. This may be from\nmuscular hypertrophy but please correlate with colonoscopy.\n3. Cholelithiasis\n4. Bladder diverticula\n5. Please see dedicated same day chest CT for complete intrathoracic findings." }, { "input": "LOWER CHEST: Small bilateral pleural effusions are new compared to prior. \nThere is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nNow large volume intra-abdominal ascites is present, significantly increased\nfrom prior.\n\nPANCREAS: The pancreas is edematous with areas of non enhancing pancreatic\nparenchyma in the body/tail and pancreatic head. There is extensive\nperipancreatic fluid. There is no acute pancreatic collection.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Oral contrast is seen extending into the small bowel. No\nextraluminal contrast is identified. There is debris within the stomach. \nSmall bowel is normal in caliber without focal wall thickening. Specifically,\nthe duodenum is without wall thickening. There is no extraluminal air.\n\nPELVIS: The bladder is decompressed with a Foley catheter. There is large\nvolume pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There are scattered retroperitoneal lymph nodes but none that are\npathologically enlarged. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. The IVC is flat. The portal vein, splenic vein, and superior\nmesenteric vein are patent. There is no pseudoaneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Severe acute necrotizing pancreatitis. No evidence of pseudoaneurysm. \nPatent vasculature.\n2. No free air or extraluminal oral contrast to suggest bowel perforation.\n3. Interval increase in now large volume intra-abdominal ascites.\n4. New small bilateral pleural effusions." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis.\nBilateral punctate renal hypodensities are too small to characterize but\nlikely cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nWithin the left lower quadrant, there is a new 7.4 x 4.1 x 5.5 cm\nwell-circumscribed fluid collection located within the mesentery adjacent to\nseveral loops of small and large bowel (2:53, 602b:41). This collection not\nappear to originate from the bowel, and abuts the left ovary.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. A\nmidline scar and subcutaneous inflammatory changes are noted within the mid\nand lower abdominal wall, compatible with the patient's given history of prior\nabdominal surgery and recent liposuction.", "output": "1. No evidence of recurrent small bowel obstruction. Normal appendix.\n2. Interval development of a 7.4 x 4.1 x 5.5 cm well-circumscribed\nthin-walled fluid collection within the mesentery of the left lower abdomen. \nDifferential includes resolving hematoma or seroma, peritoneal inclusion cyst\nor lymphocele. Infection cannot be excluded by imaging alone.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___ at 04:15 on\n___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A 5.3 x 4.3 x 3.8 cm simple attenuating fluid collection in\nthe upper left pelvis is slightly larger than ___, probably a postoperative\nseroma or lymphocele (series 601, image 17; series 2, image 59). The stomach\nis unremarkable. Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Mild ascending and descending diverticulosis. The\ncolon and rectum are otherwise within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient appears status-post hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild bilateral fat containing inguinal hernias. Nonspecific fat\nstranding Ms. ___ fat overlying the left oblique musculature.", "output": "1. No etiology identified for the patient's reported symptoms.\n2. 5.3 cm simple attenuating fluid collection in the left pelvis is slightly\nlarger than ___, probably a postoperative seroma or lymphocele." }, { "input": "There is bibasilar atelectasis. There is no pleural or pericardial effusion.\n\nCT of the abdomen: Hepatic hemangiomas are unchanged. There is no intra or\nextrahepatic biliary ductal dilatation. The gallbladder is normal. The\nadrenal glands, pancreas and spleen are normal. The left kidney demonstrates\nmultiple peripelvic cysts. Kidneys otherwise enhance symmetrically and excrete\ncontrast without evidence of hydronephrosis or renal masses.\n\nThe stomach is collapsed. There is no evidence of small bowel obstruction. \nThere is moderate fecal loading throughout the colon.\n\nNote is made of mild sigmoid diverticulosis. The lower sigmoid shows wall\nthickening and fat stranding along a segment with diverticulosis consistent\nwith diverticulitis. This site is more distal than the prior inflammatory\nprocess. There is no free air or abscess.\n\nThe intra-abdominal aorta is of normal diameter but tortuous. There are mild\nscattered atherosclerotic calcifications. The celiac axis, SMA, and bilateral\nrenal arteries are patent.\n\nCT of the pelvis: The urinary bladder and terminal ureters are normal. The\nrectum is normal. There is no pelvic free fluid. There is redemonstration of a\n5.1 x 4.0 cm left adnexal cyst, which could be paraovarian, increased from\nprior measurements of 40 x 30 mm.\n\nOsseous structures: Significant degenerative changes are noted along the lower\nlumbar spine, with compression deformity again seen at the L1 vertebral body. \nNo blastic or lytic lesion concerning for malignancy.", "output": "1. Acute sigmoid diverticulitis. Colonoscopy should be considered to exclude\nmalignancy following treatment if clinically appropriate, noting wall\nthickening, although likely inflammatory in etiology.\n\n2. 5.1 cm simple appearing cyst in the left adnexa, could be paraovarian.\nFurther evaluation with nonemergent pelvic ultrasound recommended. Also given\nsize and patient's age yearly followup recommended.\n\nNOTIFICATION: Finding #1 discussed with ___, resource nurse by NSR\nvia phone on ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (303; 31) without\nsecondary signs of adjacent inflammation.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: IUD appears in appropriate position within the uterus. \nNo adnexal abnormalities are noted..\n\nLYMPH NODES: There small enhancing prominent mesenteric lymph nodes near the\nmesenteric root which do not meet CT size criteria for lymphadenopathy but can\nbe seen in mesenteric adenitis. There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Prominent mesenteric lymph nodes which are not pathologically enlarged may\nseen in mesenteric adenitis. The appendix is visualized and appears normal." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Dense coronary calcifications\nand a coronary stent is partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is interval progression of\nintrahepatic biliary ductal dilatation, compared to ___. The common\nhepatic duct measures up to 1.0 cm, previously 6 mm (05:30 and 34), though not\nsignificantly changed since ___. The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. There is mild dilation of the proximal main pancreatic duct,\nnew since ___. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is mildly enlarged, measuring up to 14.6 cm, and\ndemonstrating normal attenuation throughout, without evidence of focal\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\nwithin normal limits. There is mild thickening and fat stranding around the\nrectum, likely due to proctocolitis. The appendix is not visualized. Linear\ndensity in the right lower quadrant may represent a surgical clip (05:59).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is a 5 mm anterolisthesis of L4 over L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild thickening of the rectum with fat stranding, likely proctocolitis.\n2. Intrahepatic and common bile duct dilation, mildly progressed since ___, though not significantly changed since ___." }, { "input": "LOWER CHEST: Compared to chest radiograph from ___, there is moderate\nleft pleural effusion and small right pleural effusion, both nonhemorrhagic. \nThere is left more than right bibasilar atelectasis. There is fluid in the\ndistal airways. There is mild septal thickening, likely from volume overload.\nThere is new trace pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Intrahepatic and extrahepatic biliary\nduct prominence is unchanged. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged, measuring up to 13 cm in axial\n___, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the lower pole of the left kidney is incompletely\ncharacterized on this exam, likely a cyst. There is no hydronephrosis\nbilaterally. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Surgical clip in the right lower quadrant\nmay be from prior appendectomy.\n\nPELVIS: The urinary bladder is collapsed with a Foley in place. Distal\nureters are unremarkable. There is small amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is grade 1, 4 mm, anterolisthesis of L5 over L4, since ___. There is anterior wedging deformity of T11, mildly progressed since ___.\n\nSOFT TISSUES: There is diffuse soft tissue stranding, may be due to volume\noverload.", "output": "1. New left greater than right small pleural effusions and atelectasis with\nfluid in the distal left lower lobe airways. Mild interstitial pulmonary\nedema.\n2. Unremarkable large bowel.\n3. No acute intra-abdominal pathology. Small amount of free fluid in the\npelvis, possibly from volume overload.\n4. Mild splenic enlargement." }, { "input": "LOWER CHEST: There are trace bilateral pleural effusions with associated\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is notable for vicarious excretion of contrast.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Note is made of an accessory spleen, medially.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size. There are no focal renal lesions.\nThere is mild bilateral ureteral and renal pelvic fullness, likely secondary\nto mass effect by a massively enlarged uterus.\n\nGASTROINTESTINAL: There is no hiatal hernia. There is no bowel obstruction. \nThere is no bowel wall thickening. Appendix is normal. There is no ascites.\n\nPELVIS: Focus of air in the bladder is likely secondary to recent\ninstrumentation. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is massively enlarged with multiple foci of\nair, likely reflecting early necrosis of fibroid. Hyperdense material\nconcentrated in fibroids, likely related to contrast used during the\nprocedure. The cervix is not distended. Candidate for a normal right ovary\nnoted in the right lower quadrant (series 2, image 55). Left ovary is not\nwell seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small hematoma in the right groin measuring 3.3 x\n2.3 cm with mild blood products extending along the iliac vessels. There is\nno large retroperitoneal hematoma.", "output": "1. Small right groin hematoma with minimal blood product tracking along the\nright iliac vessels. No large retroperitoneal hematoma.\n2. Massively enlarged fibroid uterus. Multiple foci of air in the fibroids,\nas expected post procedure early, likely reflecting early necrosis.\n3. Fullness of the bilateral renal pelvises and ureters, likely secondary to\nmass effect by the enlarged uterus." }, { "input": "Heart size is normal without significant pericardial fluid. The imaged lung\nbases are clear.\n\nLiver, gallbladder, spleen, pancreas and adrenal glands are grossly\nunremarkable in the context of a noncontrast examination.\n\nAgain seen are several bilateral renal calculi measuring up to 4 mm in the\nright interpolar kidney and 3 mm in the left lower pole kidney. Again, mild\nleft-sided hydroureteronephrosis is seen. There is no obvious renal lesion.\n\nStomach is grossly unremarkable. Duodenum and small bowel loops are normal\ncaliber without evidence of obstruction. Large bowel is thin-walled and\nunremarkable without pericolonic fat stranding or fluid collection.\n\nAbdominal aorta is normal caliber. There is no mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria. There is no ascites, pneumoperitoneum or\nventral abdominal hernia.\n\nCT pelvis without contrast: There is an obstructing 4 mm stone at the left\nureterovesicular junction. Bladder is otherwise grossly unremarkable. \nUterus, adnexa and rectum are grossly unremarkable. There is no free pelvic\nfluid or air. There is no inguinal or pelvic sidewall lymphadenopathy by CT\nsize criteria.\n\nBones and soft tissues: There is no suspicious focal bone lesion.", "output": "1. 4 mm obstructing stone at the left ureterovesicular junction with\nassociated mild left-sided hydroureteronephrosis.\n2. Several bilateral renal calculi measuring up to 4 mm in the right\ninterpolar kidney." }, { "input": "LOWER CHEST: Visualized lung fields show bilateral mild to moderate pleural\neffusions, similar in size to prior. The pleural fluid looks slightly\nhyperdense, which is likely streak artifact from patient's arms being\npositioned at their side. Mild to moderate left sided basilar compressive\natelectasis and moderate right sided basilar compressive atelectasis. The\nheart is normal in size. There are coronary artery and aortic valvular\ncalcifications. No significant pericardial effusion. Partially visualized is\na central venous line which terminates at the cavoatrial junction.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nInterval placement of a cholecystostomy tube with pigtail catheter at the neck\nof the gallbladder. The gallbladder is less distended than previously. The\ngallbladder wall cannot be adequately evaluated due to lack of IV contrast. \nAt the gallbladder fundus there is a curvilinear area of high attenuation\n(601b:20) and (02:35) which may represent layering blood products or volume\naveraging from the gallbladder wall surrounded by fluid. There is no air\nwithin the gallbladder.\n\nThere is a small amount of high density perihepatic and right pericolic\nascites consistent with hemorrhagic ascites.\n\nThere is no free air\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. No evidence\nof focal lesions.\n\nADRENALS: The right and left adrenal glands bilateral mild to moderate\npleural effusions with are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are multiple\nbilateral renal cysts some of which have septations and/or calcifications,\nbetter evaluated on the contrast-enhanced CT. There is no kidney stone. \nThere is no hydronephrosis.\n\nGASTROINTESTINAL: An enteric tube terminates within the stomach. There is a\nleft sided colostomy. No dilated loops of small or large bowel to suggest\nobstruction. There is mesenteric fluid, increased slightly when compared to\nprior.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is an infrarenal abdominal aortic aneurysm measuring 5.7 x\n5.5 cm in diameter. Extensive atherosclerotic disease is noted. Calcified\nsplenic artery aneurysms are noted measuring up to approximately 10 mm. All\nof these findings are better evaluated on the CT performed earlier today which\nhad IV contrast.\n.\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are postsurgical changes along the left abdomen. Diffuse\nsoft tissues anasarca is noted.\n\n This preliminary report was reviewed with Dr. ___\nradiologist.", "output": "1. Interval placement of a cholecystostomy tube with pigtail catheter at the\nneck of the gallbladder in adequate position. The gallbladder is less\ndistended than prior to cholecystostomy tube placement.\n\n2. No evidence for gallbladder perforation.\n3. Small hematoma in the gallbladder wall as well as small amount of\nhemoperitoneum perihepatic and in the right pericolic gutter\n\n4. Bilateral mild to moderately sized pleural effusions with mild to moderate\nleft-sided basilar compressive atelectasis and moderate right-sided basilar\ncompressive atelectasis, increased from prior." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: Limited assessment of the pancreatic parenchyma on this unenhanced\nstudy which again shows evidence of calcifications in the head and uncinate\nprocess. Again seen is a gastrostomy drain extending from the lesser\ncurvature into the area of the previously seen walled-off necrosis with its\ntip seen at the level of the distal pancreatic body. There has been\nsignificant interval decrease of the large walled-off necrosis with tiny\nresidual area of fluid seen measuring 3.7 x 0.9 cm (series 2, image 28). \nMinimal stranding is again seen in the lesser sac.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no\nhydronephrosis. There is no nephrolithiasis. Few cortical hypodensities are\nagain seen involving the kidneys, largest 1 at the lower pole of the right\nkidney.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel\nloops are normal in caliber. There is diffuse colonic diverticulosis without\nevidence of acute diverticulitis.\n\nPELVIS: The urinary bladder is partially filled. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative disc disease involving the lumbar spine.\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias (left larger than the\nright.", "output": "Interval decrease in the previously seen area of walled-off necrosis with\nresidual fluid and stranding." }, { "input": "LOWER CHEST: Aside from minimal right basal atelectasis, visualized lungs are\nwithin normal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Mild prominence of the intrahepatic bile ducts are more\npronounced on today's exam. There is mild heterogeneous enhancement of the\nliver in the periphery, which may be related to the phase of contrast. \nPreviously seen subtle subcentimeter hypodensity in hepatic segment IV a is\nnot well visualized on today's exam (02:20). The gallbladder is surgically\nabsent.\n\nPANCREAS: There has been interval cystogastrostomy tube placement between the\nstomach and in the walled of collection. The dominant collection has\ndecreased in size, now measuring 12.2 x 5.0 cm, previously 13.9 x 7.3 cm\n(02:36). New foci of gas within the collection likely reflects communication\nwith the viscera, though superimposed infection is a consideration. Small\nlobulated portion at the pancreatic head has also decreased in size, now\nmeasuring 2.9 x 3.7 cm, previously 3.8 x 4.9 cm. No foci of gas is seen\nwithin. Coarse calcification is noted posterior to the aforementioned fluid\ncollection. In addition, there is new very pancreatic fat stranding, which\nalso involve a traversing splenic flexure (02:41).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Aside from postsurgical changes from cysto gastrostomy, the\nstomach is decompressed and otherwise unremarkable. There is no bowel\nobstruction. However, there is mild bowel wall thickening along the splenic\nflexure has it abuts the inflamed pseudocyst. The bowel wall thickening is\npresumably reactive rather than a superimposed diverticulitis. Diverticulosis\nof the descending colon and the sigmoid colon are again noted without acute\ninflammatory changes. There is a small ventral hernia in the right lower\nabdomen containing nondistended loops of small bowel, previously containing a\nfocus of fluid. The neck measures 2.0 cm (2:64). The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is bilateral pars defect at L5 with 5 mm anterolisthesis of L5 on S1. \nLinear lucency along the posterior L5 vertebral body is presumably vascular\nchannel. Mild degenerative changes of the lumbar spine is again noted.\n\nSOFT TISSUES: Aside from a small ventral hernia containing nondistended loop\nof small bowel in small fat containing left inguinal hernia, the imaged soft\ntissues are grossly unremarkable.", "output": "1. Acute inflammatory changes around the pancreatic walled-off collection\nfollowing cystogastrostomy tube placement. Foci of gas within the collection\nis presumably indicated of communication with the viscera, given interval\ndecrease in size. There is likely superimposed infection given the acute\ninflammatory changes around the pancreas.\n2. Mild thickening of the splenic flexure, likely reactive.\n3. No new drainable fluid collection." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodense lesion in segment 4A is too small to characterize but\nis similar to prior (2; 23). Mild prominence of intrahepatic biliary ducts is\nsimilar to prior. There is no evidence of extrahepatic biliary dilatation. \nThe gallbladder is surgically absent.\n\nPANCREAS: Interval removal of the internal pigtail catheter with\nre-demonstration of the AXIO cystogastrostomy stent. The dominant collection\nmeasures 10.2 x 4.3 x 5.8 cm slightly decreased in size, previously measuring\n12.2 x 5.0 x 6.2 cm (2; 41). No oral contrast is seen going through the stent\ninto the collection. There is gas only adjacent to the stent and not\nelsewhere.\n\n A smaller lobulated fluid collection in the pancreatic head measures 3.0 x\n4.3 x 4.2 cm, measures similar to prior previously measuring 2.9 x 3.7 x 4.7\n(2; 46) without containing gas and there appears to have a new extension\ninferiorly of the fluid collection along the anterior aspect of the third\nportion of duodenum (601; 25).\n\nCoarse calcification again noted in the posterior pancreatic head, which may\nbe occluding the duct. Pancreatic parenchyma is atrophic. The fluid\ncollections appear to be exerting mass effect on the pancreatic parenchyma.\n\nSimilar peripancreatic fat stranding involving the splenic flexure with\nextension to the colon (2; 45).\n\nSplenic vein is attenuated but patent. Portal confluence is markedly\nattenuated as well (2; 42). There is mild mass effect on the duodenum with\nedema of second portion of duodenal wall.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis. Multiple hypodense lesions in the right kidney consistent\nwith renal cysts are noted, the largest measuring 7.5 x 5.4 cm similar to\nprior. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Hyperdense material noted within the stomach, likely oral\ncontrast. Edema of second portion of duodenal wall, as noted above. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Re-demonstration of mild wall thickening of the splenic flexure\nas it abuts the pseudocyst (2; 44). Diverticulosis of the sigmoid and\ndescending colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: Surgical clip noted in the pelvis, likely a dropped clip leery the\nurinary bladder is decompressed with a Foley catheter with mild wall\nthickening and distal ureters are unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable. Inferior portion of the prostate is excluded from the study.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRe-demonstration of bilateral pars defect of L5 with grade 1 anterolisthesis\nof L5 on S1.\n\nSOFT TISSUES: Small ventral hernia contains a loop of small bowel (2; 71)\nwithout evidence of obstruction or adjacent fat stranding or fluid. Scar\nnoted in the midline.", "output": "1. Interval removal of the pigtail catheter through the cystogastrostomy\nstent. Air is only seen adjacent to the stent within the collection. There\nis interval slight decrease in size of the dominant fluid collection but\nsimilar size of the second fluid collection within the pancreatic head with\nnew extension inferiorly anterior to the duodenum.\n2. Coarse calcification again noted posteriorly in the pancreatic head may be\nwithin and occluding the main pancreatic duct.\n3. Moderate-severe attenuation of the splenic vein and portal confluence by\nthe fluid collections again noted.\n4. Interval increase in peripancreatic fat stranding involving the splenic\nflexure with wall thickening of the adjacent colon, likely reactive.\n5. Small ventral hernia now contains a loop of small bowel without evidence of\nobstruction." }, { "input": "LOWER CHEST: Mild, bibasilar atelectasis. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Unchanged, scattered splenic calcifications likely\nreflect prior granulomatous disease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Otherwise, the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There are numerous diverticula throughout the\nsigmoid colon with mild wall thickening and adjacent fat stranding, consistent\nwith diverticulitis. There is a calcified fecalith in the sigmoid colon. \nThere is no extraluminal air or evidence of abscess formation. The remaining\ncolon and rectum are within normal limits. The appendix is normal, but there\nis some inflammation adjacent to the appendiceal tip that is centered around\nthe sigmoid colon and is likely related to the adjacent sigmoid\ndiverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus. The bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic linear area in the L5 vertebral body is likely degenerative.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Sigmoid diverticulitis without evidence of perforation or abscess formation." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis and trace right pleural\neffusion. Heart size is normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status post\nproctocolectomy with ileostomy takedown and ileoanal anastomosis. A right\nupper quadrant ileoileal anastomotic site is intact. Small bowel loops\nproximal to the anastomosis are fluid-filled and dilated, with decompressed\nloops of small bowel distal to the anastomosis. Additionally, small bowel\nloops proximal to the ileoileal anastomosis demonstrate mild circumferential\nwall thickening compatible with an ileitis. The ileo anal anastomosis is\nintact. The appendix is surgically absent. Small amount of free fluid is\nnoted in the abdomen. No free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Status post proctocolectomy and ileal anal anastomosis. Small-bowel\nobstruction with transition point at the right upper quadrant ileoileal\nanastomosis and a small amount of free fluid in the abdomen and pelvis. \nAdditionally, small bowel loops proximal to this ileoileal anastomosis appears\nto demonstrate mild circumferential wall thickening concerning for a\nnonspecific ileitis." }, { "input": "LOWER CHEST: There is mild dependant atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring up to 14.8 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.\nThere is soft tissue stranding in the right lower quadrant. There is\nthickening of the cecal base and the terminal ileum. There is a 1.5 x 1.7 cm\nfluid collection with foci of air versus Surgicel adjacent to the surgical\nsuture. There are enlarged mesenteric lymph nodes in the right lower quadrant\nmeasuring up to 12 mm, likely reactive. There is no intra-abdominal free air.\nThere is no bowel obstruction although bowel wall loops in the right lower\nquadrant are mildly dilated, consistent with focal ileus.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal.\n\nLYMPH NODES: There are scattered retroperitoneal lymph nodes, unchanged from\nprior. Mesenteric lymph nodes are enlarged, increased from prior. There is\nno pelvic sidewall or inguinal adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. The common hepatic artery and splenic artery arises directly from\nthe aorta.\n\nBONES: There is no evidence of worrisome osseous lesions or acute\nfracture.Note is made of a bone island in the right acetabulum.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Extensive inflammatory change in the right lower quadrant with reactive\nthickening of the cecal base and the terminal ileum. 1.5 x 1.7 cm thin rim\nenhancing fluid collection adjacent to a surgical suture in the right lower\nquadrant, query developing abscess versus Surgicel.\n2. Enlarged reactive right lower quadrant lymphadenopathy.\n3. Localized small bowel ileus in the right lower quadrant, with soft tissue\nstrands tethering a few of the small bowel loops in this region.\n4. Mild splenomegaly.\n\nRECOMMENDATION(S): ." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions. There is mild bilateral\nhydroureter with a pelvic fullness with stranding surrounding bilateral\nureters, likely related to active diverticulitis. Bilateral kidney show\nsimple cysts. Subcentimeter hypodensities seen in bilateral kidneys are too\nsmall to characterize but likely represent simple cysts. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia, otherwise the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is wall thickening of the sigmoid colon\nwith surrounding fat stranding and fascial thickening with a focal 1.6 x 1.5\ncm intramural collection containing gas (2; 137). Slightly inferior and\nposterior to the intramural collection there is a second 5 x 4.4 x 8.2 cm rim\nenhancing collection with tubular tail. This abscess closely abuts the\nurinary bladder with preserved fat plane. Small foci of free air are seen\ncontained within the inflammation surrounding the sigmoid colon, (for example\n2; 142). The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains calcification. The seminal\nvesicles are unremarkable.\n\nLYMPH NODES: Small retroperitoneal lymph nodes are seen which do not meet the\nCT size criteria for lymphadenopathy and are likely reactive. There is no\nmesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAn osseous hemangioma is seen in the L4 vertebral body.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Complicated perforated sigmoid diverticulitis with an intramural and pelvic\nabscess.\n2. Mild bilateral hydroureter with pelvic fullness, likely related to\ninflammation associated with active diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is in the upper limit of normal size and attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the colon is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is markedly enlarged measuring 6 cm with\nfocus of low attenuation seen in right lateral aspect of bladder,\nindeterminate. Please note CT is not the best modality for evaluate prostate\npathology.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: A 7 mm lytic lesion in the left iliac bone (series 3, image 71),\nindeterminate this lesion was not seen on prior CT on ___. This may\nrepresent myelomatous involvement. A small focus of sclerosis in T9 vertebral\nbody likely a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute findings in the abdomen or pelvis.\n2. A 7 mm lytic bone lesion in the left ilium, likely representing multiple\nmyeloma.\n3. Prostatomegaly." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent. In\nthe gallbladder fossa adjacent to the cholecystectomy clips, there is a\nhypodense fluid collection measuring 5.3 x 3.1 x 2.4 cm, likely corresponding\nwith the previously demonstrated perihepatic collection on ultrasound which\nmeasured 5.4 x 4.6 x 3.6 cm. A biliary stent remains in place and in\nappropriate positioning.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Trace amount of fluid is seen\naround the pancreatic head.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a duodenal\ndiverticulum. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. There is trace amount\nof fat stranding and fluid around the hepatic flexure. The ascending colon is\nmostly collapsed with mucosa and the colonic wall appearing grossly\nunremarkable. The appendix is normal (02:49).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There are multiple mildly enlarged lymph nodes at the\ngastrohepatic ligament and in the retroperitoneum, likely reactive. There is\nno mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is anterolisthesis of L4 on L5 measuring 4 mm and 4 mm retrolisthesis of\nL5 on S1. Degenerative changes of the lumbar spine is mild with loss of\nintervertebral disc spaces. There is mild degenerative changes of the left\nhip with a subchondral cystic change at the left femoral head.\n\nSOFT TISSUES: Stranding at the anterior abdominal wall with increased\nreticular density around a lobule of fat may represent postsurgical changes\nand fat necrosis.", "output": "Persistent fluid collection within the gallbladder fossa measuring 5.3 x 3.1 x\n2.4 cm. This finding may represent abscess, versus biloma, versus seroma. \nMild reactive thickening of the hepatic flexure with mild adjacent fat\nstranding." }, { "input": "LOWER CHEST: Small bilateral pleural effusions are incompletely evaluated. \nThese are associated with overlying compressive atelectasis. Scattered areas\nof nodular opacification are seen in the bilateral visualized lung bases. No\npericardial effusion is seen. Extensive coronary artery calcifications are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is some nodular contour of the liver which may be secondary to the\nascites. Multiple hypoattenuating hepatic lesions are poorly evaluated on\ncurrent exam and measure up to 2.4 x 2.1 cm in the right hepatic lobe (02:13).\nSome may reflect hepatic cysts/biliary hamartomas and others are not well\ncharacterized. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys are symmetrically atrophic. There is a 1.4 x 1.4\ncm right lower pole hyperdense renal lesion which is incompletely evaluated on\nthis nonenhanced scan (601:41). There is no hydronephrosis. There is no\nnephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable. No evidence of bowel\nobstruction. Small and large bowel loops are otherwise unremarkable. The\nappendix is not visualized. Large volume ascites. Scattered ill-defined\nareas of peritoneal soft tissue density are seen through out the peritoneum\nincluding the left upper quadrant where they measure up to 3.3 x 1.9 cm\n(601:34) the soft tissue densities are also seen extending into the anterior\nabdominal wall in the left periumbilical space (02:45)\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate volume fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There is a 3.7 x 3.3 cm soft\ntissue mass in the left adnexal (02:54). No definite right adnexal lesions\nare identified.\n\nLYMPH NODES: Enlarged retroperitoneal lymph nodes measure up to 1.2 cm in\nshort axis at the left parrot aortic station (02:29). No mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Aneurysmal dilatation of the infrarenal abdominal aorta up to 4.2 x\n3.5 cm. Extensive atherosclerotic disease is noted.\n\nBONES: Patient is status post fixation for a right femoral fracture with\ndemonstration of a displaced lesser trochanteric fracture fragment. Chronic\nfracture deformity of the inferior and superior left pubic ramus are also\nseen. Compression deformities of the L2 and L3 vertebral bodies are age\nindeterminate. Multilevel degenerative changes of the thoracolumbar spine are\nmoderate to severe. No aggressive osseous lesions are identified.\n\nSOFT TISSUES: Soft tissue density seen to the left of the umbilicus.", "output": "1. 3.7 cm soft tissue mass in left adnexa is incompletely assessed on this\nnonenhanced exam but is suspicious for underlying malignancy.\n2. Large volume ascites with peritoneal soft tissue nodularity which may\nreflect peritoneal carcinomatosis.\n3. Enlarged periaortic lymph node measures up to 1.2 cm.\n4. 1.4 cm right lower pole hyperdense renal lesion is incompletely evaluated\non this nonenhanced exam. If it would alter management this may be further\nevaluated with nonemergent renal ultrasound or MRI.\n5. 4.2 cm infrarenal abdominal aortic aneurysm.\n6. Compression deformities of the L2 and L3 vertebral bodies are age\nindeterminate.\n7. Small bilateral pleural effusions.\n8. Nodular opacities in the bilateral lung bases are nonspecific with\ndifferential considerations including pneumonia, aspiration, metastases, or a\ncombination.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:05 am, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hyperdense and otherwise homogeneous in\nattenuation throughout. There is no evidence of focal lesions within the\nlimitations of an unenhanced scan. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder notable for cholelithiasis\nwithout gallbladder wall edema or gallbladder distension.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral renal cysts are noted measuring 2.4 in the right upper pole\nand 1.6 cm in left lower pole. The kidneys are otherwise of normal and\nsymmetric size. There is no evidence of worrisome renal lesions within the\nlimitations of an unenhanced scan. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized, however no secondary signs of\nacute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: No large adnexal mass. Uterus is surgically absent.\n\nLYMPH NODES: Few subcentimeter inguinal lymph nodes are likely reactive\nmeasuring up to 1 cm in short axis (03:17). 0.6 cm portacaval node is likely\nreactive (03:45). No pelvic, inguinal, retroperitoneal, or mesenteric lymph\nnode enlargement by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: 0.7 cm subtle lucency within the right iliac wing (3: 87) is likely\ndegenerative. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: 2.9 x 1.3 cm area fat stranding along the right gluteal\nsubcutaneous tissues is likely posttraumatic in nature (3:83). The abdominal\nand pelvic wall is otherwise within normal limits.", "output": "1. No abdominopelvic metastasis.\n2. Cholelithiasis.\n3. Please refer to separate CT chest report for findings regarding the thorax." }, { "input": "LOWER CHEST: Stable appearance of the 6 mm nodule in the right lower lobe\n(series 4, image 7).. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere few tiny subcentimeter hypodensities are too small to be characterized..\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Accessory spleen adjacent to the left adrenal\ngland.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is malrotated with stable mild pelviectasis. \nOtherwise the kidneys are of normal and symmetric size with normal nephrogram.\nNo hydronephrosis on the right side. There is no evidence of focal renal\nlesions.. There is no perinephric abnormality. There is no hydroureter.\n\nGASTROINTESTINAL: Small hiatus hernia, the stomach is otherwise unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Colonic diverticulosis, the colon is otherwise within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder is partially distended.. There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged measuring 5.1 x 5.5 x 6.5\ncm with a volume of 95 cc.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nEvidence of degenerative disc disease, most significant at L4-L5 level which\nwith evidence of disc bulge with a focal protrusion effacing the anterior\nthecal sac and probably contacting the spinal nerve roots (series 4, image\n50).\n\nSOFT TISSUES: Small fat containing hernias in bilateral inguinal canals.", "output": "1. Degenerative disc disease with focal disc protrusion at L4-5 level probably\ncontacting the spinal nerve roots, recommend clinical correlation with\nneurological exam. This could be accounting for the patient's symptoms. MRI\nof the lumbar spine can be performed for better characterisation of the spinal\ncanal and nerve roots.\n2. Stable 6 mm right lung base pulmonary nodule compared to the CT from\n___.\n3. Prostatomegaly." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. There is no evidence of pleural or\npericardial effusion. Re-demonstration of 1.1 x 1.6 cm epicardial lymph node\n(2; 6) similar to prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low attenuation throughout consistent\nwith fatty liver. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post right nephrectomy. Subcentimeter nodularity\nin the surgical bed is again noted similar to prior (2; 37). 1.0 cm\nhypodensity in the left upper pole is too small to characterize but likely\nrepresents a cyst (2; 32), similar to prior. No hydronephrosis in the left\nkidney. There is no perinephric abnormality in the left kidney.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. 5.3 x 4.8 cm cystic left\nadnexal mass is unchanged compared to prior, as previously seen on prior CT\nand pelvic ultrasound.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is dextroscoliosis of the lumbar spine with apex at L3. Grade 1\nanterolisthesis of L4 on L5 and grade 1 retrolisthesis of L5 on S1 is\nunchanged compared to prior.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.", "output": "1. No acute intra-abdominal pathology to explain patient's abdominal pain. \nNormal appendix.\n2. Stable cystic left adenxal mass measuring up to 5.3-cm compared to the\nprior exam.\n\nRECOMMENDATION(S): Follow up pelvic ultrasound is due in ___\nper original recommendations." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis.. There is no evidence of\npleural or pericardial effusion. Coronary artery calcifications, aortic valve\ncalcifications and mitral annulus calcifications are noted.\n\nThere is an enlarged epicardial lymph node measuring 1.4 x 1.2 x 1.5 cm (2; 7)\nuncertain clinical significance.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post right nephrectomy. There is suture material\nnoted in the nephrectomy bed and a subcentimeter hyperdense density, which may\nbe postsurgical but there are no priors for comparison. The left kidney is\nnormal in size. Subcentimeter hypodense lesion in the left interpolar region\nis too small to be characterized (2; 43). Parapelvic cysts are noted in the\nkidney. There is no hydronephrosis. There is no nephrolithiasis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal\ncaliber and wall thickness throughout. The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Limited evaluation the uterus appears unremarkable. The\nright adnexa appears unremarkable. In the left adnexa, there is a hypodense\n4.9 x 5.6 cm lesion with ___ of-6 (2; 72) limited evaluation on this\nnoncontrast scan.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is trace anterolisthesis of L4 on L5, likely degenerative. Multilevel\ndegenerative changes are noted throughout the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Patient is status post right nephrectomy with subcentimeter soft tissue\ndensity in the surgical bed likely postsurgical but prior imaging should be\nused for comparison to confirm and exclude tumor recurrence.\n2. 5.6 cm cystic left adnexal mass is noted, and should be compared with prior\nimaging when available. Otherwise, pelvic ultrasound should be obtained.\n3. 1.5 cm enlarged epicardial lymph node of unclear clinical significance. \nThis should be compared with prior but if prior imaging cannot be obtained,\nfollow-up imaging should be performed in 3 months given history of malignancy.\n\nRECOMMENDATION(S): Compared with prior imaging. If not available, consider\npelvic ultrasound for left adnexal mass and repeat CT abdomen pelvis imaging\nfor epicardial lymph node in 3 months.\n\nNOTIFICATION: The updated recommendations were discussed with Dr. ___,\nM.D. by ___, M.D. on the telephone on ___ at 9:14 am, 10 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST:\n\nThe imaged lung bases demonstrate opacities in the medial left lower lobe\n(2:5). There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nhypodensity measuring 1.4 cm in segment V of the liver (02:23) is unchanged\nfrom the prior MRI, compatible with a hemangioma. No new hepatic lesion is\nidentified. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A small accessory spleen is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. The appendix contains air and has normal caliber and no evidence of\nsurrounding fat stranding (601B:31, 23). There is no free air or free fluid.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is a small amount of free fluid\nin the pelvis, likely physiologic.\n\nREPRODUCTIVE ORGANS: Uterus is of normal size and enhancement. No evidence of\nadnexal abnormality bilaterally. Normal physiologic activity is seen in both\novaries.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. Airspace opacities in the left lower lobe are likely infectious.\n2. No evidence of appendicitis or other acute intra-abdominal process.\n3. Stable hemangioma in segment V of the liver." }, { "input": "LOWER CHEST: Small pleural effusions are noted at the imaged lung bases with\nbasal dependent atelectasis and mild bronchial wall thickening in the\nposterior lower lobes which raises potential concern for sequelae of\naspiration. Background emphysema is also noted. The imaged portion of the\nheart appears top-normal in size with subtle aortic valvular and coronary\nartery calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally without focal concerning lesion. \nThe main portal vein and central branches are patent. There is intrahepatic\nbiliary ductal dilation, mild. The common bile duct is within normal limits\nfor a patient of this age. The gallbladder appears normal.\n\nPANCREAS: The pancreas appears somewhat atrophic. A hypodensity is noted\nwithin the mid body of the pancreas best seen on series 2, image 31 measuring\n8 mm. No evidence of mass at the pancreatic head. Calcifications in the\nregion of the ampulla are of unclear significance or etiology. No signs of\npancreatitis. The pancreatic duct is top-normal in size. Given provided\nhistory of painless jaundice, MRCP is recommended to further assess.\n\nSPLEEN: Spleen is normal in size without focal abnormality.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys enhance normally with prompt excretion of contrast. Tiny\ncortical hypodensities in the lower pole right kidney are too small to\ncharacterize.\n\nGASTROINTESTINAL: Stomach is decompressed. The duodenum appears normal. \nSmall bowel loops demonstrate no signs of ileus or obstruction. The appendix\nis normal. The colon is thin walled containing a mild fecal load. No free\nair. Trace free fluid is nonspecific though may reflect presence of a VP\nshunt.\n\nPELVIS: The urinary bladder is decompressed around a Foley catheter. The\nbladder wall appears somewhat thickened, please correlate for infection. \nBrachytherapy clips are noted in the prostate gland. No pelvic sidewall or\ninguinal adenopathy.\n\nLYMPH NODES: No retroperitoneal, mesenteric, pelvic sidewall or inguinal\nadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSchmorl's nodes noted at L2 and L3.\n\nSOFT TISSUES: Shunt tubing extends along the anterior chest wall extending\ninto the abdomen and terminating in the lateral right hemiabdomen.", "output": "1. Intrahepatic biliary ductal dilation, mild, mild prominence of the\npancreatic duct without definite signs of pancreatic head lesion. Given\nhistory of painless jaundice, MRCP is advised to exclude underlying lesion. \nSmall hypodensity in the midbody pancreas can also be further assessed at the\ntime of MRCP.\n2. Tiny pleural effusions at the lung bases with bronchial wall thickening\nlikely the sequelae of chronic aspiration. Emphysema noted.\n3. Thickening of the urinary bladder, correlate for infection.\n\nRECOMMENDATION(S): Nonemergent MRCP." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2:53, 601b:31).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal or pelvic process to explain patient's pain." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas again demonstrates hypodense lesions in the body and\ntail, central unchanged from ___, likely representing IPMNs. High-density\nfocus along the inferior aspect of the pancreas (601b:26) is unchanged from\nprior exam, possibly representing an aneurysm off a branch of the\ngastroduodenal artery.\nSPLEEN: The spleen again contains multiple hypodense lesions in the\nperiphery, the majority of which are too small to characterize. These lesions\nare decreased in size since the prior study from ___, with the dominant\nlesion of the lower pole of the spleen measuring up to 13 mm, previously 18 mm\n(601b:46).\nADRENALS: The left adrenal gland is surgically absent and the right adrenal\ngland demonstrates a heterogeneously enhancing nodule measuring 3.2 x 2.1 cm,\npreviously 3.2 x 2.4 cm.\nURINARY: The left adrenal gland is surgically absent with no evidence of local\nrecurrence in the nephrectomy bed. The right adrenal gland enhances\nhomogeneously with an exophytic simple cyst off the lower pole. There is no\nhydronephrosis are concerning renal lesion.\nGASTROINTESTINAL: The distal esophagus, stomach, and small bowel is normal in\ncaliber. There is a small bowel containing ventral hernia with no evidence of\ncomplication. Surgical suture material is seen in the right lower quadrant,\nfrom prior ileocecectomy. There is pancolonic diverticulosis without evidence\nof diverticulitis.\nRETROPERITONEUM: There are no pathologically enlarged retroperitoneal lymph\nnodes. A single prominent central mesenteric lymph node (2:89) measures 1.5 x\n1.1 cm, unchanged from ___. No new pathologically enlarged mesenteric\nlymph nodes are appreciated. There is no intra-abdominal free air or free\nfluid.\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\nThe urinary bladder is normal. Brachytherapy seeds are noted in the prostate.\nNo pelvic lymphadenopathy or free fluid.\n\nBONES AND SOFT TISSUES:\nRight iliac wing lesion has minimally decreased in overall size, now measuring\n5.2 x 2.5 cm, previously 5.2 x 2.8cm, however the soft tissue component of the\nlesion has significantly decreased in size. Multilevel degenerative changes\nof the lumbar spine are again seen, with retrolisthesis of L2 on L3 and L5 on\nS1.", "output": "1. Interval decrease in size of right adrenal nodule, measuring 3.2 x 2.1 cm,\npreviously 2.2 x 2.4 cm.\n2. Slight interval decrease in size of multiple splenic hypodensities, with\nthe largest lesion at the lower pole of the spleen now measuring 13 mm,\npreviously 18 mm.\n3. Unchanged hyperdensity at the inferior aspect of the pancreas, possibly an\naneurysm off a branch of the gastroduodenal artery.\n4. Decrease in size of the right iliac wing lytic lesion and adjacent soft\ntissue component, as noted above.\n5. Stable hypodensities in the body and tail of the pancreas, possibly\nrepresenting IPMNs.\n6. Stable central mesenteric lymph node with no new retroperitoneal or\nmesenteric lymphadenopathy." }, { "input": "CT abdomen with contrast: 7 mm hypodense lesion in hepatic segment VI is new\n(05:25). Liver otherwise enhances homogeneously without biliary dilatation. \nGallbladder is unremarkable. Portal vein is patent.\n\n11 mm hypodense splenic lesion is unchanged compared to the most recent prior\nexamination, however has intervally decreased in size compared to ___\nwhere it measured 13 mm. Another punctate hypodense lesion in the lateral\nportion the spleen measures 4 mm, having measured 10 mm in ___\nanother millimetric exophytic hypodense lesion in the lateral posterior aspect\nof the spleen measuring 5 mm is unchanged (05:25). Postsurgical changes from\nleft adrenalectomy and nephrectomy.\n\nHeterogeneously enhancing lobulated right adrenal mass measuring 3.2 x 2.4 cm\nis unchanged. High density right interpolar renal lesion measuring 1.4 cm is\nunchanged from the prior examination, previously best noted on the 3 minutes\ndelayed phase (05:37). This lesion appears to have been present since at\nleast ___. Other right-sided renal cysts measuring up to 4.3 cm are\noverall unchanged. There is no hydronephrosis.\n\nThere is a moderate paraesophageal hiatal hernia. Stomach is grossly\nunremarkable. Duodenum and small bowel loops are normal caliber without\nevidence of obstruction. There is sigmoid predominant diverticulosis without\nevidence of diverticulitis. The large bowel is otherwise thin-walled and\nunremarkable without pericolonic fat stranding or fluid collection.\n\nAbdominal aorta is normal caliber. There are several para-aortic surgical\nclips from prior nephrectomy. Mildly enlarged lymph node at the mesenteric\nroot measuring 1.4 x 1.1 cm is largely unchanged (2:86). Other scattered tiny\nmesenteric and retroperitoneal lymph nodes are not pathologically enlarged. A\nrounded rim enhancing mesenteric node measuring 12 mm closely opposed to a\nbranch of the inferior pancreaticoduodenal artery is unchanged (2:73). No new\nenlarged lymph nodes are identified. There is no ascites or pneumoperitoneum.\nThere is a moderate paraumbilical hernia containing nonincarcerated loops of\nsmall bowel (2:91).\n\nCT pelvis with contrast: Numerous brachytherapy seeds are noted within the\nprostate. In the bladder and rectum are grossly unremarkable. There is no\npelvic sidewall or inguinal lymphadenopathy by CT size criteria. There is no\nfree pelvic fluid or air.\n\nBones and soft tissues: Synovial herniation pit is noted at the right to\nfemoral neck. Mixed lytic and sclerotic lesions in the right greater than\nleft iliac bones appears grossly unchanged compared to the prior examination. \nMixed lytic and sclerotic lesions at the superior endplate of T12, inferior\nendplate of L1 and the anterior inferior aspect of the L2 vertebral body are\nunchanged. Punctate sclerotic lesion in the L5 vertebral body is also\nunchanged. No new focal bony lesion is identified.", "output": "1. New 7 mm hypodense lesion in hepatic segment VI, suspicious for new focus\nof metastatic involvement.\n2. Otherwise stable metastatic lesions in the abdomen and pelvis including\nnumerous bone lesions, splenic lesions, right adrenal lesion and 2 mesenteric\nlymph nodes, as described above.\n3. A 14 mm high density right interpolar renal lesion has not been previously\ndescribed, however is unchanged since at least ___ and likely\nrepresents a hemorrhagic or proteinaceous cyst.\n4. Moderate paraesophageal hiatal hernia.\n5. Moderate paraumbilical hernia containing nonincarcerated loops of small\nbowel.\n6. Diverticulosis." }, { "input": "LOWER CHEST: Again, multiple metastatic lesions are seen at the lung bases,\nlargest measuring 2.5 x 2.0 cm in the left lower lobe. Please refer to\nseparate report of CT chest performed on the same day for description of the\nthoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis a 1.0 x 0.7 cm hypodensity seen in segment 4A of the liver, incompletely\ncharacterized and not definitely seen on prior images- close evaluation on\nfollow-up is recommended. A 1.3 x 1.4 cm hyperdense lesion is seen in segment\n6 of the liver has increased in size from prior when it measured 5 x 6 mm. No\nother focal liver lesions are seen. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Re- demonstration of a peripancreatic metastatic lesion abutting the\nuncinate process of the pancreas. It measures 1.8 x 1.8 cm on today's\nevaluation, previously 1.2 x 1.2 cm. An additional peripancreatic metastatic\nlesion is seen abutting the tail of the pancreas measuring 1.1 x 1.7 cm,\npreviously 1.0 x 1.3 cm.\n\nMultiple hypodensities are seen in the body/ tail of the pancreas which are\nincompletely characterized on current CT. These demonstrated mild progressive\nincrease in size as compared to priors. On today's exam, the largest\nconglomerate measures 1.8 x 2.2 cm, previously 1.6 x 2.0 cm on a scan dating\nback from ___. Given the relatively hypodense appearance, these\nlikely represent pancreatic cystic lesions. If further characterization is\nneeded, MRI should be performed. There is no peripancreatic stranding.\n\nSPLEEN: Scattered splenic hypodensities are incompletely characterized but\nunchanged when compared to prior examination. The largest measures 1.0 cm at\nthe lower pole of the spleen.\n\nADRENALS: There is re- demonstration of a 2.6 x 3.4 cm right adrenal\nheterogeneous lesion. This has demonstrated mild increase in size from prior\nwhere it measured 2.5 x 3.1 cm.\n\nURINARY: Patient is status post left nephrectomy. On the right, there is a\n1.8 x 2.1 cm cyst seen at the upper pole of the right kidney, in addition to a\n4.8 x 3.7 cm simple cyst at the interpolar region of the right kidney. No\nconcerning solid right renal lesions are identified. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is colonic diverticulosis. There is a tiny hiatus\nhernia. Remainder of the visualized small and large bowel loops are\nunremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. There are brachytherapy seeds within the prostate.\n\nLYMPH NODES: Multiple borderline mesenteric lymph nodes are seen, in\nparticular a preaortic mesenteric lymph node measuring 0.8 x 1.3 cm previously\nmeasured 1.1 x 1.4 cm and has demonstrated mild decrease in size.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Re- demonstration of known extensive metastatic disease involving the\nbony pelvis. Although the bony changes appear unchanged the associated soft\ntissue component appears to have increased most notable along the right iliac\nbone posteriorly where a 1.2 x 2.2 cm soft tissue component previously\nmeasured 0.7 x 1.7 cm, 10 and the left acetabulum/ posterior superior pubic\nramus where the soft tissue component measures 1.3 x 2.4 cm, previously only\na 0.7 x 1.3 cm.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. A small\nfat containing anterior abdominal wall hernia is once again seen.", "output": "1. Mixed response but with overall slight worsening as compared to prior, with\nincrease in size of the 2 peripancreatic metastatic lesions, mild interval\nincrease in size in the right adrenal lesion, and mild progression of the soft\ntissue component involving the right iliac bone and left acetabulum as above. \nThere has been mild decrease in size of a mesenteric lymph node. Please refer\nto the body of the report for full details.\n2. Re- demonstration of a 1.3 x 1.4 cm enhancing nodule in segment 6 of the\nliver, increased in size from prior when it measured 5 x 6 mm. A 1.0 x 0.7 cm\nhypodensity in segment 4A of the liver was not clearly seen on prior imaging.\nBoth of these regions are concerning for metastatic disease and should be\nevaluated closely on follow-up.\n3. Multiple metastatic lesions are seen at the lung bases, largest measuring\n2.5 x 2.0 cm in the left lower lobe. Please refer to separate report of CT\nchest performed on the same day for description of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is an ill-defined hypoattenuating lesion in hepatic\nsegment 4A, measuring 1.8 x 1.4 cm, previously measuring 1.1 x 1.0 cm. There\nis a hypoattenuating lesion in hepatic segment VIII, measuring 1 cm, not\nappreciated on the prior examination. There is a 4 mm hypoattenuating lesion\nin hepatic segment 8, not appreciated on the prior examination (image 51,\nseries 2). No intrahepatic biliary ductal dilatation. The gallbladder is\nnormal, without stones or wall thickening.\n\nPANCREAS: There is pancreatic ductal dilatation in the distal body and tail of\nthe pancreas, with parenchymal atrophy, and an ill-defined pancreatic body\nmass, best seen on image 28 of series 601, measuring up to approximately 7 mm.\nThere is no peripancreatic stranding.\n\nSPLEEN: Hypoattenuating splenic lesions measuring up to 7 mm are unchanged\nfrom the prior examination. The spleen is not enlarged.\n\nADRENALS: The patient's right adrenal heterogeneously enhancing mass measures\nup to 3.3 cm, unchanged. The left adrenal is surgically absent.\n\nURINARY: The left kidney is surgically absent. The right kidney is unchanged\nin appearance, with cysts measuring up to 4.9 cm. No hydronephrosis or\nconcerning right renal lesions.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel is seen and a\nperiumbilical hernia, without evidence for obstruction. Diverticulosis noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Brachytherapy seeds noted in the prostate.\n\nLYMPH NODES: Surgical clips noted in the left periaortic retroperitoneum. No\nretroperitoneal adenopathy. Necrotic nodal along the course of the SMV\nmeasures up to 2.2 cm, unchanged. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There has been marked in progression of the patient's osseous\nmetastatic disease. For example: There is an expansile lesion involving the\nright iliac bone, measuring 8.1 x 5.8 cm, with marked interval extension into\nthe iliacus and right gluteal musculature. (Image 101, series 2). Similarly,\nthere has been worsening of the patient's left iliac lesion adjacent to the\nsacroiliac joint. The left ischial tuberosity mass now measures 5.2 by 5.1\ncm, previously measuring 3.5 x 3.2 cm. There is a femoral lesion just distal\nto the greater trochanter, which now extends into the femoral musculature.\n\nSOFT TISSUES: Periumbilical hernia containing small bowel noted, without\nevidence for obstruction. There is intramuscular extension of tumor as above.", "output": "Progression of metastatic disease characterized by:\n\n1. Marked interval progression of osseous metastatic disease, with\nextraosseous, intramuscular extension, most notably involving the large right\niliac metastasis measuring up to 8 cm.\n2. New and enlarging liver lesions as above.\n3. The patient's necrotic mesenteric node and right adrenal metastatic lesion\nare unchanged.\n4. Poorly visualized, ill-defined mass the body of the pancreas, measuring up\nto approximately 7 mm, producing upstream ductal dilatation.\n5. Periumbilical hernia, containing small bowel, without evidence for\nobstruction.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 17:56 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "For a full report of the chest component of this examination, please refer to\nconcurrent acquired examination from the same day.\n\nCT of the abdomen:\n\nThe liver enhances homogeneously without focal hepatic lesions identified.\nThere is no intra or extrahepatic biliary ductal dilatation. The gallbladder\nis normal. Lobulated hypodense lesion in the body of the pancreas measures\napproximately 17 x 11 mm, stable as compared to prior CT examination and\nlikely reflective of IPMN (series 5, image 61). Hypodense lesions within the\nspleen have increased in size, the largest measuring 1.6 x 1.5 cm in the lower\nsegment of the spleen (series 5, image 73), previously measuring up to 11 mm.\nSmaller hypodensities along the lateral aspect of the spleen are also\nincreased in size, measuring up to 6 mm (series 5, image 60). There is\nredemonstration of a 3.2 x 2.4 cm heterogeneous lesion within the right\nadrenal gland, slightly decreased in size as compared to prior CT (series 5,\nimage 60). Patient is status post left adrenalectomy, left nephrectomy and\nretroperitoneal lymph node dissection. There is no evidence of local\nrecurrence or new soft tissue lesions within the nephrectomy bed. The right\nkidney is normal with no renal masses identified. There is a 1.4 cm and 3.6 cm\ncyst in the upper and lower pole of the right kidney respectively.\n\nNote is made of a high density rounded focus arising adjacent to a branch of\nthe gastroduodenal artery along the inferior pancreas which given its\nappearance and morphology might reflect a small aneurysm, however this lesion\nwas not present on prior CT from ___, might alternatively represent\na small metastatic lesion (series 8, image 22).\n\nThe stomach and small bowel are grossly unremarkable. There is a bowel\ncontaining small ventral hernia, with no evidence of bowel incarceration or\nobstruction. There is extensive sigmoid diverticulosis with no evidence of\nacute diverticulitis. A prominent mesenteric lymph node now measures up to 15\nmm (series 5, image 85), decreased in size as compared to prior CT\nexamination. The intra-abdominal aorta is of normal diameter. The celiac axis,\nSMA, right renal artery and ___ are grossly patent. There is no free fluid.\nThere is no free air.\n\nCT of the pelvis:\n\nThe urinary bladder and terminal ureters are normal. The rectum is normal. \nThickened right spermatic cord is similar but more prominent as compared to CT\nexamination from ___. There is a small left-sided fat containing inguinal\nhernia.\n\nOsseous structures: A 5.2 x 2.8 cm predominately lytic lesion in the right\niliac wing with associated cortical destruction and soft tissue component, has\nincreased in size as compared to prior CT (series 5, image 106). No additional\nconcerning lesions identified.There are moderate multilevel degenerative\nchanges of the lower lumbar spine.", "output": "1. Progression of metastatic disease involving splenic and right iliac wing\nlesions.\n\n2. Right adrenal mass and mesenteric lymphadenopathy has slightly decreased\nin size.\n\n3. Rounded focus arising adjacent to a branch of the gastroduodenal artery\nalong the inferior pancreas which given its appearance and morphology might\nrepresent a small aneurysm, however this lesion was not present on older CT\nstudies such as from ___, and findings could also represent a small\nmetastatic lesion.\n\n4. Stable cystic pancreatic lesions, likely IPMN." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The patient is status post\ncolectomy with formation of a J-pouch. A small bowel-small bowel anastomosis\nin the right lower quadrant is without evidence of complication. There is\nextensive bowel wall thickening and edema of involving approximately 20 cm of\nthe patient's distal small bowel, immediately proximal to the rectal\nanastomosis. The appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no upper retroperitoneal or mesenteric lymphadenopathy. \nThere is mild prominence of pelvic lymph nodes, likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Findings consistent with pouchitis. No evidence of obstruction" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Contrast is noted\nwithin the renal collecting system. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is a segment of sigmoid\ncolon at the site of the anastomosis which appears irregular and dilated with\nextensive surrounding extraluminal locules of gas, fat stranding, and stool\ncontents, compatible with perforation, possibly from diverticulitis. Rectal\ncontrast is seen within this collection and the contrast extends within the\nproximal remaining colon. Additional extraluminal gas is seen tracking along\nthe left retroperitoneal space (02:19). Multiple scattered colonic\ndiverticulosis is seen in the remaining segments of colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. Multiple prominent\nmesenteric lymph nodes are noted without meeting CT size criteria for\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen along the lumbosacral spine, at the L5-S1 level.\n\nSOFT TISSUES: Postsurgical changes are seen along the anterior abdomen. There\nare 2 ventral hernias which contain loops of nonobstructive bowel and fat.", "output": "1. A segment of sigmoid colon along the anastomosis appears perforated with\nextensive extraluminal locules of gas, surrounding fat stranding, and bowel\ncontents, possibly secondary to diverticulitis. Rectal contrast is noted\nwithin this collection and extends into the proximal colon.\n2. Retroperitoneal air is seen to extend along the left flank to the spleen" }, { "input": "LOWER CHEST: There is right basilar atelectasis and a trace effusion, similar\nto prior. There is mild unchanged left basilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.3 x 1.3 cm simple cyst is unchanged. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is no evidence of\nsmall-bowel obstruction.\n\nContrast extends to the rectum. Surgical suture noted in the left hemipelvis\nwith persistent wall thickening of the colon in this location. Adjacent to\nthe anastomosis is extensive extraluminal gas/fluid tracking along the\nretroperitoneal space to the level of the mid abdomen. A new pigtail drainage\ncatheter is noted in the left flank. Compared to prior examination there has\nbeen mild interval increase in the amount of fluid and air with some areas\nbecoming more walled-off when compared to the most recent prior examination. \nThis is best demonstrated by a 5.9 x 8.5 x 9.7 cm air in fluid containing\norganizing collection inferior to the right kidney. Linear high density\nmaterial just distal to the anastomosis in a similar location to prior CT from\n___ and is likely the site of perforation (Series 2, image 67; series\n601, image 49).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a large bowel containing midline abdominal wall hernia\nand a small bowel containing right ventral hernia.", "output": "1. Mild interval increase in extensive extraluminal gas and fluid since\n___, with some of these areas for example inferior to the right kidney\nbecoming more organized when compared to the prior examination from ___.\n2. Tiny focus of extraluminal oral contrast just distal to the large bowel\nanastomosis (601, 49) in a similar location to prior which likely reflects the\nsite of perforation." }, { "input": "LOWER CHEST: There is right basal atelectasis, which has improved comparison\nto the prior study. There are multiple centrilobular nodules within the\ndependent portions of the right lower lobe (axial series 2, image 3).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 13 mm renal cortical cyst within the lower pole of the right kidney. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a rim enhancing\ncollection within the left anterior abdomen abutting the greater curvature of\nthe stomach superiorly as well as a loop of small bowel inferiorly which\nmeasures 3.8 x 3.7 x 8.0 cm (axial series 2, image 48; coronal series 601,\nimage 27). This has increased in size in comparison to the prior study dated\n___ where it measured 1.7 x 1.9 x 3.6 cm.\n\nThere is diffuse mural thickening with surrounding inflammatory stranding\ninvolving the proximal jejunum (axial series 2, image 76) with associated\ntethering of the small bowel loops. Posterior and to the right of these\nthickened small bowel loops, there is a rim enhancing collection measuring 5.0\nx 4.4 x 4.7 cm (axial series 2, image 73; coronal series 601, image 36), not\npreviously measurable. This is at the location of prior surgical drains,\nwhich have been removed in the interval. This collection does appear to\ncommunicate with a thin portion of fluid which extends towards the left (axial\nseries 2, image 73), and this portion of the fluid collection appears to have\nslightly decreased in size or redistributed in the interval. There is also a\n28 mm loculated component superior to the bladder and superior to the vaginal\ncuff scratch (axial series 2, image 78). This fluid collection does contain\nfoci of gas, which are not evident on the prior exam. However, the small\nbowel remains normal in caliber without evidence of mechanical obstruction.\n\nPatient is status post left hemicolectomy with rectal stump and left lower\nquadrant colostomy. There is oral contrast within the distal ileum as well as\nremnant colon, exiting through the colostomy.\n\nThere is a large ventral wall hernia containing multiple nonobstructed loops\nof small and large bowel.\n\nPELVIS: Interval removal of Foley catheter. Normal contour of the urinary\nbladder wall. There is gas within the bladder lumen, likely post\ncatheterization. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy. There is trace fluid within\nthe vaginal cuff.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is moderate degenerative disc disease at L4-L5 and L5-S1.\n\nSOFT TISSUES: Large ventral wall hernia containing nonobstructed loops of\nlarge and small bowel as well as trace free fluid, which appears comparable to\nprevious. There is a drainage catheter which traverses the left anterior body\nwall subcutaneous tissues with tip in the left upper midline subcutaneous\ntissues. There is a small adjacent loculated fluid collection which has\ndecreased in size in comparison to prior (axial series 2, image 34). Deeper\npelvic percutaneous drains have been removed since the prior study.", "output": "1. New rim enhancing gas and fluid containing collection within the pelvis\nadjacent to the proximal jejunum at site of prior drains, with several\nloculations insinuating deeper into the pelvis. Associated inflammatory\nchanges of the adjacent small bowel.\n2. Interval increase size of left anterior abdominal rim enhancing collection.\n3. No evidence of mechanical bowel obstruction.\n4. Centrilobular nodular opacities within the right lower lobe, likely\ninfectious/inflammatory. Aspiration is a differential consideration.\n5. Stable postsurgical changes of a left hemicolectomy with left lower\nquadrant colostomy. Large ventral wall hernia containing nonobstructed large\nand small bowel appears unchanged." }, { "input": "LOWER CHEST: There is persistent bibasilar atelectasis. Note is again made of\nmucous plugging and multiple centrilobular nodules in the right lower lobe,\nlikely secondary to aspiration. This has slightly increased in extent\ncompared to the prior study.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n13 mm right renal cyst is unchanged. There is no other focal renal lesion. \nThere is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL:\nThe stomach is unremarkable.\nNote is again made of mild thickening of jejunal loops in the central abdomen\nassociated with tethering. There is no bowel obstruction. Bowel wall\nenhancement is preserved.\nPatient is status post left hemicolectomy with a rectal stump and left lower\nquadrant colostomy. There is no evidence of large bowel obstruction.\n\nPreviously seen collection within the left anterior abdomen inferior to the\ngreater curvature of the stomach has almost completely resolved with a pigtail\ncatheter in situ.\nThe second collection in the lower abdomen interposed between loops of small\nbowel has also been drain in the interval with near complete resolution. A\nsmall amount of residual fluid is noted anterior to the rectal stump within\nthe hysterectomy bed. A small residual linear pocket of gas tracks superiorly\nfrom this region and into the left lower abdomen.\nThere is no new intra-abdominal fluid collection. Note is made of focal fat\nstranding/fat necrosis within the central mesentery (series 2, image 55)\nsimilar to the prior study.\n\nMultiple prominent mesenteric lymph nodes are likely reactive.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or pelvic lymphadenopathy. Slightly\nprominent right common iliac node is likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Re-demonstration of large ventral wall hernia containing\nnonobstructive loops of large and small bowel and trace free fluid, comparable\nto the prior study. Drainage catheter previously seen in the left anterior\nbody wall has been removed. Small loculated fluid collection within the lower\nanterior abdominal wall has slightly decreased in size in the interval\nmeasuring 4 cm, previously 5.7 cm.", "output": "1. Near complete resolution of previously seen fluid collections in the pelvis\nand left lower abdomen. Small amount of residual fluid persists just anterior\nto the rectal stump.\n2. No new collection seen in the abdomen and pelvis.\n3. Interval decrease in size of the fluid collection in the anterior abdominal\nwall.\n4. Persistent centrilobular opacities in the right lower lobe which have\nslightly increased in extent, likely secondary to aspiration." }, { "input": "LOWER CHEST: Persistent atelectasis is noted in the right lower lobe that is\npartially visualized. The centrilobular nodules discussed on the prior study\nwere not imaged on the current examination. A few paraseptal emphysematous\nbullae are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is incompletely imaged. Within this limitation,\nthere is hepatomegaly with the liver measuring at least 26.8 cm in\ncraniocaudad dimension. The liver is homogeneous in attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.3 cm right lower pole renal cyst is again noted. No hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status post left\nhemicolectomy with a rectal stump and a left lower quadrant colostomy. \nPreviously, two left sided abdominal drainage catheters were noted. There has\nbeen interval removal of the superior drainage catheter in the left abdomen. \nAlong the tract of the removed drainage catheter, there is a 4.3 x 1.1 x 1.6\ncm residual fluid collection with peripheral enhancing lymph which is not\nsignificantly changed from the prior study (06:25). A small residual linear\npocket of gas tracks inferiorly along this region into the left lower abdomen,\nunchanged from the prior study.\n\nThe lower drainage catheter is unchanged in position with near complete\nresolution the collection. No new abscess is identified. Again noted is\nfocal fat stranding/fat fat necrosis within the central mesentery, unchanged. \nThere is a 3.3 X 2.3 X 4.2 cm fat and soft tissue density collection with a\nhyperattenuating rim suggestive of an omental infarction (05:50).\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes of the lower lumbar spine, bilateral sacroiliac\njoints, and bilateral hips.\n\nSOFT TISSUES: There is increased gas and skin ulceration on long the midline\nanterior abdominal wall scar spanning greater than 10 cm in craniocaudad\ndimension (see 5: 53). No underlying abscess is identified in this region. \nThere is a 2.7 cm fluid collection along the inferior margin of the scar,\ndecreased in size since prior. This is approximately 10 cm inferior to the\ninferior margin of the above-mentioned skin ulceration and likely unrelated.", "output": "1. Since ___, there has been interval removal of the superior left\nabdominal abscess drain. Along the tract of the removed drainage catheter is\na 4.3 x 1.6 cm fluid collection with peripheral enhancement which is not\nsignificantly changed from the prior study.\n2. The lower drainage catheter is unchanged in position with near complete\nresolution of the collection.\n3. No new abscess is identified.\n4. There is increased gas and skin ulceration along the midline anterior\nabdominal wall scar spanning greater than 10 cm. Findings are concerning for\ndehiscence. No abscess is identified. However, underlying infection cannot\nbe excluded. Clinical correlation is requested.\n5. Subcutaneous fluid collection along the inferior margin of the scar\nmeasuring 2.7 cm, decreased in size since prior.\n6. 3.3 x 2.3 x 4.2 cm fat soft tissue density with a hyperattenuating rim\nsuggestive of an omental infarct." }, { "input": "LOWER CHEST: There are ___ opacities along with areas of atelectasis\nin the right lower lobe consistent with lung collapse with superimposed\ninfectious or inflammatory bronchiolitis.\n\nHEPATOBILIARY: There is homogeneous hepatic enhancement with no suspicious\nmass lesions. Gallbladder is unremarkable. There is no biliary ductal\ndilatation. Portal vein and hepatic veins are patent.\n\nPANCREAS: Pancreas remains atrophic with no suspicious mass lesions or biliary\nductal dilatation.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY: There is no hydronephrosis. There is a right subcentimeter renal\ncortical hypodensity anteriorly likely representing a cyst.\n\nGASTROINTESTINAL: Re-demonstration of extensive postsurgical changes within\nthe abdomen status post left hemicolectomy, midline surgical scar, left lower\nquadrant colostomy, right lower quadrant wound VAC and left pelvic drain\ncatheter placement. There is re-demonstration of extensive inflammatory\nchanges surrounding the small and large bowel loops, mainly the transverse\ncolon. There has been interval increase in the size of a intra-abdominal\nirregular collection surrounding the transverse colon and adjacent to the\ncolostomy, measuring 4.6 cm in thickness, 11 cm in width and up to 3.3 cm in\nheight. Gas locules are noted within this collection. No enteric contrast is\nnoted within to suggest bowel leak. This is bordered on the right side close\nto the skin by the wound VAC, however it does not communicate with the wound\nVAC. There is no evidence of bowel obstruction. Oral contrast reaches the\ncolostomy bag.\n\nPERITONEUM: As above. There is a linear air filled tract along the left\npelvic sidewall that has not significantly changed (series 601, image 37). \nLeft pelvic drain is again noted with no large amount of fluid collection\nsurrounding the pigtail.\n\nLYMPH NODES: Prominent reactive mesenteric lymph nodes as well as prominent\nretroperitoneal lymph nodes.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches.\n\nPELVIS: Rectal pouch is unremarkable. Urinary bladder is filled with\ncontrast.\n\nBONES:There are no acute osseous abnormalities. There are degenerative\nchanges at L5-S1.\n\nSOFT TISSUES: Wound VAC is present in the right lower quadrant. There is\ndiastasis of the anterior abdominal wall muscles.", "output": "1. Irregular 11 cm anterior intra-abdominal collection surrounding the\ntransverse colon and adjacent to the colostomy. This is technically amenable\nfor CT-guided drainage.\n2. Extensive postsurgical changes as detailed above.\n3. No significant amount of fluid surrounding the left pelvic drain. This can\nbe potentially removed.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:09 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Persistent centrilobular nodules involving the right lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. No hepatic mass. Mild prominence\nof the right intrahepatic bile ducts, unchanged from previous. The\ngallbladder is within normal limits.\n\nPANCREAS: Mildly atrophic appearance of the pancreatic parenchyma appears\nunchanged from previous. No pancreatic mass is identified.\n\nSPLEEN: Is normal in size.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: 1.4 cm cyst arising from the lower pole of the right kidney. No\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. No small or large bowel\ndistention. Is a large ventral hernia containing multiple nonobstructed loops\nof large and small bowel. Patient has had a prior left hemicolectomy with\ndiverting left lower quadrant colostomy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ninflammatory stranding within the pelvis without discrete fluid collection. \nThere is a persistent gas filled tract extending from the vaginal cuff along\nthe left hemipelvis (axial series 2, image 72). This is unchanged from\nprevious and there is no oral contrast opacification of this tract.\n\nREPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass.\n\nLYMPH NODES: Several prominent retroperitoneal lymph nodes, none of which are\nenlarged by CT size criteria. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes of the lumbar spine, worst at L5-S1.\n\nSOFT TISSUES: Large ventral wall hernia containing nonobstructed loops of\nsmall and large bowel. There are 2 percutaneous drainage catheters, 1\nentering from the left lower abdomen with its tip in the subcutaneous tissues\nof the left anterior abdominal wall and a second with a left pelvic insertion\nwith its tip in the anterior lower pelvis. There is no significant fluid\ncollection around either of these catheters or elsewhere in the soft\ntissues/pelvis.", "output": "1. No residual fluid collection/abscess is identified within the subcutaneous\ntissues or pelvis. 2 percutaneous pigtail drainage catheters remain in stable\nposition, without significant surrounding fluid.\n2. Persistent centrilobular nodules within the right lower lobe, suspicious\nfor aspiration pneumonitis/pneumonia.\n3. Postsurgical changes from left hemicolectomy and left lower quadrant\ncolostomy." }, { "input": "LOWER THORAX: Bronchial wall thickening is noted in the lung bases. No pleural\nor pericardial effusion.\n\nHEPATOBILIARY: The liver is unremarkable. A small portion of the hepatic dome\nis excluded from the field-of-view. Calcified granuloma is noted within\nsegment 4A. No biliary ductal dilatation. The gallbladder is contracted.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. 12 mm cyst arising from the lower pole\nof the right kidney. No hydronephrosis. Bladder is only partially filled but\ndemonstrates diffuse wall thickening, likely reactive.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel are\nnormal in caliber, without evidence of mechanical obstruction. Status post\n___ with diverting left lower quadrant colostomy and rectal stump. \nThere is extensive inflammatory change within the pelvis, with soft tissue\nphlegmon but no drainable collection. The degree of phlegmonous change\nappears to have increased in comparison to the prior study (coronal series\n303, image 30). There is associated tethering of multiple small bowel loops\nin the pelvis as well as the rectal stump in this region (axial series 2,\nimage 60). There is a large ventral wall hernia containing a portion of the\nliver, distal stomach, transverse colon, and small bowel. There is no\nextravasation of oral contrast identified to suggest a definite leak.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent. No adnexal mass.\n\nLYMPH NODES: Prominent portocaval lymph nodes. there are multiple enlarged\nleft-sided external iliac lymph nodes, which appear increased in size in\ncomparison to the prior examination. Borderline prominent aortocaval lymph\nnode.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Organized enhancing inflammatory\nscarring within the pelvis with tethering of the multiple small bowel loops,\nthe rectal stump, and vaginal cuff and appears to have increased in comparison\nto the prior examination with increased peritoneal thickening and stranding\nextending up the left iliac fossa (axial series 2, image 55). There is a\npercutaneous drainage catheter in situ, however no drainable fluid collection\nis identified. There is also a 12 x 27 mm soft tissue mass within the small\nbowel mesentery (axial series 2, image 49) which appears slightly increased in\nsize in comparison to the prior examination and may represent an enlarged\nmesenteric lymph node.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic calcification.\n\nBONES: Degenerative changes of the lumbar spine, worst at L4-L5 and L5-S1.\n\nSOFT TISSUES: Large ventral wall hernia containing a portion of the liver,\nstomach, small bowel, and colon without evidence of mechanical obstruction. \nLeft lower quadrant diverting colostomy. Interval removal of percutaneous\npigtail drainage catheter from the left anterior abdominal wall near the level\nof the left lower quadrant colostomy.", "output": "1. Interval worsening inflammatory scarring within the pelvis extending up the\nleft side of the peritoneum without definite drainable fluid collection. \nThere is associated tethering of several loops of small bowel, the rectal\nstump, and vaginal cuff. No definite contrast extravasation is identified to\nsuggest bowel leak. Percutaneous drainage catheter remains in situ.\n2. Left pelvic sidewall and retroperitoneal adenopathy, likely reactive. \nEnhancing mass within the small bowel mesentery may also represent an enlarged\nlymph node.\n3. Large ventral wall hernia containing a portion of the liver, stomach, small\nbowel, and colon without evidence of mechanical obstruction." }, { "input": "LOWER CHEST: Bibasilar consolidation, right greater than left. Please refer\nto separate report of CT chest performed on the same day for description of\nthe thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is distended, without\nassociated wall thickening or inflammatory change. A tiny focus of free a\nintraperitoneal air is demonstrated near the anterior hepatic margin (2:61),\nlikely sequela of recent surgery.\n\nPANCREAS: There is mild diffuse fatty atrophy of the pancreas, without\nevidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. A 1.3 cm simple renal cyst is seen in the\ninterpolar region of the right kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Interval midline laparotomy with colostomy revision and\nreduction of previously identified large ventral hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The patient is status post proctosigmoidectomy\nwith an end colostomy in the left paramidline abdomen. In the mid pelvis\nanterior to the rectal stump there is a 6.8 x 4.6 cm rim-enhancing collection\nwhich is new from most recent CT scan from ___. A left anterior\napproach surgical drain traverses the length of the collection. At the right\nanterior pelvis adjacent to small bowel loops there is another 4.9 x 3.6 cm\nrim-enhancing fluid collection (602:39, 601:26). A previously seen soft\ntissue density mass within the mesentery is no longer visualized. There is\nill-defined, focal stranding of the mesentery anterior to the left of the\naortic bifurcation (2:90).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: Prominent lymph nodes within the mesentery and paraortic region\nare likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Redemonstration of degenerative changes of the lumbar spine, worst at\nL4-L5 and L5-S1.\n\nSOFT TISSUES: There is a midline laparotomy wound with associated fat\nstranding, consistent with postsurgical changes. There is also some stranding\nof the anterior mesentery below the rectus sheath. Surgical drains are seen\nin the subcutaneous tissues bilaterally along the anterior abdominal wall. \nThere is no fluid collection in the abdominal wall. There is stoma in the\nleft paramidline abdomen from revision colostomy.", "output": "1. Interval midline laparotomy with colostomy revision and reduction of large\nventral hernia. A left paramidline ostomy is present. Surgical drains course\nalong either side of the abdominal wound. No fluid collection in the\nabdominal wall.\n2. Rim-enhancing fluid collection in the right anterior pelvis measuring 4.9 x\n3.6 cm, which could represent hematoma or abscess.\n3. 6.8 x 4.6 cm rim-enhancing fluid collection in the mid pelvis anterior to\nthe rectal stump, traversed by a surgical drain. Findings could represent\nhematoma or abscess. Correlate with drain output.\n4. Please refer to separate report of CT chest performed on the same day for\nfull description of thoracic findings." }, { "input": "LOWER CHEST: There is very mild dependent atelectasis in the right middle\nlobe. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low attenuation throughout compatible\nwith hepatic steatosis. There is a small amount of subcapsular simple fluid\nposterior to the right lobe. There is no focal lesion. There is no intra or\nextrahepatic biliary dilatation. The gallbladder is unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a splenule.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. There is a trace\namount of fluid in the right hemipelvis (series 4:69). There is also small\ncircumscribed area of simple fluid in the left pericolic gutter (series 4:41).\nThere is no evidence of obstruction. There is mild fatty stranding of the\nabdomen and pelvis, nonspecific.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormality to explain patient's right flank and right lower\nquadrant pain. The appendix is normal. No evidence of obstruction. No\nhydronephrosis or nephrolithiasis.\n2. There is a small amount of perihepatic ascites or subcapsular fluid. There\nis also a trace amount of free fluid in the right lower quadrant and left\nparacolic gutter, nonspecific but could be related to liver disease." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in bilateral lower lobes. \nThere is a subpleural pulmonary nodule in the right lower lobe measuring 0.5\ncm (2:3), not visualized on CT abdomen and pelvis ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a heterogeneous subcapsular ovoid lesion in the posterior right lobe\n(segment VI/VII) which measures 3.7 x 2.6 cm (2:20), not clearly seen on the\nprior exam from ___. Of note, there was a subcapsular simple fluid\ncollection in this region on ___. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. There is small volume\nascites in the abdomen and pelvis which is increased as compared to ___, with some perihepatic ascites noted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a probable accessory spleen adjacent to\nthe medial margin of the spleen measuring 1.3 x 1.3 cm (02:16).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nsubmucosal fat within the ascending colon, not definitely visualized on ___, which likely can be seen in normal individuals or reflect sequela\nof chronic inflammatory changes. The appendix is normal.\n\nPELVIS AND REPRODUCTIVE ORGANS: There is a new left adnexal heterogeneous\nmixed solid and cystic mass with irregular mural nodularity measuring 9.8 x\n10.0 cm (2:68), new as compared to ___. There is significant\nsurrounding fatty stranding and a small volume of fluid in the pelvis. Right\nadnexa and uterus are grossly unremarkable.\n\nLYMPH NODES: There is a left para-aortic lymph node measuring 1.5 cm (02:40)\nin short axis, new as compared to ___. Mesenteric lymph nodes\nmeasuring up to 0.6 cm in short axis (2:39) are not pathologically enlarged in\nsize by CT size criteria, grossly unchanged from ___\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New left adnexal mixed cystic and solid mass with irregular peripheral\nmural nodularity measuring 9.8 x 10.0 cm, highly suspicious for a primary\novarian neoplasm. Gynecologic consultation is suggested and MRI with contrast\nof the pelvis can be obtained for further assessment.\n2. Subcapsular lesion in the right lobe of the liver measuring up to 3.7 cm,\nnot clearly seen on ___, concerning for metastatic disease. Of note,\non ___, there was a subcapsular simple fluid collection in this area.\nMRI of the liver with IV contrast is suggested for further assessment.\n3. Enlarged left para-aortic lymph node is new since ___, concerning\nfor metastatic disease.\n4. 5 mm subpleural nodule in the right lower lobe, new as compared to ___. Nonurgent dedicated CT chest is recommended for further\ncharacterization.\n5. Small amount of ascites is increased as compared to ___.\n6. Normal appendix.\n\nRECOMMENDATION(S):\n1. MRI of the pelvis with IV contrast for further assessment of the left\nadnexal mass.\n2. MRI of the liver with IV contrast for further assessment of the subcapsular\nright hepatic lobe lesion.\n3. Noncontrast chest CT for evaluation of the chest." }, { "input": "LUNG BASES: There is bibasilar atelectasis. There are calcified granulomas\nin the lung bases. Cardiomegaly with significant right atrial enlargement is\nnoted.There is no pericardial pleural effusion.\n\nCT ABDOMEN: The liver enhances homogeneously. There are no focal liver\nlesions. The portal and hepatic veins are patent. There is no intra hepatic\nbiliary dilatation. The common bile duct is prominent measuring 8 mm,\nunchanged compared to prior studies. The gallbladder is surgically absent. The\npancreas enhances homogeneously. The spleen and adrenal glands are normal.\nKidneys enhance and excrete contrast promptly. A right renal cyst measures 4\nx 4.6 cm. Multiple additional subcentimeter renal hypodensities are too small\nto further characterize but most likely represent simple cysts. There are no\nconcerning renal lesions.\n\nCT PELVIS: The patient is status post cystectomy with ileal cutaneous\nconduit. The ileal conduit in the right lower quadrant and appears patent\nwithout evidence of obstruction. A peristomal hernia is again noted to contain\na nonobstructed loop of transverse colon. The prostate and seminal vesicles\nappear normal.\n\nThere is no retroperitoneal or abdominal adenopathy. No ascites is present.\nThe aorta and its major branches are patent and not dilated. The stomach and\nintra-abdominal loops of small bowel are normal caliber and appearance. There\nis a large fecal load throughout the colon. There is colonic diverticulosis\nwithout evidence of diverticulitis.\n\nBONES: A compression deformity of the L3 vertebral body is stable. No\nconcerning osteolytic or osteoblastic lesions.", "output": "1. No acute intra-abdominal process.\n2. Large fecal load throughout the colon.\n3. Cardiomegaly." }, { "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is unremarkable. No biliary dilation. Gallbladder is\nunremarkable.\n\nPANCREAS: The native pancreas is mildly atrophic. Transplant pancreas with\nassociated duodenal stump and enteric drainage is noted in the right lower\nquadrant. There is a small amount of loculated peripancreatic fluid and a\nregion of parenchymal fluid attenuation adjacent to the duodenal stump which\nmay be related to a pre-existing pancreatic cystic lesion or loculated\npostoperative fluid within the parenchyma (3,27), amenable to follow up.\n\nThe venous drainage of the pancreas is to the common iliac vein and appears\npatent although mildly attenuated at the anastomosis. The arterial supply is\nfrom the right common iliac vein is also patent. A right lower quadrant JP\ndrain terminates just adjacent to this area.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: Bilateral native kidneys appear mildly atrophic. Numerous hypodense\nlesions throughout bilateral native kidneys are too small to characterize. \nLeft lower quadrant transplant kidney appears well perfused and without\nhydronephrosis. A small amount of perinephric fluid around the transplant\nkidney may be postsurgical. A ureteral stent extends from the collecting\nsystem of the transplant kidney into the bladder.\n\nGASTROINTESTINAL: No bowel obstruction. Postoperative changes are noted in\nthe anorectal region from known imperforate anus repair. No free air, ascites\nor drainable fluid collections. Mild soft tissue stranding in the lower\nabdomen and pelvis likely from recent instrumentation.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: No pelvic lymphadenopathy. Trace free fluid in the pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ncalcifications are seen. New central grafts to the pancreas transplant appear\npatent. Transplant renal artery and renal vein appear patent. A right\nfemoral approach central venous catheter terminates in the right external\niliac vein.\n\nBONES: Osseous findings related to renal osteodystrophy are noted.\n\nSOFT TISSUES: Postsurgical changes are noted along the anterior abdominal\nwall. Right lower quadrant approach drain is also noted as above.", "output": "1. The pancreatic and renal transplant vasculature is patent. Small amount of\nloculated fluid around the renal and pancreatic strands plans are likely\npostoperative. No drainable fluid collections.\n2. Focal fluid density in the proximal pancreas adjacent to the blind ending\nduodenum and expected drainage of the pancreatic duct may be postoperative\nfluid or a pre-existing pancreatic cystic lesion, amenable to reassessment on\nroutine imaging.\n3. No acute intra-abdominal process. No findings to explain diarrhea." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The native pancreas is mildly atrophic, without evidence of focal\nlesions or pancreatic ductal dilatation. The patient is status post\npancreatic transplant. The transplanted pancreas is closely surrounded by\nbowel slightly limiting evaluation for fluid collection, however within this\nlimitation there is no evidence of drainable fluid collection. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are mildly atrophic, without evidence of contrast\nexcretion and without concerning renal lesions or hydronephrosis. \nSubcentimeter hypodensities in bilateral native kidneys are too small to\ncharacterize, but are statistically likely to be simple cysts. Punctate renal\nstones are seen in bilateral kidneys. The left iliac fossa transplant kidney\nis again no hydronephrosis. A small amount of fluid around the transplant\nkidney is similar compared to prior.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized. \nPostoperative changes from and imperforate anus are noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or lymphadenopathy. Small inguinal lymph nodes do not meet the\nCT size criteria for lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are pronounced at L3-4 with moderate disc space\nnarrowing. There has been prior resection of the lower sacrum and coccyx.\n\nSOFT TISSUES: Soft tissue stranding along the midline is consistent with prior\nsurgery. Otherwise, the abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal abnormality. Specifically no evidence of\ndrainable fluid collection abutting the transplant pancreas, however\nevaluation is slightly limited by the close association of the small bowel\nwith the pancreas and lack of oral contrast.\n2. Status post renal transplant without evidence of complication.\n\nRECOMMENDATION(S): In the future, CT of the abdomen pelvis should be\nperformed with oral contrast given postsurgical change and difficulty in\nseparating pancreatic transplant from adjacent bowel loops." }, { "input": "Please refer to the same-day dedicated CT chest exam for full description of\nintrathoracic findings\n\nThere are numerous hepatic cysts, hypodense lesions too small to characterize\nand a few hemangiomas (series 4, image 51). Mild intrahepatic biliary\ndilatation is noted, likely sequela of prior cholecystectomy. The adrenal\nglands, spleen, and pancreas are unremarkable.\n\nMultiple peripelvic cysts are seen in the kidneys. No hydronephrosis.\nSubcentimeter hypodensities in the renal cortices are too small to fully\ncharacterize.\nUnchanged appearance of a 1.6 cm aneurysm of the proximal celiac artery since\n___.\n\nThere is no obstruction or ascites. Mild sigmoid diverticulosis is seen\nwithout evidence of acute diverticulitis. There is a 1.6 x 0.9 cm calcified\nstone in the bladder (4:109)\n\nPatient is status post left hip arthroplasty, lumbar spinal hardware removal\nand lower lumbar laminectomy. No aggressive osseous lesions. Fatty atrophy\nof the left iliopsoas muscle noted.", "output": "1. No acute CT findings in the abdomen or pelvis to account for patient's\nsymptoms. Specifically, no abdominopelvic adenopathy.\n2. 1.5 cm bladder stone. Multiple peripelvic cysts are seen in the kidneys. \nNo hydronephrosis." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis, right greater than left. \nRight middle lobe nodules are also unchanged. There is no evidence of pleural\nor pericardial effusion. Heart is moderately enlarged. Pacer leads and\naortic valve calcifications as well as coronary artery calcifications are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple round hypodensities within the liver, the\nlargest measuring up to 3.2 x 2.1 cm in the left lobe, and is compatible with\nthe simple cyst. Additional hypodensities are too small to characterize but\nlikely cysts. No focal concerning lesions identified. There is no evidence\nof intrahepatic biliary dilatation. Patient is status post cholecystectomy\nwith the common bile duct measuring up to 1.3 cm.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple bilateral renal hypodensities, most of which are too small\nto further characterize. The largest arising from the interpolar region of\nthe left kidney and measuring up to 3.3 x 3.6 cm is compatible with a simple\ncysts. Otherwise, the kidneys are of normal and symmetric size. No\nconcerning renal lesion identified. No hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable besides a small hiatal hernia. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnot seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcified fibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative changes of the lumbar spine. There is grade\n1 anterolisthesis of L4 on L5, unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process to explain patient's symptoms." }, { "input": "LOWER CHEST: Visualized lung bases are clear. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A\n12 mm hypodensity in segment ___ measures fluid density and likely represents\na cyst. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas demonstrates normal bulk and attenuation. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple punctate nonobstructing stones are noted within the\ncollecting system in the right kidney. There is moderate right\nhydroureteronephrosis secondary to an obstructing 3 mm stone in the distal\nright ureter just proximal to the UVJ. No stones are seen in the left kidney.\nThere are no concerning renal lesions within limitation of an unenhanced exam.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber. The colon and\nrectum are unremarkable. The appendix is normal.\n\nPELVIS: As above, there is a 3 mm obstructing stone in the distal right\nureter, just proximal to the UVJ (2:62). The left distal ureter is\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: No lymphadenopathy within the abdomen pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: No concerning osseous lesions. No acute fracture. There is mild\nlumbar levoscoliosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Moderate right hydroureteronephrosis secondary to a 3 mm obstructing stone\nin the distal right ureter, just proximal to the UVJ. Additional punctate\nnonobstructing stones are seen in the right kidney." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hepatic hypodensities measuring up to 3.6 cm are unchanged from ___ and are consistent with hepatic cysts or biliary hamartomas. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid, descending and transverse colon is mild. No evidence of\ndiverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is moderately decreased in size in comparison\nto CT ___. Multiple hypodense lesions with peripheral rim\ncalcifications are consistent with fibroids status post embolization. \nOtherwise, the reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of acute intra-abdominal abnormality.\n2. Diverticulosis without evidence of diverticulitis.\n3. Fibroid uterus with expected post embolization changes.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non ___ at 2:55 ___, 10 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Mild bilateral centrilobular emphysema. Pacemaker lead is noted\nin the right ventricle. There is no evidence of pleural or pericardial\neffusion. Coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 1.0 cm\nhypodensity in the left upper renal pole consistent with simple cyst,\nunchanged since ___ (2; 17). There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. The stomach is otherwise unremarkable.\nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nColon is within normal limits. The appendix is not visualized though no\ninflammatory changes identified in its expected location.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a calcified fibroid in the anterior uterine wall\nnear the fundus measuring 2.6 x 2.1 cm (602; 39).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild grade 1 anterolisthesis of L4 on L5, likely degenerative.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No acute intra-abdominal pathology to explain patient's abdominal pain.\n2. No nephrolithiasis or hydronephrosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is decompressed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost resection of a rectal cancer with diverting colostomy and subsequent\ncolostomy reversal. There is re-demonstration of suture lines in the low\npelvis and mid abdomen without evidence of anastomotic complication. There is\nno evidence of local disease recurrence.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Re-demonstration of a soft tissue density in the right lower\nquadrant corresponding to prior diverting colostomy (series 4, image 93). \nSmall fat containing umbilical hernia (Series 4, image 87).", "output": "1. No evidence of local recurrence or metastatic disease within the abdomen or\npelvis.\n2. Please refer to separate report of CT chest performed the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Minimal subsegmental atelectasis are noted at the lung bases\nbilaterally. There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse decreased attenuation of the liver parenchyma\nin keeping with fatty infiltration. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: Patient is status post transgastric drainage of pancreatic\npseudocyst with a stent in situ. The previously seen pancreatic walled-off\nnecrosis has almost completely resolved. There is however heterogeneous\nthickened appearance of the pancreatic parenchyma with significant\nperipancreatic stranding. Pancreatic parenchymal enhancement is preserved\nwith no areas of necrosis. There is no new pancreatic or peripancreatic fluid\ncollection. No evidence of pancreatic duct dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis.\n\nThere is perirenal stranding and thickening of the anterior para renal fascia\nin continuity with the inflammatory changes surrounding the pancreas.\n\nGASTROINTESTINAL: The stomach is not significantly distended. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThere is fat stranding surrounding the duodenum and proximal jejunum without\nevidence of obstruction. The colon and rectum are within normal limits. The\nappendix is normal.\n\nThere is small amount of free fluid in the pelvis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Few enlarged upper retroperitoneal lymph nodes are likely\nreactive. For example, portacaval node (series 2, image 29) measures 12 mm in\nshort axis. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:\nThere is no abdominal aortic aneurysm. No atherosclerotic disease is noted.\nThere is conventional hepatic arterial anatomy. Stranding is noted around the\nproximal branches of the celiac trunk and SMA without occlusion or\npseudoaneurysm formation.\n\nThere is significant stranding surrounding the splenic vein which is\nattenuated in caliber without evidence of thrombosis. SMV and portal vein are\npatent\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nNote is made of bilateral pars interarticularis defects at L4 in keeping with\nspondylolysis. There is no spondylolisthesis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post transgastric drainage of pancreatic pseudocyst with near\ncomplete resolution of the previously seen peripancreatic necrotic collection.\n2. Heterogeneous appearance of the pancreas with significant peripancreatic\nstranding as described is consistent with acute/subacute pancreatitis. There\nis no evidence of parenchymal necrosis, new fluid collection or vascular\ncomplications.\n3. Hepatic steatosis." }, { "input": "Bilateral silicone breast implants are partly imaged. A 3-4 mm subpleural\nnodule found in the left lower lobe (2:6).\n\nThere is no biliary dilatation. No focal liver lesions are identified. Gall\nbladder is only partly full. Pancreas appears normal. Spleen is normal in\nsize and appearance. Adrenals are unremarkable. There is no evidence for\nsolid masses or hydronephrosis involving either kidney. In the mid to lower\nright pole, an 8 mm diameter hypodense focus is too small to characterize,\nalthough not likely of clinical significance. It appears mildly hyperdense,\nhowever.\n\nOrientation of gastric band appears unchanged. Above the band, the esophagus\nand included stomach (which is in the lower chest as a small hiatal hernia)\nboth show mild to moderate wall thickening, suggestive of reflux esophagitis. \nOtherwise stomach appears normal. Small bowel appears within normal limits. \nSigmoid diverticulosis is mild. Appendix appears normal.\n\nUterus shows several small hyperenhancing fibroids and accordingly a mildly\nlobular contour. Adnexa are unremarkable with and these consistent with\nphysiological cyst. The bladder appears normal.\n\nAtherosclerotic changes are mild. Major vascular structures appear patent. \nThere is no lymphadenopathy, free air, or free fluid.\n\nThere are no suspicious bone lesions. Moderate degenerative changes affect\nL5-S1 facet joints. L5-S1 interspace is also moderately narrowed.", "output": "1. Thickening of the visualized lower esophagus and included stomach, which\nis herniated into the lower chest. These finding suggests reflux esophagitis.\nNo change in positioning of gastric band.\n\n2. Fibroid uterus.\n\n3. Small hyperdense lesion in the right kidney. Evaluation with ultrasound\nis recommended to confirm a benign cysts when clinically appropriate.\n\n4. Very small left lower lobe nodule measuring 3-4 mm, likely benign. \nHowever, if there are risk factors such as smoking, occupational exposures\nstrong family history of pulmonary malignancy, then follow-up chest CT could\nbe considered for surveillance in ___ year." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates hypoattenuation throughout compatible\nwith fatty liver disease. There is no evidence of focal lesions within the\nlimitations of an unenhanced scan. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There are bilateral\nupper pole well-circumscribed hypodensities, measuring 5.7 x 6.3 cm on the\nright and measuring 5.2 x 5.1 cm on the left, likely representing renal cysts\nwithin the limitations of an unenhanced scan. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted throughout the abdominal aorta and its major tributaries.\n\nBONES: Multilevel degenerative changes are seen throughout the imaged portion\nof the spine without evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or pelvic abnormalities.\n2. Moderate atherosclerotic calcifications of the abdominal aorta and its\nmajor tributaries.\n3. Diverticulosis without diverticulitis.\n4. Fatty liver disease." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: There is a millimetric subtle hypodensity in the spleen with no\nconcerning features likely represents a benign hemangioma or cyst (02:53 ). \nThe spleen is not enlarged..\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: There are bilateral hypodense lesions within both kidneys that are\ntoo small to characterize but likely represent cysts. There is a 1.6 cm simple\ncyst in the lower pole of the left kidney. There is no hydronephrosis or\nsuspicious mass bilaterally. There are no renal calculi.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is mild calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: The ovaries and uterus are not seen.\n\nBONES AND SOFT TISSUES:\n\nThere is an unchanged focus of sclerosis in the right ischium (2:88) with no\ndefinitely suspicious bone lesion. There is no acute fracture. The soft\ntissues are unremarkable.", "output": "No evidence of metastatic disease to the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is borderline splenomegaly, with the spleen measuring 14.5 cm. \nThis has shown slight increase in size from the prior study where it measured\n13.6 cm. There is no evidence of splenic infarct or other acute splenic\nprocess.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is subtle soft tissue density surrounding the superior\nmesenteric vein and portions of the superior mesenteric artery. This may\nrepresent a conglomerate of tiny lymph nodes versus lympho vascular\ncongestion. The appearance is unchanged when compared to previous CT from\n___. There is also an increased number of subcentimeter retroperitoneal\nlymph nodes, specifically in the left para-aortic station. This finding 2 is\nunchanged when compared to prior.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process, in particular no splenic infarct." }, { "input": "LOWER CHEST: There is dependent bibasilar atelectasis, right greater than\nleft. The lungs are otherwise clear an without evidence of pericardial or\npleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is top normal in size and homogeneous and attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post left renal biopsy. There is a 3.4 x 3.1\nx 0.7 cm crescentic hyperdensity along the inferior pole of the left kidney\n(4b:41, 5b:50), compatible with post-biopsy perinephric hematoma. There is\ninferior extension of blood products along the left perinephric space and\nretroperitoneum, with a mild to moderate amount of free fluid noted in the\npelvis. There is no overt hydronephrosis or nephrolithiasis identified.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: A Foley catheter and accompanying foci of air are noted within the\nbladder. A 2.8 x 1.5 cm hyperdensity lying dependently along the right\nposterior wall of the urinary is compatible with a blood clot, as seen on\nrecent ultrasound. A small-moderate amount of free fluid is noted within the\npelvis.\n\nLYMPH NODES: Multiple prominent retroperitoneal and mesenteric lymph nodes are\nagain noted, unchanged from the prior several examinations, none of which are\npathologically enlarged. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Status post left renal biopsy complicated, now demonstrating a perinephric\nhematoma noted along the inferior pole of the left kidney, with extension of\nhemorrhagic products along the retroperitoneum and into the pelvis.\n2. Stable appearance of a blood clot within the urinary bladder, correlating\nwith findings on recent ultrasound examination.\n3. Borderline, mild splenomegaly." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Interval\nresolution of the left perinephric hematoma.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval resolution of the left perinephric hematoma." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nIn the midpole of the left kidney, there is a a linear hypodensity in the\nposterior aspect of the midpole (4:64), likely sequela of prior renal biopsy.\nThere is no evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic abnormalities.\n2. Linear density in the posterior midpole of the left kidney, likely a\nsequela of prior renal biopsy." }, { "input": "LOWER CHEST: There is new consolidation at the right lung base. A trace\npericardial effusion is increased from prior. Incidental note is made of\nlipomatous hypertrophy of the intra-atrial septum. Aortic valvular\ncalcifications are noted. Hypoattenuation of the blood pool relative the\nmyocardium is suggestive of anemia.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is distended and contains gallstones without wall\nthickening or evidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status post partial\ncolectomy and left lower quadrant colostomy. Small bowel loops are normal in\ncaliber without wall thickening or evidence of obstruction. ___ pouch\nis re-identified. There is a lipoma in the rectum, unchanged.\n\nPELVIS: A Foley catheter is present in the decompressed flatter. The distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Compared with ___, and abscess in the subcutaneous\ntissues of the lower anterior abdominal wall, just in the right of the\nmidline, has been opened, with no significant residual fluid (2:70). There is\ndiffuse anasarca.", "output": "1. Right lower and middle lobe pneumonia.\n2. Interval decompression of an abscess in the subcutaneous tissues of the\nlower anterior abdominal wall, with no significant residual fluid.\n3. Cholelithiasis, with no evidence of acute cholecystitis.\n4. Trace pericardial effusion is slightly increased from prior.\n5. Hypoattenuation of the blood pool relative to the myocardium is suggestive\nof anemia." }, { "input": "LOWER CHEST: Atelectasis is seen in the lung bases bilaterally, left greater\nthan right. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic central\nbiliary dilatation, which can be seen in the setting of cholecystectomy. \nThere is no extrahepatic biliary dilatation. The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas appears atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter hypodensity is seen in the left lower renal pole, too small to\nfully characterize. There is no evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube is seen terminating in the stomach. There\nis evidence of prior abdominal surgeries with multifocal surgical clips and\nbowel anastomosis. Multiple fluid-filled dilated loops of small bowel are\nseen in the mid abdomen, similar to the prior study in ___, measuring up\nto 3.5 cm (series 2: Image 40), without abrupt transition point identified. \nThere is extensive stool burden seen throughout the colon, compatible with\nconstipation. The appendix is not visualized, however, there are no secondary\nsigns concerning for appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is resected\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is a right external\niliac vascular stent which appears grossly patent. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are seen along the visualized spine.\n\nSOFT TISSUES: Multifocal coarse calcifications are seen within the\nsubcutaneous tissues of the bilateral gluteal regions, likely from injection\ngranulomas. Mild subcutaneous edema is seen along the bilateral groin and\nproximal thighs.", "output": "Patient is status post prior abdominal surgeries with anastomosis in the bowel\nnoted at multiple levels. There are multiple loops of fluid-filled dilated\nsmall bowel in the mid abdomen without a definite transition point to suggest\nobstruction, similar to prior exam in ___. Large stool burden is again\nseen throughout the colon, compatible with constipation." }, { "input": "LOWER CHEST: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent. \nMain portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Radiodense pills are seen\nwithin the lumen of the stomach and small bowel. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus contains an IUD which appears well positioned.\nThe ovaries appear normal. There is a left ovarian corpus luteum.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Implanted device is in the buttocks are noted with catheters\nextending into the thoracic spinal canal.", "output": "No acute findings to account for left lower quadrant pain." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A horseshoe kidney is again seen. The kidneys appear unremarkable\nexcept for a few left renal lesions are too small to characterize.\n\nGASTROINTESTINAL: There is no bowel obstruction. The appendix is within\nnormal limits.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa are unremarkable for age. \nRight-sided corpus luteum cyst is noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No CT findings to explain pain. No bowel obstruction or evidence of acute\nappendicitis.\n2. Horseshoe kidney." }, { "input": "LOWER CHEST: There is a small right and trace left pleural effusion. There is\nnodule atelectasis with linear scarring at both lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: Hepatic steatosis is again seen with sparing of the gallbladder\nfossa. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is distended\nwithout surrounding inflammation.\n\nPANCREAS: There is mild pancreatic atrophy. There is unchanged dilation of\nthe main pancreatic duct up to 4 mm. There are numerous hypodense lesions\nagain seen in the pancreas, better assessed on MRCP from ___. \nAgain seen is subtle fusiform enlargement of the pancreatic tail raising\nsuspicion of focal autoimmune pancreatitis, which is better assessed on recent\nMRCP. There is minimal surrounding peripancreatic stranding. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is normal in size. There is an incompletely characterized\n12 mm hypodense lesion within the inferior aspect of the spleen, which likely\nrepresents cyst or hemangioma, similar to prior.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is mild bilateral renal atrophy. There is no hydronephrosis. \nSimple cysts are noted on both kidneys, measuring up to 5.3 cm in the lower\npole of the left kidney, similar to prior.1.1 cm intermediate density cyst on\nthe upper pole of the right kidney is a hemorrhagic cyst and is characterized\non prior MRI. Renal lesions are better assessed on recent MRI from ___. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis extensive colonic diverticulosis without surrounding inflammation to\nsuggest diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fiducials noted in the prostate. The visualized\nreproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is mild, unchanged\nectasia of the bilateral iliac arteries. Moderate atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAgain seen is mild superior endplate compression at T12, progressed compared\nto prior. There is extension of air into the retroperitoneal soft tissues\nwith surrounding soft tissue prominence at the T11-12 level. Patient is\nstatus post right hip arthroplasty which mildly limits view of the pelvis.\n\nSOFT TISSUES: Small fat containing umbilical hernia.", "output": "1. No acute intra-abdominal process noted. The appendix is normal. Small\nright and trace left pleural effusions.\n2. Mild pancreatic atrophy with unchanged dilation of the main pancreatic duct\nup to 4 mm. Multiple hypodense lesions in the pancreas are better assessed on\nrecent MRCP. Subtle fusiform enlargement of the pancreatic tail is unchanged\nand better evaluated on the recent MRCP. Minimal surrounding peripancreatic\nstranding, similar to CT abdomen and pelvis from ___.\n3. Progression of endplate compression at T12 with extension of air into the\nretroperitoneal soft tissues with surrounding soft tissue prominence at the\nT11-12 level.\n4. Mild bilateral renal atrophy with multiple simple cysts, measuring up to\n5.3 cm in the lower pole left kidney. 1.1 cm intermediate density cyst on the\nupper pole of the right kidney is a hemorrhagic cyst is characterized on prior\nMRI.\n5. Unchanged hepatic steatosis.\n6. Unchanged moderate size hiatal hernia.\n7. Diffuse colonic diverticulosis without surrounding inflammation." }, { "input": "LOWER CHEST: There is small right pleural effusion new since prior. There is\nmild bibasilar atelectasis. Trace pericardial fluid may be physiologic. The\nblood pool is hypodense compared to the myocardium suggestive of anemia.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThere is new moderate volume ascites.\n\nSevere low attenuation of the liver is consistent with fatty liver, worsened\ncompared to prior. There is no evidence of focal lesions within the\nlimitations of an unenhanced scan. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. There is biliary sludge. There is wall\nthickening of the gallbladder, which may be from chronic liver disease and the\ngallbladder is not distended.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is a 3 mm nonobstructing right renal stone. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: There is diffuse thickening of the stomach, small bowel, and\nlarge bowel, most notably the ascending and transverse colon. Areas of fat\nwithin the walls of the ascending large bowel suggest acute on chronic\ninflammation of the wall. No evidence of obstruction. The appendix is not\ndefinitely visualized but may be normal in caliber containing contrast and air\n(601; 38).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Prominent retroperitoneal lymph nodes are seen with increased\nsoft tissue stranding surrounding the celiac axis (2; 29). There is no\nmesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "1. Diffuse wall and fold thickening involving the stomach, whole small bowel\nand large bowel. This is most likely to be due to portal hypertension. \nSequela of peritonitis is also possible but seems less likely. Given diffuse\ndistribution of the abnormality, gastritis and/or anterograde colitis appears\nless likely but difficult to entirely exclude.\n2. Prominent retroperitoneal lymph nodes with soft tissue stranding around the\nceliac axis are probably reactive.\n3. Gallbladder wall thickening likely due to chronic liver disease. Biliary\nsludge is seen in a nondistended gallbladder.\n4. New moderate volume ascites.\n5. 3 mm nonobstructing right renal stone.\n6. New small right pleural effusion.\n7. Fatty liver increased in severity compared to prior.\n\nNOTIFICATION: Findings discussed with Dr. ___ at 9:50 pm by telephone\non ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Duplicated kidney on the left with atrophy (series 6, image 62). The\nkidneys are of normal and symmetric size. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Small\nfat containing umbilical hernia is noted.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Left duplicated kidney with atrophy.\n3. Small fat containing umbilical hernia." }, { "input": "LOWER CHEST: Increased since ___, there is moderate amount\nnonhemorrhagic pleural effusion on the right. Numerous lung nodules are\nbetter evaluated on the CT from ___ obtained at an outside\nhospital. The largest nodule measures up to 1.2 x 1.2 cm in the left lower\nlobe (5 a: 13). A central catheter terminates in the right atrium. There is\nno pericardial effusion. Enhancing collapsed lung parenchyma in the right\nlower lobe is likely atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: In the right lobe of the liver, there is a confluent\nill-defined hypoenhancing area, measuring up to 11.7 x 7.5 cm, in addition to\ninnumerable hypodensities throughout the liver, not significantly changed\nsince ___ though somewhat progressed since the outside CT from ___. Patient is status post a metallic biliary stent with minimal\npneumobilia centrally and extending into the left intrahepatic ducts (5A:35). \nMild dilation of the left intrahepatic ducts is similar when compared to the\nprior MRI (5A:36). There is no significant pneumobilia in the right lobe of\nthe liver. No dilated intrahepatic ducts seen in the right lobe of the liver.\nThe gallbladder is collapsed with edematous gallbladder-wall, likely secondary\nto hepatic dysfunction. The portal vein is severely attenuated as described\nbelow.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 1.1 cm accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The enhancement of the kidneys are somewhat heterogeneous with\nstriated areas of hypodensity (08:35, 33, 30). Hypodensity in the lower pole\nof the right kidney is too small to characterize by CT. There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The visualized bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis mild edema of the visualized ascending colon, likely due to portal\nhypertension and congestion. The visualized colon is otheriwse within normal\nlimits. The visualized appendix is normal. Small volume nonhemorrhagic\nascites is seen in the bilateral paracolic gutters.\n\nLYMPH NODES: There is no pathologic retroperitoneal or mesenteric\nlymphadenopathy by CT size criteria. However, there are multiple mildly\nenlarged lymph nodes along the celiac axis, aorto caval station and\npara-aortic station, measuring up to 8 mm. Periportal soft tissue likely\nreflects a conglomerate of lymph nodes versus extension of an intrahepatic\nmass (08:22), unchanged compared to the prior MRI.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. The hepatic veins are distorted by the large infiltrative mass in\nthe right lobe and multifocal lesions throughout both lobes. The main portal\nvein is markedly narrowed to a string like contrast column at the hepatic\nhilum, encased by hypoenhancing masses (conglomerate lymphadenopathy described\non prior MRI) at the hepatic hilum, measuring up to 2.7 x 3.5 cm (08:22,\n05:39), unchanged from prior. The left portal vein is somewhat narrowed,\nthough patent throughout its course. The right portal vein is patent. \nHowever, the anterior branch is significantly narrowed at the origin with\nminimal opacification distally and the peripheral portion is not well\nvisualized. The right posterior branch is not well visualized, likely\noccluded (5A: 37). The splenic vein and the SMV are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged appearance of the mass (nodal conglomerate on prior MRI) at the\nporta hepatis resulting in significant narrowing of the main Portal vein. \nPosterior branch of the right portal vein is not seen, presumed occluded,\nunchanged from prior exam. Diminutive appearance of the anterior branch of\nthe right Portal vein, unchanged.\n2. Numerous lesions throughout the liver, compatible with metastatic disease. \nA large hypoenhancing lesion in the right lobe of the liver likely reflects a\nconglomerate of masses.\n3. Diffuse edema of the gallbladder-wall, unchanged from prior exam.\n4. Retroperitoneal lymphadenopathy and lung nodules, unchanged from prior\nexam.\n5. Status post metallic stent with pneumobilia.\n6. Large right pleural effusion, increased from prior." }, { "input": "LOWER CHEST:\nPlease refer to CT chest performed on the same date for intrathoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are two wedge-shaped areas of hyperenhancement in the\nliver, measuring 13 mm in segment VII (series 3, image 50) and 13 mm in\nsegment VIII, both located along the periphery without any capsular retraction\nor bulging, most compatible with perfusional shunts. No concerning hepatic\nmass is detected. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits, without stones\nor gallbladder wall thickening.\n\nPANCREAS: There is pancreas divisum. The pancreas has normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones. A 7 mm hypodensity in the lower pole the left\nkidney (series 3, image 68) is statistically likely a simple cyst, but is too\nsmall for further characterization. There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. There is moderate reflux of stool\nacross the ileocecal valve into the terminal ileum. A large amount of colonic\nstool is present. There is a small duodenal diverticulum.\n\nRETROPERITONEUM: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm, flow-limiting stenosis, or\ndissection. There is mild calcium burden in the abdominal aorta and great\nabdominal arteries.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no pelvic\nor inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. There are multilevel moderate\ndegenerative changes throughout the thoracolumbar spine, with multilevel disc\nspace narrowing and anterior and posterior osteophytosis. Anterolisthesis of\nL4 on L5 is demonstrated. There is an anterior fusion of L5 and S1.", "output": "1. No intra-abdominal lymphadenopathy or metastasis detected.\n2. Two small perfusional shunts along the periphery of hepatic segments VII\nand VIII.\n3. Pancreas divisum.\n4. Tiny duodenal diverticulum.\n5. Large amount of colonic stool with moderate fecal reflux into the terminal\nileum." }, { "input": "LOWER CHEST: Dependent atelectasis bilaterally. No pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Subcentimeter hypodensities in the interpolar region\nof the left kidney are too small to characterize, but likely represent simple\ncysts.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild\ndiverticulosis of the sigmoid and descending colons without evidence of\ndiverticulitis. Appendix is not definitively visualized, but there are no\nsecondary signs of appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is a mildly prominent porta hepatis node that measures up\nto 12 mm (02:28). No other retroperitoneal lymphadenopathy. Numerous\nprominent mesenteric lymph nodes are not pathologically enlarged. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Right hip prosthesis is noted. There are moderate degenerative changes\nof the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Colonic diverticulosis without evidence of acute diverticulitis." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nPunctate subcapsular hypoattenuating lesions in segment VI are too small to\ncompletely characterize, but unchanged since ___ CT abdomen/pelvis,\nprobably hepatic cysts or biliary hamartomas. No new or enlarging hepatic\nlesions. The portal veins are patent. No evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is 1.4 cm interpolar right renal cyst. Additional hypoattenuating\nlesions are too small to completely characterize, but probably reflect\nadditional simple cysts. No concerning lesions or hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops are unremarkable. No bowel obstruction. \nStatus-post right hemicolectomy. There is approximately 1.9 x 1.2 cm of soft\ntissue abutting hemicolectomy suture margin (series 8, image 100; series 12,\nimage 25). Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding.\n\nPELVIS: The urinary bladder is unremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: An infrarenal abdominal aortic aneurysm sac is essentially unchanged\nin size making comparative measurements in the coronal plane, with a diameter\nof 5.3 cm (series 12, image 26). The excluded aneurysm sac is partially\nthrombosed with intraluminal contrast resulting from the inferior mesenteric\nartery and one to two probable small lumbar arteries. The stent graft is\npatent.\n\nBONES/SOFT TISSUES: There is no aggressive osseous lesion or acute fracture.\nChronic, healed posterior lower right rib fractures are unchanged.", "output": "1. Focal soft tissue attenuation adjacent to the right hemicolectomy suture\nmargin could reflect evolving postoperative change. Recommend attention on\nfollow-up imaging. Otherwise, no evidence of metastasis in the abdomen or\npelvis.\n2. Type 2 abdominal aortic aneurysm endoleak probably resulting from the\ninferior mesenteric artery and at least 1 lumbar artery. The partially\nthrombosed aneurysm sac is unchanged in size. The stent graft is widely\npatent." }, { "input": "LOWER CHEST: There is linear scarring/subsegmental atelectasis in the left\nlower lobe. There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThere is normal morphology of the liver.\nThere is a large heterogeneous centrally hypodense mass in the right lobe\nmeasuring 17 x 10 x 11 cm. Additional centrally hypodense lesions are noted\nin segment ___ (series 6, image 37) measuring 1.7 x 2.7 cm and segment 4 B\n(series 6, image 55) measuring 1.6 cm. These lesions are peripherally located\nand bulge the liver capsule. A subcentimeter hypodense focus is noted in the\nleft medial segment adjacent to the falciform ligament (series 6, image 45).\n\nIntrahepatic portal veins are patent.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is decompressed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 17 mm right peripelvic simple cyst. There is no evidence of a\nsolid renal mass. There is no nephrolithiasis or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost partial right hemicolectomy. There is minimal fat stranding within the\nmesentery around the anastomosis which may represent resolving postoperative\nchange. There is a subcentimeter mesenteric lymph node (series 9, image 65)\nmeasuring 7 mm, previously 9 mm. There is extensive diverticulosis in the\ndistal descending colon and sigmoid colon without evidence of acute\ndiverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Slightly enlarged periportal lymph node (series 9, image 49)\nmeasures 10 mm in short axis, previously 6 mm. Portacaval node (series 9,\nimage 42) measures 10 mm, previously 5 mm. Aortocaval node (series 9, image\n57) is minimally larger measuring 5 mm, previously 4 mm. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: Patient is status post endovascular aortic aneurysm repair. Aortic\nstent graft is unchanged in position and remains patent. The aneurysm sac\nmeasures 5.3 x 5.6 cm, previously 5.3 x 5.3 cm. Note is again made of\ncontrast extravasation within the left lower aneurysm sac (series 6, image 77)\nwhich appears more prominent compared to the prior study. Moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia", "output": "1. Multiple liver lesions including a large heterogeneous centrally hypodense\nmass in the right lobe measuring up to 17 cm and lesions in the left lobe\nbulging the liver capsule as documented above. These most likely represent\nliver metastases.\n2. Minimal interval increase in size of few retroperitoneal lymph nodes\nconcerning for metastatic lymphadenopathy. Attention on follow-up is\nrecommended.\n3. Persistent type 2 endoleak likely from a lumbar arterial branch. The\naneurysm sac has slightly increased in size in the interval now measuring up\nto 5.6 cm, previously 5.3 cm." }, { "input": "CT abdomen with contrast: Liver enhances homogeneously without focal lesion\nor biliary dilatation. Portal vein is patent. Gallbladder is collapsed and\nunremarkable.\n\nSpleen, pancreas and adrenal glands are unremarkable.\n\nKidneys present symmetric nephrograms and excretion of contrast without focal\nlesion or hydronephrosis.\n\nStomach is unremarkable. Duodenum and distal small bowel loops are normal\ncaliber without evidence of obstruction. Redundancy of the sigmoid colon is\nnoted. Large bowel is thin-walled and unremarkable without pericolonic fat\nstranding or fluid collection.\n\nMild atherosclerotic plaques along a normal caliber abdominal aorta. \nScattered mesenteric and retroperitoneal lymph nodes are not pathologically\nenlarged. Mildly prominent left periaortic lymph node measures 6 mm in short\naxis, unchanged. No ascites, pneumoperitoneum or ventral abdominal hernia.\n\nCT pelvis with contrast: Bladder, seminal vesicles, prostate and rectum are\nunremarkable. No free pelvic fluid or air. No inguinal or pelvic sidewall\nlymphadenopathy by CT size criteria.\n\nBones and soft tissues: No suspicious focal bone lesion.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. For thoracic findings, refer to the separately dictated report under clip\n___." }, { "input": "LOWER CHEST: Bilateral lung bases are grossly clear, with the exception of\nsmall cystic spaces in the left lung base (4:41, 43) and a punctate pulmonary\nnodule in the peripheral right lung base (04:38). There is no pleural or\npericardial effusion. These in other intrathoracic findings are better\nassessed on concurrently obtained CT of the chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of small bowel obstruction or other acute abdominopelvic\npathology.\n2. Intrathoracic findings are better characterized on concurrently obtained CT\nof the chest." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is apparent thickening of the medial limb of the right adrenal\ngland. The left adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Right renal sinus\ncysts. There is no evidence of solid mass within the limitations of an\nunenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminates within the stomach which is\notherwise unremarkable in appearance. Small bowel loops demonstrate normal\ncaliber and wall thickness throughout. The colon and rectum are within normal\nlimits. Rectal tube in place. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcified uterine fibroids. The visualized reproductive\norgans are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative change without fracture or suspicious osseous lesion.\n\nSOFT TISSUES: Small fat containing periumbilical hernia and left inguinal\nhernia. Symmetric rounded calcifications within the gluteal subcutaneous fat\ncompatible with injection granulomas. Otherwise normal.", "output": "1. No acute inflammatory change identified on this noncontrast CT of the\nabdomen pelvis.\n2. Cholelithiasis without CT evidence of cholecystitis.\n3. Medial limb thickening versus small nodule in the right adrenal gland. \nAttention on follow-up imaging is recommended.\n4. Additional chronic changes as above." }, { "input": "For a report on the chest component of this examination, including bibasilar\npleural effusions, please refer to separate chest CT performed on the same\nday.\n\nCT of the abdomen: Evaluation of solid abdominal viscera is limited by lack of\nIV contrast. The nonenhanced liver is grossly unremarkable with no focal\nhepatic lesions identified. Multiple gallstones are seen within an otherwise\nunremarkable gallbladder. The adrenal glands, pancreas and spleen are grossly\nunremarkable. The noncontrast kidneys are normal with no evidence of renal\nmasses or hydronephrosis.\n\nAn orogastric tube is post pyloric. The stomach, small and large bowel are\ngrossly unremarkable. There is no evidence of small bowel obstruction or\nileus. There is a small amount of stranding along the lateral conal fascia\nbilaterally. There is no significant intra-abdominal free fluid. Extensive\natherosclerotic disease is noted along the intra-abdominal aorta and its major\nbranches. Vessel patency cannot be evaluated in this examination. There is no\nfree air. Small scattered retroperitoneal lymph nodes not meet CT size\ncriteria for lymphadenopathy.\n\nCT of the pelvis: There is a small amount of simple free fluid in the pelvis.\nFoley catheter is seen within a predominantly collapsed urinary bladder. Foci\nof air in the urinary bladder is likely secondary to the presence of a Foley\ncatheter. Thickening of the distal sigmoid colon could relate to\nunderdistention. A rectal tube is noted. There are bilateral fat containing\ninguinal hernias with a small amount of fluid seen in the right.\n\nOsseous structures: Moderate multilevel degenerative changes are noted along\nthe thoracolumbar spine. No blastic or lytic lesion concerning for\nmalignancy.", "output": "1. No evidence of ileus or small bowel obstruction.\n\n2. Small amount of simple density pelvic free fluid.\n\n3. Cholelithiasis, no acute cholecystitis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a punctate hypodensity in the anterior right lobe of the liver on\nseries 6, image 59 likely a cyst or hemangioma. There is no evidence of\nsuspicious focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nCortical scarring is noted bilaterally. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a 5 cm\nsegment of apparent wall thickening of the sigmoid colon seen on series 9b,\nimage 23 which may be inflammatory nature however correlation with colonoscopy\nis recommended. There is sigmoid diverticulosis\nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 3.9 x 3.4 cm left uterine fibroid similar to\nprior. An IUD is in place.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Small amount of stranding in\nthe right groin is noted to\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Focal 5 cm region of wall thickening of the sigmoid colon may be\ninflammatory/contraction however correlation with colonoscopy is recommended.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 13:30 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. The left\nadrenal gland appears diffusely thickened consistent with adrenal hyperplasia\nsimilar to prior.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are areas of bilateral cortical scarring, likely secondary to prior\nembolic infarcts, as seen on CT in ___. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus, the largest measuring 2.7 cm in the left\nfundal region similar to prior from ___. IUD is seen in the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a large left rectus sheath hematoma measuring 5.6 x 9.3\nx 9.1 cm. Within this hematoma, there are punctate areas of hyperdensity\nsimilar to blood pool concerning for possible active extravasation (2; 33).", "output": "1. 9.3 cm left rectus sheath hematoma with punctate foci of hyperdensity\nsimilar to blood pool concerning for possible active extravasation.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___,\nM.D. on the telephone on ___ at 8:37 am, 30 minutes after discovery of\nthe findings." }, { "input": "Lack of IV contrast limits evaluation of solid organs and vascular structures.\n\nLOWER CHEST: There is a trace of right-sided pleural effusion. Otherwise,\nlung bases are clear. There is no cardiomegaly.\n\nHEPATOBILIARY: There is a cirrhotic liver morphology. Unenhanced liver\nappears otherwise unremarkable with no suspicious lesions. Post\ncholecystectomy.\n\nPANCREAS: Unenhanced pancreas appears unremarkable.\n\nSPLEEN: Splenomegaly measures 15 cm.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY:There is no hydronephrosis or nephrolithiasis.\n\nGASTROINTESTINAL: Stomach is under distended. Small bowel loops are not\ndilated. There are areas with mild colonic wall thickening, especially the\nright hemicolon, indicating portal hypertensive colopathy. There are colonic\ndiverticulosis without diverticulitis.\n\nPERITONEUM: There is moderate amount of simple fluid ascites and no free air. \nThere is no retroperitoneal hemorrhage.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Normal caliber mildly atherosclerotic abdominal aorta. Upper\nabdominal varices noted.\n\nPELVIS: Urinary bladder is unremarkable. Status post hysterectomy. There are\nno adnexal masses. Rectum is unremarkable.\n\nBONES:There are no acute osseous abnormalities.\n\nSOFT TISSUES: There is mild subcutaneous soft tissue stranding, indicative of\nminimal anasarca. There is a small fat containing umbilical hernia.", "output": "1. Moderate amount of moderate simple fluid ascites and minimal anasarca.\n2. Stigmata liver cirrhosis and portal hypertension: Ascites, splenomegaly,\nupper abdominal ascites and portal hypertensive collapse the.\n3. No retroperitoneal hemorrhage." }, { "input": "FINDINGS:\n\nLOWER CHEST: Mild bibasilar atelectatic changes are noted. New trace right\npleural fluid. Coronary artery calcifications are noted. The previously\nnoted pericardial cyst is stable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\n\nMultiple hypoenhancing hepatic lesions are stable in number but a few appear\nminimally increased in size compared to ___. For example a 1.0 cm\nlesion in the inferior right hepatic lobe on ___:33 previously measured up to\n0.8 cm on ___. A 0.9 cm lesion slightly more superiorly but also in\nthe right inferior hepatic lobe (04:31) previously measured up to 0.5 cm. No\ndefinite new lesions are seen.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nThere is new mild pneumobilia likely related to the history of recent\nsphincterotomy and interval placement of a metallic biliary stent which\ncontains air and a small amount fluid. The stent extends from the proximal\ncommon hepatic duct and its tip terminates in the second portion of the\nduodenum. The gallbladder is surgically absent. Portal and hepatic veins are\npatent.\n\nPANCREAS: Exact boundaries of the known uncinate process mass are difficult to\ndiscern. The lesion measures 5.0 x 3.3 cm in the axial plane on ___:35,\npreviously 4.6 x 3.1 cm when remeasured on the prior study in similar planes\non 2:69 on ___. The mass abuts the third portion of the duodenum,\nalthough the lumen appears to be preserved.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Anterior 1.0\ncm splenic hypodensity is stable, demonstrated to be a cyst on prior MRI.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral renal scarring is stable. Multiple bilateral renal cysts\nare noted. The largest lesion in the upper pole of the left kidney measures 4\ncm. Although the attenuation is higher than expected, the lesion had simple\ncystic signal intensity on prior MRI. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is within normal limits. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed by a Foley catheter and contains a\nfew foci of gas.. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. The\nbladder wall is mildly thickened.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. A right groin port is noted in situ. The catheter tip\nterminates in the infrahepatic IVC.\n\nBONES: L1 anterior superior corner fracture is unchanged since ___ and\nshows no substantial signs of healing. Tiny left L3 transverse process\nfracture stable. Left paramedian lucent lesion in the sacrum is stable. \nHealed posterior right rib fractures are unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute process in the abdomen or pelvis\n2. New mild pneumobilia likely related to interval placement of a metallic\nbiliary stent.\n3. The known pancreatic mass appears minimally increased in size compared to\n___. There is a stable number of hepatic metastatic lesions, some\nof which may be minimally increased in size but the majority of which are\nstable compared to ___. No new lesions are seen.\n4. New trace right pleural effusion.\n5. Additional chronic findings as detailed above." }, { "input": "LOWER CHEST: There are diffuse ground-glass opacities in bilateral lungs. \nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: There is a small linear calcification within the body of the spleen\nmeasuring 1.1 cm. There is vascular prominence at the splenic hilum, which\nappears similar to prior CT dated ___.\n\nADRENALS: The left adrenal glands are normal in size and shape. There is\nredemonstration of a 10 mm right adrenal nodule, unchanged from prior study\ndated ___ (03:57).\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: An enteric tube is in place with tip terminating at the\npylorus. The stomach is unremarkable. Small bowel loops demonstrate normal\ncaliber and wall thickness throughout. The colon and rectum are within normal\nlimits. The appendix is normal. There is redemonstration of a hypodense mass\nin the right lower quadrant measuring 3.9 x 2.4 cm, unchanged from prior ___\nPET CT dated ___.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. The previously enlarged right\ninguinal lymph node measures 7 mm (3:120). There is a 10 mm lymph node in the\nsplenic hilum, unchanged from prior study (03:56).\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No intra-abdominal or intrapelvic process to account for the patient's\nclinical presentation.\n2. Unchanged right lower quadrant intraperitoneal mass and inguinal and\nsplenic hilar lymph nodes, with no evidence of new focal lesions or\nlymphadenopathy in the abdomen and pelvis.\n3. Limited evaluation of the lower lungs demonstrate diffuse ground-glass\nopacities compatible with an infectious process. Please refer to the separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. The\ndensity of the liver is somewhat low, suggestive of mild steatosis. There is\nno evidence of focal lesions within the limitations of an unenhanced scan. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable without\ncalculi identified. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormality identified to account for the patient's left flank\npain including no urolithiasis.\n\n2. Slightly low attenuation of the liver suggests mild hepatic steatosis." }, { "input": "LOWER CHEST: Interval resolution of the previously seen right pleural\neffusion. Left basilar dependent atelectasis is noted. A 12 mm pulmonary\nnodule in the left lower lobe is size stable compared with prior chest CT in\n___. Partially imaged aortic valve replacement is noted. Coronary\nartery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. Nonspecific\nthickening of the left adrenal gland is noted.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA hypodensity in the interpolar region of the right kidney is likely a cyst.\nCalcifications of the renal arteries are again noted. Bilateral perinephric\nstranding is unchanged compared to prior study.\n\nGASTROINTESTINAL: A gastrostomy tube is noted Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. Large fecal load is noted within the distal colon. The appendix\nis normal.\n\nPELVIS: A Foley catheter is seen in the bladder. The bladder wall appears\nthickened despite decompressed status. There is no free fluid in the pelvis. \nThe prostate appears enlarged measuring up to 6 cm in transverse dimension.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Moderate to severe degenerative changes throughout the thoracolumbar\nspine are noted. Grade 1 retrolisthesis of L5 on S1 is again noted. Patient\nis status post right hip total arthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 12 mm left lower lobe pulmonary nodule, size stable since ___. \nRecommend six-month follow-up per ___ criteria.\n2. Thickened urinary bladder wall, may reflect chronic outlet obstruction\nversus infection. Please correlate clinically.\n\nRECOMMENDATION(S):\n-Followup chest CT in 6 months.\n-Clinical correlation for bladder infection." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is an 8 mm hypodense lesion in hepatic segment VII, which is\nincompletely characterized but most likely represents a hepatic cyst or\nbiliary hamartoma. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are two nonobstructing stones in the inferior pole of the right kidney\nmeasuring up to 4 mm. Additional nonobstructing punctate stones are noted in\nboth kidneys. There is a 2.2 cm hypodense lesion in the superior pole of the\nleft kidney with an internal septation, which is incompletely characterized. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is focal\nbowel wall thickening, mucosal enhancement and submucosal edema involving the\ntransverse colon, Which is centered around an enlarged diverticulum. There is\npericolonic fat stranding without evidence of extraluminal air or drainable\nfluid collection. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are multiple uterine fibroids. The adnexa are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of suspicious osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Uncomplicated diverticulitis of the transverse colon. No evidence of\nextraluminal air or drainable fluid collection.\n2. Two nonobstructing stones in the inferior pole of the right kidney\nmeasuring up to 4 mm. Additional punctate nonobstructing stones in both\nkidneys. No hydronephrosis or hydroureter.\n3. A 2.2 cm hypodense lesion in the superior pole of the left kidney with an\ninternal septation, which is incompletely characterized. Further evaluation\nis recommended with non emergent renal ultrasound.\n\nRECOMMENDATION(S): Nonemergent renal ultrasound for further evaluation of the\nhypodense lesion in the superior pole of the left kidney." }, { "input": "LOWER CHEST: Mild fibrosis and dependent atelectasis in the lung bases.\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable aside for a cyst in the left lobe\nliver measures 3.2 x 2.3 cm. Mild intra and extrahepatic biliary dilation is\nlikely related to post cholecystectomy state. The gallbladder is surgically\nabsent.\n\nPANCREAS: There is diffuse fatty replacement of the pancreas. There is no\nperipancreatic stranding.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable aside for a few small left parapelvic\ncysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate length segment of distal ileum that\ndemonstrates mild surrounding soft tissue stranding. This segment of ileum is\nnormal in caliber and demonstrates enhancement, therefore is nonspecific for\nmild enteritis either infectious or inflammatory. No free air or drainable\ncollections. Multiple small bowel and end-to-side sigmoid anastomoses are\nnoted as well as multiple surgical clips are seen in the pelvis. The appendix\nis within normal limits. Oral contrast is seen to the level of the rectum.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy. There are no adnexal\nabnormality seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes lumbar spine worst at its L4-L5. There is\ngrade 1 anterolisthesis of L3 on L4.\n\nSOFT TISSUES: Hernia repair mesh seen in the anterior abdominal wall.", "output": "Soft tissue stranding around a moderate length segment of nondilated distal\nileum in the right lower quadrant is nonspecific, but may represent early\nchanges of enteritis. No free air, bowel obstruction, drainable fluid\ncollection and no findings to suggest bowel ischemia." }, { "input": "Coronary and aortic valvular calcifications are present. There are no pleural\neffusions.\n\nMultiple hepatic cysts are again present including several with rim\ncalcification. The pancreas, spleen and adrenal glands are unremarkable. \nEach kidney is markedly enlarged in association with numerous cysts, some of\nwhich are hyperdense suggesting hemorrhagic or proteinaceous content. This\nstudy cannot exclude solid masses given the lack of administration of\nintravenous contrast, however, although there has been no change.\n\nThe stomach and small bowel are unremarkable. Sigmoid diverticulosis is\nmoderate.\n\nThe patient is status post hysterectomy. The bladder is unremarkable. A\nrenal graft in the right lower quadrant appears unchanged. Hilar structures\nare again indistinct and difficult to visualize although without convincing\nabnormality. A small superficial fluid collection measuring 35 x 19 mm in\naxial ___ along the incision site appears unchanged, probably a seroma.\nThere is no lymphadenopathy or ascites. Patchy vascular calcifications are\npresent.\n\nThere are no suspicious bone lesions. Moderate degenerative changes affect\nfacet joints at L4-L5 bilaterally and L5-S1 primarily on the right side.", "output": "1. Polycystic kidneys including some hyperdense cysts, but without change; no\nevidence for stones or hydronephrosis. Evaluation for whether any solid\nmasses may be present is very limited without intravenous contrast\nadministration.\n\n2. Slight fat stranding about the renal graft of uncertain significance; this\nis new and may be due to slight edema from fluid overload although\ninflammation of the graft is a possibility." }, { "input": "LOWER CHEST: There is a large right-sided pneumothorax with atelectasis of the\nright associated leftward shift of mediastinal structures compatible with\ntension pneumothorax. There are fractures of the lateral right fifth and\nsixth ribs. There is a small right-sided pleural effusion. There is\nbilateral dependent atelectasis also noted. Heart size is moderately\nenlarged. No large pericardial effusion is present.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is slightly asymmetrically smaller relative to the\nright. Bilateral nephrograms are unremarkable. There is no evidence of\nconcerning focal renal lesions or hydronephrosis. There are numerous\nbilateral renal cysts. The largest arises from the upper pole of the left\nkidney and measures up to 7.2 cm. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminates in the stomach. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The bladder contains a Foley catheter and is decompressed.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. There is a 2.7 cm right\nadnexal cyst. Left adnexa is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate hemoperitoneum is present about the liver and spleen as\nwell as within the pelvis and tracking within the right retroperitoneum. \nThere is a fusiform infrarenal abdominal aortic aneurysm measuring up to 3.9 x\n3.4 cm at the origin of the ___. There is also a large aneurysm of the right\ncommon iliac artery measuring up to 6.5 x 5.6 cm with large degree of mural\nthrombus. There is hyperdense, heterogeneous fluid predominantly seen around\nthe right common iliac aneurysm compatible with blood and aneurysm rupture. \nThere is no active extravasation seen. There is extensive atherosclerotic\ndisease. There is severe stenosis at the origin of the celiac axis and mild\nstenosis of the origin the SMA. ___ is patent.\n\nBONES: There is no evidence of worrisome osseous lesions. Acute displaced\nfractures of the right lateral fifth and sixth ribs are present.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Ruptured right common iliac artery aneurysm with moderate hemoperitoneum\nand right retroperitoneal hemorrhage.\n2. Large right-sided tension pneumothorax. Small right effusion.\n3. Right fifth and sixth lateral acute rib fractures.\n4. 3.9 x 3.4 cm infrarenal abdominal aortic aneurysm\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 13:19 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There is a small right pleural effusion. Visualized lung fields\nare within normal limits. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Gallbladder wall edema is likely\nsecondary to third spacing. There is periportal edema.\n\nThere is a small amount of free ascitic fluid throughout the abdomen and\npelvis, with ___ measuring up to 27, minimally complex. Portal vasculature\nappears patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of free fluid in the pelvis, with ___ of 27, minimally complex and\nmay be secondary to a ruptured corpus luteum but a ruptured ectopic cannot be\nfully excluded.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits. There is a right\ncorpus luteal cyst. The left ovary is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Small to moderate amount of ascites, minimally complex within the pelvis,\nmay be secondary to a ruptured corpus luteum but a ruptured ectopic cannot be\nfully excluded. Recommend pelvic ultrasound.\n2. Small right pleural effusion.\n3. Gallbladder wall edema likely secondary to third spacing. Periportal edema\n(from hydration?)" }, { "input": "Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nCT abdomen with and without contrast: The liver enhances homogeneously without\nfocal lesion, intra or extrahepatic biliary dilatation. The portal vein is\npatent. The gallbladder is thin-walled and unremarkable.\n\nThe spleen, pancreas and right adrenal gland is unremarkable. There is a\nwell-circumscribed 2.6 x 2.0 cm left adrenal nodule containing areas of bulk\nfat suggestive of adrenal myelolipoma. The kidneys present symmetric\nnephrograms and excretion of contrast without focal lesion, hydronephrosis or\nperinephric abnormality.\n\nThe stomach, duodenum and remainder of the small bowel is unremarkable without\nevidence of obstruction the large bowel is thin-walled and unremarkable\nwithout pericolonic fat stranding. Normal appendix is visualized in the right\nlower quadrant.\n\nAbdominal aorta is normal in caliber without focal aneurysmal segment. There\nis a 1.2 cm centrally necrotic lymph node with peripheral fat stranding in the\nleft periaortic station slightly caudal to the take-off of the left renal\nartery (03:57). There are other scattered nonenlarged left periaortic lymph\nnodes measuring from 5-7 mm (3: 63, 67, 69). There is no mesenteric\nlymphadenopathy by CT size criteria. There is no ascites, pneumoperitoneum.\nThere is a small fat containing umbilical hernia.\n\nCT pelvis with contrast: There is prominent, heterogeneous expansion of the\nuterus centered along the endometrial canal with very of central calcification\nat the level of the fundus with lesion extending inferiorly to the level of\nthe cervix with total ___ measuring roughly 11.2 x 6.7 x 7.4 cm.\nSeveral heavily calcified exophytic lesions of the uterus with the largest\nanterior to the fundus measuring up to 7.5 x 4.4 cm likely represent fibroids.\nFocus of calcification within the fundus may represent an additional fibroid\nenveloped by the endometrial lesion.\n\nThe ovaries are not definitively seen. There is no free pelvic fluid or air.\nThe bladder and rectum are grossly unremarkable. There are a few prominent\nlymph nodes in the external iliac and internal iliac stations measuring up to\n7 mm (3: 83). There is no inguinal or pelvic sidewall lymphadenopathy by CT\nsize criteria.\n\nOsseous structures: There is grade 1 anterolisthesis of L5 on S1. There is no\nsuspicious focal osseous lesion.", "output": "1. Heterogeneous expansion of the uterus by endometrial mass measuring 11.2 x\n6.7 x 7.4 cm compatible with given diagnosis of endometrial carcinoma.\n2. Centrally necrotic lymph node with surrounding inflammatory change at the\nleft periaortic station measuring 1.2 cm compatible with metastatic\ninvolvement. Other scattered left periaortic retroperitoneal lymph nodes as\nwell as a few scattered lymph nodes in the left external and internal iliac\nstations are not enlarged by CT size criteria however given their distribution\nremain suspicious for involvement.\n3. Several exophytic, calcified uterine lesions likely representing fibroids.\n4. Well-circumscribed 2.6 x 2.0 cm left adrenal nodule with bulk fat\ncompatible with adrenal myelolipoma." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal. A 2.6 x 1.4 cm hypodense lesion\nwithin the left adrenal gland contains bulk fat and likely represents a benign\nmyelolipoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nModerate left hydronephrosis and proximal hydroureter is unchanged, without\nevidence of obstructing calculus. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The ascending,\ndistal transverse, descending, and sigmoid colon are entirely fluid-filled\nwithout significant adjacent inflammatory changes or focal wall thickening. \nThe appendix is normal.\n\nPELVIS: A rim enhancing, centrally hypodense complex lesion is again noted at\nthe introitus, which abuts and causes mass effect on the adjacent bladder\nbase. Although the entirety of this lesion is not imaged on this examination,\nit appears to measure approximately 4.8 x 6.4 x 3.7 cm.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.\n\nLYMPH NODES: Multiple prominent retroperitoneal lymph nodes are identified,\nmeasuring up to 1.0 cm in short axis (05:50). There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. There is a 4.3 x 4.2 x 5.3 cm rim enhancing centrally\nhypodense lesion noted within the proximal portion of the left psoas muscle\n(05:40, 7:35, 8:42), with surrounding inflammatory changes. This lesion abuts\nbut does not appear to erode into the adjacent vertebral bodies.", "output": "1. Large, rim-enhancing, centrally hypodense lesion within the proximal left\npsoas muscle with surrounding inflammatory fat stranding. Findings appear\natypical for retroperitoneal hematoma, with metastatic disease versus abscess\nfelt more likely. However, if this is a small retroperitoneal bleed, its\nsmall size would not explain the patient's hematocrit drop. Abdominal\ninterventional radiology can be consulted for drainage/biopsy as indicated.\n2. Large heterogeneous enhancing mass at the introitus/labia, which is\ndifficult to measure but appears grossly larger as compared to the prior\ncontrast enhanced examination dated ___. This lesion causes mass\neffect on the adjacent bladder base and ureter, as before.\n3. Persistent moderate left hydronephrosis and proximal hydroureter. No\ndiscrete obstructing calculus is identified, and findings may be secondary to\nthe inflammatory changes surrounding the adjacent left psoas muscle, as\ndescribed above. Urology consultation is recommended for further management.\n4. Stable left adrenal myelolipoma.\n5. For description of the intrathoracic findings, please see the separate\ndedicated CT chest examination.\n\nRECOMMENDATION(S): 1. Abdominal interventional radiology can be consulted\nfor drainage/biopsy of left psoas lesion/collection.\n2. Advise urologic consulation for management of left hydronephrosis and\nhydroureter." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Trace right\npleural effusion..\n\nABDOMEN:\n\nHEPATOBILIARY: Small residual fluid collection remains in the right hepatic\nlobe (03:28) measuring approximately 4.6 x 3.8 x 2.8 cm with an indwelling\ndrainage catheter in place. A small hepatic subcapsular hematoma is noted at\nthe site of drain entrance in the liver (03:21) measuring 4.6 x 1.3 cm. The\nliver otherwise demonstrates homogenous attenuation throughout. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder's content is mildly\nheterogeneous, likely filled with biliary sludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Again redemonstrated is an abscess in the right hepatic lobe with an\nindwelling drainage catheter with grossly estimated volume of 25 cc.\n2. A small subcapsular hematoma is noted in the site of drain entrance into\nthe liver.\n3. Trace right pleural effusion.\n4. Otherwise, no significant interval change." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There are small\nbilateral pleural effusions. Dependent opacity in the left upper lobe likely\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHypodense lesion in the left lobe of the liver measuring up to 10 mm and\npunctate hypodensity in the middle liver measuring up to the 4 mm are\nincompletely characterize the likely represent hemangioma or hammertoe mild,\nlesion in the left lobe of the liver is stable since ___. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multifocal regions of subtle hypoenhancement in the left\nkidney concerning for pyelonephritis. There is no hydronephrosis. There is\nno perinephric abnormality. There is no evidence of focal renal lesions. \nThere is no evidence of urothelial lesions. Punctate hyperdensity seen\ndependently in the urinary bladder in series 2, image 70 may represent a small\nstone versus a calcification in the wall.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 3.7 cm left uterine hyopdensity compatible\nwith a fibroid. Prominent gonadal veins with reflux of contrast on the left\nare compatible with pelvic vein congestion. No adnexal masses are seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multifocal regions of hypoenhancement in the left kidney represent\npyelonephritis. No abscess.\n2. The punctate calcification seen dependently in the urinary bladder may\nrepresent stone versus wall calcification.\n3. Small bilateral pleural effusions.\n4. Focal uterine hypodensity most likely represents a fibroid, though could be\nbetter characterized with ultrasound if clinically indicated." }, { "input": "LOWER CHEST: There is mild left basilar atelectasis. There is no pericardial\nor pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically. There is no\nhydronephrosis. A subcentimeter hypodensity in the midpole of the right\nkidney is too small to characterize. There are parapelvic left renal cysts. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia. The appendix is\nwell-visualized and normal. The large bowel is normal in caliber without\nfocal wall thickening. Small bowel is fluid and air-filled and dilated\nwithout clear transition. There is hyper enhancement of the proximal small\nbowel. There is trace intra-abdominal ascites. There is a small bowel\nmesentery containing umbilical hernia with associated fat stranding. Hernia\ndefect measures approximately 2.1 cm. There is no intra-abdominal free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no worrisome bony lesion. There are severe compression\ndeformities of the L1 and L2 vertebral bodies, which have mildly progressed\ncompared to ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Umbilical hernia containing small bowel mesentery with associated\ninflammatory changes, findings consistent with a recently reduced obstructive\nhernia.\n2. Dilated hyperemic small bowel without clear transition; it is highly likely\nthat the obstruction was due to bowel incarceration within the\nrecently-reduced umbilical hernia.\n3. Trace intra-abdominal ascites.\n4. Moderate hiatal hernia." }, { "input": "LOWER CHEST: There is bibasilar atelectasis without focal consolidation. \nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is mildly shrunken and nodular consistent with\ncirrhotic morphology. In the right lobe of the liver, there is a dense focus\nconsistent with granuloma, unchanged compared to ___. No concerning liver\nlesions are identified on this split bolus exam. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation. Thickening at the fundus is consistent with\nadenomyomatosis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\n\nLEFT KIDNEY:\nThere is delayed excretion of contrast via the left kidney with mild\nhydronephrosis and proximal hydroureter caused by an obstructing 2 mm calculus\nlocated in the mid ureter (series 2, image 53). There is significant free\nfluid surrounding the left proximal ureter and the left kidney along with\nleakage of contrast via the left renal pelvis into the medial perinephric\ntissues suggestive of forniceal rupture and leakage of urine surrounding the\nleft kidney and proximal ureter.\nAnterior to the left kidney, there is a 4.6 x 3.5 cm simple cyst.\n\nRIGHT KIDNEY:\nThere is a 2.3 cm simple cyst on the interpolar right kidney. Otherwise the\nright kidney shows no suggestion of hydronephrosis, concerning renal mass, or\nrenal stone. There are two right ureters which reach the bladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber. There is a small amount of fatty replacement in the right\nlower quadrant small bowel wall, likely sequelae of prior infection. There is\nextensive colonic diverticulosis without surrounding inflammation to suggest\ndiverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Visualized prostate is mildly enlarged. Seminal vesicles\nare unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute\nfracture.There is mild anterior wedging of the lower thoracic spine without\nsuggestion of acute compression fracture. Severe degenerative changes of the\nright hip.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 2 mm obstructing ureteral stone in the left mid ureter causing forniceal\nrupture and perinephric leakage of urine.\n2. There is a small amount of fatty replacement in the wall of the small bowel\nloops located in the right lower quadrant, likely sequelae of prior infection.\n3. Extensive sigmoid diverticulosis.\n4. Cholelithiasis without suggestion of cholecystitis. Gallbladder fundal\nfocal adenomyoamtosis.\n5. Cirrhotic liver morphology without evidence of focal masses. Unchanged\ngranuloma in the right lobe of the liver." }, { "input": "LOWER CHEST: There is bibasilar dependent atelectasis. Visualized lung fields\nare otherwise within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout, with\ncirrhotic morphology. A 5 mm granuloma is again seen. There is no evidence\nof focal lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder contains gallstones without wall\nthickening or surrounding inflammation. Focal thickening at the fundus\nconsistent with adenomyomatosis is again seen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Delayed excretion of contrast is again seen on the left, with\nunchanged mild hydroureteronephrosis proximal to an obstructing 2 mm stone,\nwhich is now seen in the distal left ureter (2:81). The proximal left ureter\ndemonstrates increased enhancement, likely due to recent stone passage. Free\nfluid and stranding are again seen around the left kidney, though without\nleakage of contrast seen on prior CT. A 4.6 x 3.5 cm simple cyst is again\nseen anterior to the left kidney. A 2.3 cm simple cyst is again seen in the\ninterpolar region of the right kidney. There is no right hydronephrosis,\nnephrolithiasis or renal mass.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe colon is noted, without evidence of wall thickening and fat stranding. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged anterior wedge deformity of the T11 and T12 vertebral bodies.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "2 mm obstructing stone in the distal left ureter, with mild\nhydroureteronephrosis. Left perinephric fluid and edema is again seen,\nsuggestive of forniceal rupture, though without contrast extravasation seen on\nprior CT." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nHEPATOBILIARY: Left hepatic lobe cyst measuring 3.5 cm. No suspicious hepatic\nmasses. Portal vein is patent. No intrahepatic or extrahepatic ductal\ndilatation. Gallbladder is unremarkable.\n\nPANCREAS: Appears unremarkable with no pancreatic ductal dilatation.\n\nSPLEEN: Normal size spleen.\n\nADRENALS: Right adrenal gland appears normal in size and shape. Left\nadrenal gland is mildly hypertrophied with no nodules identified.\n\nURINARY:No hydronephrosis. No nephrolithiasis.\n\nGASTROINTESTINAL: Stomach is distended with low density material,\nunremarkable. Imaged small bowel loops are normal in caliber. Scattered\ncolonic diverticulosis without diverticulitis.\n\nPERITONEUM: No free air. No free fluid.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Normal caliber abdominal aorta..\n\nBONES:Degenerative changes lower thoracic spine.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. No suspicious adrenal masses. Mild left adrenal gland hypertrophy. \nAppearance of a left adrenal mass on the prior imaging is attributable to\nvolume averaging.\n2. Left hepatic lobe cyst." }, { "input": "LOWER CHEST: Detailed evaluation of the pulmonary parenchyma is markedly\nlimited by respiratory and cardiac motion artifact. Other than mild bibasilar\natelectasis, the partially imaged lower lungs are essentially clear. No\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: A small hypodensity in the spleen corresponds to the hemangioma on\nthe recent MR ___ 2, image 15). The spleen otherwise shows normal size\nand attenuation throughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nA 9-mm right mid pole renal cortical hypodensity corresponds to a cyst on the\nprior MR ___ 601b, image 35). No evidence of concerning focal renal\nlesions, hydronephrosis, or perinephric abnormality.\n\nGASTROINTESTINAL: Oral contrast reaches the distal small bowel. There is\nagain a moderate amount of ingested food contents, in addition to ingested\noral contrast in the stomach. There is a relative change in caliber of the\nduodenum as it courses between the SMA and aorta, which is non-specific but\nmay suggest SMA syndrome. Small bowel loops otherwise demonstrate normal\ncaliber but appear somewhat diffusely edematous. The colon and rectum are\nwithin normal limits. No evidence of acute appendicitis. No free air.\n\nPELVIS: The urinary bladder is underdistended. The distal ureters are\nunremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. A 6-mm\nlucent lesion with a sclerotic rim in the left pelvis has no aggressive\nfeatures (series 601b, image 45). Multilevel degenerative changes in the\nvisualized spine are mild.\n\nSOFT TISSUES: There is diffuse, extensive edema within the body fat,\nsubcutaneous and intraabdominal, some of which appears to have been present on\nthe prior exam.", "output": "1. Diffuse subcutaneous and intraabdominal edema as well as small bowel wall\nedema consistent with third-spacing of uncertain etiology. Correlate with\nlaboratory data and clinical assessment.\n\n2. Non-specific change in caliber of the duodenum as it crosses between the\naorta and SMA. Although sometimes seen in normal, asymptomatic patients, this\ncould be also seen with SMA syndrome, and consideration of fluoroscopic upper\nGI study if suspicious for this entity.\n\nRECOMMENDATION(S): Consider fluoroscopic upper GI study to assess for\nmechanical obstructive etiology/SMA syndrome if supported by clinical\npresentation.\n\nNOTIFICATION: The findings and impression were discussed with Dr. ___,\n___. by ___, M.D. on the telephone on ___ at 4:58 ___, 15 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nMain portal vein, SMV, and splenic vein are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No hiatal hernia. The stomach is unremarkable. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits. The appendix is normal. No\nfat stranding, focal fluid collection, or extraluminal air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence to explain patient's symptoms. Specifically, no evidence of\nacute appendicitis.\n2. Small amount of pelvic free fluid is likely physiologic in a patient of\nthis age." }, { "input": "LOWER CHEST: Scarring or atelectasis at the lung bases. No focal\nconsolidations. The heart is mildly enlarged. Trace pericardial effusion. \nNo pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: 1.9 cm hypodensity within the right lobe of the liver has\ndecreased in size compared to ___, likely hepatic cysts. Additional\nsubcentimeter hypodensities within the liver too small to characterize, but\nalso likely represent cysts or biliary hamartomas. Otherwise, the liver\ndemonstrates homogenous attenuation throughout. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: 1.3 cm hypodensity within the spleen was present in ___, and likely\nbenign, either a hemangioma or lymphangioma. Otherwise, the spleen shows\nnormal size and attenuation throughout.\n\nADRENALS: No adrenal nodules. Mild thickening of the bilateral adrenal glands\nis likely due to adenomatoid hyperplasia.\n\nURINARY: Simple cysts within the interpolar region of the left kidney. \nAdditional subcentimeter hypodensities within the kidneys bilaterally are too\nsmall to characterize, but also likely represent simple cysts. Otherwise, the\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Within the right lower quadrant, there is extensive fat\nstranding and extraluminal foci of air with phlegmonous change. Although the\nappendix is not definitively visualized, a candidate for the appendiceal tip\nis seen on series 601, image 37. Proximal to this, there are multiple round\nradiodensities, likely representing appendicoliths (series 601, image 31, 33,\n35). These findings are most compatible with perforated appendicitis. No\nfocal drainable fluid collections are visualized. There is no distant\npneumoperitoneum. There is extensive wall thickening involving the terminal\nileum and cecum, which is likely secondary. The proximal small bowel loops\nare distended with air-fluid levels, but no transition point, compatible with\nileus. Multiple distended loops of small bowel with air-fluid levels, but no\ntransition point. The stomach is unremarkable. There is a small hiatal\nhernia. The distal colon and rectum are within normal limits. The appendix\nis normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring approximately 5.5 x\n4.6 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diastasis of the rectus abdominus muscles containing loops of\nbowel. Otherwise, the abdominal and pelvic wall is within normal limits.", "output": "1. Although the appendix is not definitively visualized, the above findings\nare most compatible with perforated appendicitis with multiple appendicoliths.\nNo focal drainable fluid collections. No distant pneumoperitoneum. Bowel wall\nthickening affecting the terminal ileum and cecum is likely reactive to the\nadjacent inflammation.\n2. Distended loops of small bowel with air-fluid levels but no transition\npoint, compatible with generalized ileus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:29 am, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: There are small left and trace right nonhemorrhagic pleural\neffusions. Adjacent compressive atelectasis is noted on the left. A slightly\nhypoenhancing consolidation at the right base may reflect atelectasis,\nalthough superimposed infection cannot be excluded. Extensive coronary artery\ncalcifications are noted. There are mitral annular and aortic valvular\ncalcifications of indeterminate hemodynamic significance.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\nScattered subcentimeter hypodensities are too small to characterize, but most\nlikely represent cysts. A 1.7 cm cyst in the hepatic dome is unchanged. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nLayering hyperdense material within the gallbladder is most likely vicarious\nexcretion of intravenous contrast.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: A 1.3 cm hypodensity the superior margin of the spleen is likely a\ncyst or hemangioma (05:13). The spleen is normal in size and attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nScattered subcentimeter hypodensities are too small to characterize, but most\nlikely represent cysts. There is a 2 cm parapelvic cyst in the left kidney. \nThere is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL:\n\nExtensive fat stranding, phlegmonous change, fluid and extraluminal gas is\nagain demonstrated in the right lower quadrant in keeping with perforated\nappendicitis. An irregularly-shaped fluid collection containing air now\ndemonstrates better defined margins. In the coronal plane, the collection\nmeasures up to 5.3 x 7.0 cm (06:32), although it is difficult to distinguish\nfrom surrounding bowel and appears to be draped over the terminal ileum\n(5:63). Multiple appendicoliths are again demonstrated.\n\nAn enteric tube is coiled in the gastric fundus. There is diffuse small bowel\ndilatation up to 5 cm extending from the proximal jejunum to the distal ileum\nwithout a gradual transition point in the right lower quadrant, progressed\nwhen compared to the prior study and now concerning for small bowel\nobstruction related to the inflammatory phlegmon in the right lower quadrant. \nThe colon is mostly collapsed.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The urinary bladder contains a small amount of air. \nCorrelate with recent Foley catheterization or instrumentation.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diastasis of the rectus abdominus muscles.", "output": "1. Perforated appendicitis with a collection containing fluid and extraluminal\ngas in the right lower quadrant that has become more organized since ___.\n2. Worsening partial small bowel obstruction with a gradual transition in the\nright lower quadrant, related to the phlegmon abscess.\n3. Small left and trace right pleural effusions with adjacent atelectasis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 9:41 am, 10 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Small bilateral pleural effusions with associated atelectasis,\ndecreased in size from most recent prior. Opacities in the visualized right\nmiddle lobe and lingula, along with hypoenhancing consolidation in the right\nbase are concerning for infection. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is heterogeneously hypoattenuating, similar to prior.\nUnchanged 1.6 cm cyst in the right lobe and additional punctate hypodensity in\nsegment 4. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic. There is normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Unchanged\n1.2 cm hypodensity, likely a cyst.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Stable 1.9 cm\nsimple cyst in the interpolar region of the left kidney. Multiple bilateral\nsubcentimeter renal hypodensities are too small to characterize on CT. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: A gastric tube is in place. The patient is status post\nright hemicolectomy and diverting jejunostomy, and subsequent takedown. The\nleft lower quadrant anastomosis intact, with no extravasation of contrast. \nFree fluid is noted tracking down to the pelvis. There is wall thickening\nversus decompression of the proximal sigmoid colon. There is a fluid\ncollection adjacent to the ascending colon, with equivocal, perhaps incomplete\nrim enhancement possibly representing an organizing fluid collection (02:56)\nmeasuring 5.2 x 2.0 x 5.1 cm. Contrast passes through to the rectum. The\nappendix is surgically absent.\n\nPELVIS: The urinary bladder wall is thickened, which may be due to\ndecompression, and a locule of air is seen anteriorly (2:76). The distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes, focally moderate at L5-S1.\n\nSOFT TISSUES: Within the left psoas, there is a mixed density collection,\nlikely hematoma, new from prior. The psoas measures up to 6.8 x 5.6 cm in\ngreatest dimension (02:47).", "output": "1. Left psoas hematoma, measuring up to 6.8 x 5.6 cm in axial plane with\ndiffuse expansion of the entirety of the psoas musculature.\n2. No evidence of anastomotic leak.\n3. Small to moderate amount of free fluid throughout the abdomen and pelvis. \nSome scattered areas of apparent sigmoid and rectal wall thickening may be due\nto collapse, or inflammation from the free fluid\n4. Possible organizing fluid collection lateral to the ascending colon\nmeasures 5.2 x 2.0 x 5.1 cm with subtle, perhaps incomplete rim enhancement,\nwhich could represent a developing abscess.\n5. Right middle lobe, lingular, and right lower lobe opacities concerning for\npneumonia.\n6. Small bilateral pleural effusions, slightly decreased from prior.\n7. Punctate focus of air within the bladder. Correlate with recent\ninstrumentation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:40 pm, 40 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Moderate right and small left pleural effusion are similar to\nprior with associated atelectasis. Consolidative changes in the bilateral\nlower lobes are mildly improved since the prior examination. Coronary artery\ndisease. Mild prominence of the heart is similar.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. In\nthe right hepatic lobe, there is a 1.6 cm hypodense nodule which is unchanged\nfrom prior examinations with CT and ultrasound characteristics suggesting a\nhepatic cyst. Subcentimeter hypodensity in the inferior left hepatic lobe is\nunchanged dating back to at least ___. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: Similar mild atrophic changes of the pancreas. The pancreas has\nnormal attenuation throughout, without evidence of focal lesions or pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Rounded and nodular hypodensity in the lateral posterior aspect of the\nspleen measuring 1.3 cm unchanged dating back to at least ___ likely\nrepresenting a cyst. Additionally, wedge-shaped hypodense region in the dome\nof the spleen is unchanged since ___, however not seen on prior\nexaminations is nonspecific, however may represent splenic infarction.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis bilaterally. Bilateral parenchymal and peripelvic cysts\nwith the largest peripelvic cyst being in the left kidney measuring 1.5 cm. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Status post removal of enteric tube. Small hiatal hernia. \nGastrostomy tube within the antrum of the stomach. The stomach is otherwise\nwithin normal limits. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Status post right hemicolectomy and\ndiverting jejunostomy with subsequent takedown. Anastomosis in the left lower\nquadrant small bowel which is patent and without evidence of extravasation. \nLikely underdistention of the sigmoid colon given similar appearance on the\nprior examination rather than wall thickening. Marked interval decreased size\nof fluid collection along the right paracolic gutter. Mild predominantly\nlower pelvic ascites.\n\nPELVIS: Similar mild thickening of the bladder. The distal ureters are\nunremarkable.\n\nREPRODUCTIVE ORGANS: Few calcifications within the prostate. Normal seminal\nvesicles.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nCongenital nonunion of the transverse processes of L1. Moderate degenerative\nchanges of L5-S1.\n\nSOFT TISSUES/RETROPERITONEUM: There is heterogeneous, mixed density fluid\ncollection within the left psoas muscle measuring 6.3 x 6 cm, previously\nmeasured 6.7 x 5.6 cm, and thickening of the left iliacus muscle measuring 4.3\nx 2.4 cm, previously measured 4.6 x 2.4 cm. These likely represent\nretroperitoneal hematomas. Cutaneous staples along the left lower abdomen. \nMidline abdominal scar. Diffuse mild muscle atrophy.", "output": "1. Similar to minimally improved size of left iliopsoas hematomas measuring\n6.3 cm.\n2. Similar moderate right and small left pleural effusions.\n3. Mildly improved consolidative changes of the lung bases.\n4. Wedge-shaped hypodense region in the dome of the spleen is unchanged since\n___, however not seen on prior examinations is nonspecific, however\nmay represent splenic infarction.\n5. Similar abdominal postsurgical changes with intact anastomosis." }, { "input": "LOWER CHEST: Bilateral pleural effusions are again seen which appear similar\nin overall size with associated compressive atelectasis in the lower lobes. \nThere is also ground-glass opacity within the lower lungs which is concerning\nfor edema. The imaged portion of the heart is top normal in size with aortic\nvalvular and mitral annular calcification.\n\nABDOMEN:\n\nHEPATOBILIARY: A hypodensity within segment 8 is unchanged measuring\napproximately 10 x 18 mm, indeterminate. A small rounded hypodensity is noted\nwithin segment 4B, series 2, image 64, also indeterminate and unchanged. Main\nportal vein is patent. No biliary ductal dilation is seen. The gallbladder\nis decompressed. Common bile duct is nondilated.\n\nPANCREAS: The pancreas appears slightly atrophic but otherwise unremarkable.\n\nSPLEEN: The spleen is normal in size and contains a peripheral hypodensity\nwhich is unchanged in appearance and size and may represent a cyst or\nhemangioma. A linear hypodensity in the upper pole of the spleen is\nunchanged.\n\nADRENALS: Adrenals appear normal in size and configuration bilaterally.\n\nURINARY: The kidneys enhance symmetrically. A small hypodensity in the left\nrenal interpolar region is likely a parapelvic cyst measuring approximately\n1.9 cm in maximal diameter. No worrisome renal lesion is seen. No\nhydronephrosis or signs of pyelonephritis.\n\nGASTROINTESTINAL: The stomach contains a PEG tube which appears well\npositioned entering the mid anterior upper abdomen. The duodenum appears\nnormal. Small bowel is distended with contrast and there is mild dilation of\nsmall bowel loops which measure up to 4 cm in diameter. There is no small\nbowel transition point. Dilated small bowel extends to the enterocolonic an\nanastomosis in the right hemiabdomen. Beyond the enterocolonic anastomosis,\nthe transverse colon appears somewhat gas distended though there is complete\ncollapse of the descending and sigmoid colon. This overall appearance is most\nsuggestive of an adynamic ileus. There is no free air. Small volume free\nfluid tracks into the lower pelvis.\n\nThere is an expanded appearance of the left psoas muscle with heterogeneous\ninternal content likely reflecting subacute hematoma. The overall size of\nthis intramuscular hematoma is approximately 15.0 X 5.0 X 6.7 cm. \nSuperinfection is difficult to exclude.\n\nPELVIS: Urinary bladder contains a Foley catheter and is moderately distended\ncontaining a small volume of gas. Small volume free fluid is noted within the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is not enlarged. The seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is generalized body wall edema mostly involving the\npelvis. The scrotum appears edematous those only partially visualized likely\nwith bilateral hydroceles.", "output": "1. Status post ileocecectomy for perforated appendicitis with reversal a\njejunostomy. Dilated small bowel likely due to adynamic ileus. Enterocolonic\nanastomosis with relative decompression of the majority of the colon. Small\nvolume free fluid.\n2. Left psoas intramuscular hematoma again noted, similar in overall size,\ndifficult to exclude superinfection.\n3. Bilateral pleural effusions, similar to prior with associated compressive\natelectasis in the lower lobes. Additionally, there is partially visualized\nground-glass opacity within the lower lungs concerning for edema with\ntop-normal heart size.\n4. Body wall edema mostly along the pelvis with partially visualized scrotal\nwall edema and bilateral scrotal hydroceles." }, { "input": "LOWER CHEST: Limited evaluation of the lung bases are notable for bibasilar\natelectasis. There are moderate, right greater than left, nonhemorrhagic\npleural effusions, similar in appearance to ___. No pneumothorax.\nPartially visualized heart is top-normal in size. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: No interval change in a 1.4 x 0.8 cm hypodense lesion within\nsegment 8 which is too small to characterize but likely representing a simple\ncyst or biliary hamartoma (2: 27). The liver demonstrates homogenous\nattenuation throughout. There are no suspicious hepatic lesions. Small\namount nonhemorrhagic perihepatic free fluid has increased since prior\nexamination. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is a 1.3 x 1 cm peripheral hypodensity which is unchanged since\nprior examination (02:29). The spleen otherwise shows normal size and\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral subcentimeter renal hypodensities are incompletely\ncharacterize and likely represent renal cysts. The kidneys otherwise are of\nnormal and symmetric size with normal nephrogram. There is no evidence of\nsuspicious renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Again seen is a percutaneous gastrostomy tube in appropriate\nposition. The stomach is unremarkable. Patient status post ileocecectomy and\njejunostomy take-down following a perforated appendix with an intact\nenterocolonic anastomosis. There is persistent small bowel distension likely\ndue to ileus. Small bowel loops are otherwise unremarkable with preserved\nwall thickness and enhancement throughout. The colon and rectum are within\nnormal limits with contrast extending through the rectum. No contrast\nextravasation noted. The appendix is surgically absent.\n\nPELVIS: The bladder is moderately well distended with a Foley catheter and\nexpected locules of gas. There is diffuse bladder wall thickening measuring\nup to 1 cm with subtle fat stranding (2:153). There is mild increase in\nmoderate nonhemorrhagic pelvic free fluid.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. Celiac axis and ___ are patent. There is dense\natherosclerotic calcification at the origin of the SMA which remains patent\nwithout aneurysmal dilatation. ___ is patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Diffuse\nanasarca noted. Interval decrease in size of the expanded left psoas muscle\nwhich measures 6 x 5.2 cm (previously 6.5 x 6 cm) with heterogeneous contents\nand internal cystic components. A coiled pigtail catheter is in appropriate\nposition within this collection. (2:95).", "output": "1. Status post ileocecectomy and jejunostomy takedown with intact\nenterocolonic anastomosis, with persistent degree of small-bowel distention\nlikely due to ileus. No definite bowel obstruction.\n2. Increase in moderate nonhemorrhagic ascites.\n3. Decrease in size of 6 cm left psoas muscle collection with a pigtail\ncatheter in appropriate position. No new collection." }, { "input": "LOWER CHEST: Please refer to dedicated CT of the chest performed the same day\nfor intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation. A tiny subcapsular\nhypodensity in segment 7 (series 601b, image 35), is too small to characterize\nbut stable since at least ___ and therefore benign. The gallbladder\nis within normal limits. There is no intra- or extrahepatic biliary ductal\ndilatation.\n\nPANCREAS: There is diffuse fatty atrophy of the pancreas. There is a 0.6 cm\nhypodensity in the pancreatic tail, stable since at least ___ and\nlikely representing a side-branch IPMN. There is no main pancreatic ductal\ndilatation.\n\nSPLEEN: The spleen is normal in size and homogeneous in attenuation. There is\na calcified granuloma centrally within the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size and demonstrate normal bilateral\nnephrograms. There is a dominant 2.6 x 2.2 cm cyst in the upper pole of the\nleft kidney. A 0.6 x 0.4 cm hypodensity in the upper pole of the right kidney\nmeasures higher than of fluid attenuation ___ 57) and is too small to\ndefinitively characterize, but likely represents a hemorrhagic or\nproteinaceous cyst. There is no hydronephrosis. Note is made of a small\nright extrarenal pelvis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A gastrostomy tube is in place. Again seen is a large\nhiatal hernia containing the gastric fundus and body. Small bowel loops are\nnormal in caliber. There are scattered colonic diverticula. The rectum is\nwithin normal limits.\n\nPERITONEUM: Previously seen pneumoperitoneum has resolved.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent. There is no adnexal\nmass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. The major mesenteric branch vessels are patent.\n\nBONES: Again seen is a severe chronic fracture deformity of the T12 vertebral\nbody. There is mild lumbar levoscoliosis and multilevel spinal degenerative\nchanges. There also degenerative changes of the bilateral sacroiliac joints,\nhips and pubic symphysis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal pathology.\n2. Other unchanged findings as above, including a large hiatal hernia and\ngastrostomy tube in place, stable 0.6 cm probable IPMN in the pancreatic tail,\nand severe chronic fracture deformity of the T12 vertebral body." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nmild right hydronephrosis. There are punctate bilateral hyperdense foci\nconsistent with nonobstructing calculi (2; 32). These measure 1-2 mm in size.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: There is an obstructing 3 mm right UVJ stone (2; 79) with mild right\nhydroureter. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 2 anterolisthesis of L5 on S1, similar to prior.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Obstructing right 3 mm UVJ stone with mild right hydroureter and\nhydronephrosis.\n2. Bilateral punctate nonobstructing calculi." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is dilated to 1.3 mm and hyperemic, with surrounding\nfat stranding, without drainable fluid collection or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute appendicitis without drainable fluid collection or free air." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Scattered diverticula of the\nsigmoid colon is noted, without evidence of wall thickening and fat stranding.\nThe appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal abnormality." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Geographic hypodensity adjacent to the falciform ligament\nlikely represents focal fat. Otherwise, the liver demonstrates homogenous\nattenuation throughout. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The appendix is enlarged measuring up to 1.2 cm in maximal\ndiameter. There is mucosal hyperemia and multiple appendicoliths, concerning\nfor acute appendicitis. There is minimal haziness of the periappendiceal fat.\nThere is no drainable fluid collection or extraluminal gas. Small hiatal\nhernia. No bowel obstruction is seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Enlarged appendix measuring up to 1.2 cm with mucosal hyperemia and multiple\nappendicoliths, compatible with acute appendicitis. Minimal haziness of the\nperiappendiceal fat. No drainable fluid collection or extraluminal gas.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:48 pm, 30 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Mass-like consolidation in the right middle lobe and bilateral\nlower lobes are partially imaged. There is confluent centrilobular emphysema,\npartially imaged. Coronary vascular calcifications are moderate.\n\nABDOMEN: The unenhanced liver, spleen, pancreas, adrenal glands and kidneys\nare unremarkable.\n\nGASTROINTESTINAL: In the region of the rectosigmoid junction, there is a 3.5\ncm curvilinear hyperdensity, likely a foreign body such as fish or chicken\nbone, protruding out halfway from the lumen into the rectus sigmoid mesocolon\nwith small amount of extraluminal air and inflammatory changes (303:17). No\nintraperitoneal gas is otherwise seen. The oral contrast did not reach the\ncolon.\n\nThere is marked colonic dilatation within insidious return to normal caliber\ndistal colonic loops, however in close proximity to the region where the\nforeign body is visualized. The possibility includes colonic ileus from the\ninflammation or an obstructing mass with an impacted finding body within it.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen.", "output": "1. Sigmoid colonic perforation by foreign body which could represent a piece\nof bone. There is also marked colonic distension with a gradual transition\ninto this level suggestive of either colonic ileus related to the inflammation\nor an obstructing mass at this level which caused lodging of the foreign body.\n2. Partially image emphysema with masslike consolidation which is only\npartially visualized. Dedicated CT chest is recommended.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:16 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: There is moderate to severe atelectasis in the bilateral lower\nlobes. Moderate to severe centrilobular and paraseptal emphysematous changes\nare seen in the imaged lung bases, worse in the lingula. No pleural\npericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: A subcentimeter hypoattenuating area in the posterior periphery\n(02:23) is too small to characterize. The spleen is normal in size.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the gastric fundus.\nPatient is post sigmoid colectomy and ileocecectomy, with reversal of\nileostomy. Anastomosis sutures are seen in the pelvis and right lower\nquadrant.\n\nMultiple dilated loops of small bowel measure up to 4.1 cm in diameter. \nFecalized material is seen in distal small bowel loops (2:74). A focal area\nof small-bowel narrowing and tethering of adjacent small bowel loops in the\nmid pelvis (2:77), likely secondary to adhesions, may represent a transition\npoint.\n\nGas and stool is seen in the remaining colon, which is mildly distended up to\n6.5 cm in the transverse portion. Small volume free intraperitoneal fluid is\nnoted. No pneumoperitoneum.\n\nPELVIS: The urinary bladder is collapsed around a Foley balloon. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: A partly calcified porta hepatis lymph node is again seen\n(02:30). There is no evidence of abdominal, pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. There is moderate to severe stenosis of the celiac axis and\nproximal SMA secondary to calcified atherosclerotic plaques.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the lower thoracic and lumbar\nspine.\n\nSOFT TISSUES: Postsurgical changes are noted in the anterior abdominal wall.", "output": "1. Moderate to severe atelectasis in the bilateral lower lung lobes.\n2. Multiple findings involving small and large bowel loops, as detailed above,\nincluding a possible transition point/area of tethering of small bowel in the\nmid pelvis. Overall, findings suggest ileus, however, a partial/early\nsmall-bowel obstruction is also a possibility.\n3. Extensive atherosclerotic disease, with moderate to severe stenosis of the\nceliac axis and proximal SMA." }, { "input": "LOWER CHEST: There is bibasilar atelectasis with trace bilateral pleural\neffusions, improved compared to prior examination. Calcifications at the\nright lung base likely represent sequela of prior granulomatous disease. \nThere is moderate to severe background paraseptal and centrilobular emphysema,\nmost notable in the lingula.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is distended without\ngallbladder wall thickening, slightly more distended compared to ___.\nDensity at the gallbladder neck is of uncertain etiology, unchanged compared\nto ___ and may represent cholelithiasis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is normal in size and attenuation. There is a subcentimeter\narea of hypoattenuation in the posterior aspect of the spleen (series 2; image\n24), which is too small to characterize and unchanged compared to prior.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Again seen is enteric tube tip which terminates in the\ngastric body. Stomach is otherwise unremarkable.\n\nPatient is status post ileocecectomy and sigmoid colectomy. Anastomosis\nsutures are again seen in the pelvis and in the right lower quadrant.\n\nMultiple dilated loops of small bowel are again seen, measuring up to 5.3 cm\nin size, increased compared to most recent prior with increased bowel wall\nedema and mesenteric stranding. Dilation of these loops of bowel appears to\nhave a transition point in the mid-abdomen (series 2; image 45, series 601;\nimage 24). Colon does not appear entirely decompressed, but does appear\ndecreased in caliber throughout its course when compared to prior. Minimal\nintraperitoneal free of fluid persists. There is persistent fat stranding\nwithin the peritoneum, most notable in the right upper quadrant, likely\npostoperative. There is no pneumoperitoneum.\n\nPELVIS: Bladder is decompressed with Foley catheter in situ.\n\nREPRODUCTIVE ORGANS: Visualized prostate and seminal vesicles are within\nnormal limits.\n\nLYMPH NODES: There are multiple prominent lymph nodes at the porta hepatis and\nin the retroperitoneum, none of which meet CT size criteria for enlargement. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is again noted. There is moderate to severe stenosis of the celiac\naxis and proximal SMA, as on prior.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is moderate to severe degenerative change in the visualized\nthoracolumbar spine, most notable at L3 through S1.\n\nSOFT TISSUES: Soft tissue defect along the right anterior abdominal wall is\nlikely postoperative in nature. Otherwise, soft tissues of the abdomen and\npelvis are unremarkable.", "output": "1. Again seen are multiple findings involving the small and large bowel loops,\nas detailed above, including diffuse small bowel dilation, increased in\ncaliber, wall edema, and mesenteric stranding compared to prior with\ntransition point in the mid abdomen, at the distal small bowel. Previously\nseen area of tethering of small bowel in the pelvis is less conspicuous\ncompared to prior. These findings are consistent with small-bowel\nobstruction. There is no pneumoperitoneum. No intra-abdominal or intrapelvic\ncollection is identified.\n2. Increased distension of the gallbladder without wall thickening. Density\nat the gallbladder neck is of uncertain etiology and may represent\ncholelithiasis, although unchanged in appearance since ___. No\nspecific findings to suggest cholecystitis. Right upper quadrant fat\nstranding is likely postoperative and confounds assessment for surrounding\ninflammation.\n3. Bibasilar atelectasis with trace bilateral pleural effusions, improved\ncompared to prior.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:32 pm, 15 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. The gallbladder is no longer\ndistended as previously seen on prior study. Focal density at the gallbladder\nneck is unchanged, likely compatible with cholelithiasis.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable aside for stable cyst.\n\nADRENALS: Unremarkable.\n\nURINARY: Unremarkable without evidence stones or hydronephrosis.\n\nGASTROINTESTINAL: Patient is status post ileocecectomy and sigmoid colectomy\nwith ileocolic anastomosis. Enteric tube terminates within the gastric body. \nMultiple dilated, fluid-filled loops of small bowel are again seen, with no\nevidence of transition point identified and oral contrast reaching the level\nof the distal ileum, findings which are compatible with improved partial bowel\nobstruction versus ileus. Mild intraperitoneal fat stranding with minimal\nfluid persists, likely postoperative. There is no pneumoperitoneum.\n\nPELVIS: Small amount of pelvic free-fluid.\n\nLYMPH NODES: No abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe stenosis\nof the origin of the celiac axis and proximal SMA, unchanged.\n\nBONES: There is no evidence of worrisome osseous lesions. Moderate multilevel\ndegenerative change of the thoracolumbar spine is stable, most notably\nincluding disc space narrowing at L4-L5 and L5-S1.\n\nSOFT TISSUES: Soft tissue defect along the right anterior mid abdominal wall\nis likely postoperative. The abdominal and pelvic wall is otherwise within\nnormal limits.", "output": "1. Multiple dilated small bowel loops now without transition point and further\npassage of contrast in the distal ileum. Findings may represent ileus versus\npartial small bowel obstruction. The oral contrast has not reached the colon\nwhich could be assessed with radiographs.\n2. Cholelithiasis with improved distention of the gallbladder.\n3. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day." }, { "input": "There is moderate to large hiatal hernia. Opacities at the lung bases suggest\natelectasis. The heart is mildly enlarged. Coronary artery calcification is\ndetected.\n\nSeveral cysts in the right kidney appear simple. A structure suggesting a\nmildly prominent extrarenal pelvis is noted on the left. Each kidney shows\nmild cortical thinning. Small stones are present within the gallbladder. The\nliver, spleen, pancreas, and adrenal glands are unremarkable.\n\nThe ileum shows mildly prominent enhancement. Mildly prominent mural\nenhancement also affects the whole colon. Sigmoid diverticulosis is moderate\nto severe. There is a very small fat-containing periumbilical hernia.\n\nPatient is status post hysterectomy. Ovaries are not discretely identified,\nif present. Bladder shows mild inflammatory change confirmed clinical\ninformation suggesting coinciding urinary tract infection.\n\nThere are no suspicious bone lesions. Moderate degenerative changes are\npresent throughout the lumbar spine.", "output": "1. Mild hyperenhancement along the colon and distal ileum suggestive of mild\nileocolitis.\n\n2. Mild inflammatory change suggesting cystitis.\n\n3. Moderate to large hiatal hernia, not significantly changed.\n\n4. Gallstones." }, { "input": "LOWER CHEST: Previously seen trace bilateral pleural effusions have resolved. \nMinimal bibasilar dependent atelectasis. Partially imaged heart is top-normal\nin size. Dense coronary artery and aortic and mitral valve annular\ncalcification. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nSeveral hypodensities are scattered throughout the liver, unchanged since\nprior exam. The largest hypodense lesion within segment III of the liver is\nincompletely characterized on this unenhanced scan, though better assessed on\nprior CT from ___ and consistent with a hepatic hemangioma. No new\nor concerning focal hepatic lesions identified. There is no evidence of\nintrahepatic or extrahepatic biliary ductal dilatation. The gallbladder\ncontains layering gallstones without wall thickening or evidence of\ninflammation.\n\nPANCREAS: The pancreas is atrophic. No concerning pancreatic lesion\nidentified. There is no main pancreatic ductal dilatation. No peripancreatic\nabnormality.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Lobulated appearance of the bilateral kidneys is unchanged since at\nleast ___. Several bilateral renal hypodensities, many of which are too\nsmall further characterize, are unchanged since prior exam. No new renal\nlesion is identified, within limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Otherwise, the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. Again seen is a large anterior abdominal wall hernia containing\nnondilated transverse colon with a wide neck, measuring approximately 6.4 cm. \nRemaining loops of colon and rectum are unremarkable. No pneumatosis. No\nfree intraperitoneal air. No ascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple calcifications within the uterus, likely\nreflecting calcified fibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted. The abdominal aorta is\nmoderately tortuous. Infrarenal abdominal aortic aneurysm at the level of the\ninferior mesenteric artery measures 3.5 x 3.1 cm, previously 3.5 x 3.0 cm. In\naddition, there is aneurysmal dilatation of the right common femoral artery at\nthe site of previous right femoral bypass, measuring approximately 3.1 x 3.0\ncm, which appears increased in size since prior exam from ___,\nmeasuring approximately 2.2 x 1.9 cm at that time, though only partially\nimaged.\n\nBONES: Multilevel degenerative changes of the imaged thoracolumbar spine, most\nnotable at L4-L5. There is no focal lytic or sclerotic osseous lesion. No\npathological or compression fracture identified.\n\nSOFT TISSUES: Patient is status post left inguinal hernia repair with a\npostoperative seroma in the surgical bed measuring approximately 9.4 x 2.9 x\n5.8 cm (3:70, 5:26). Otherwise, abdominal and pelvic wall is within normal\nlimits.", "output": "1. Status post left femoral hernia repair with postoperative seroma within the\nsurgical bed.\n2. Stable large anterior abdominal wall ventral hernia containing nondilated\ntransverse colon. No evidence of bowel obstruction or ischemia.\n3. Interval increase in size of right common femoral artery at the site of\nprevious right femoral bypass, now measuring approximately 3.1 x 3.0 cm. \nGiven lack of true comparison with prior examination, due to partial imaging\nof the structure, recommend ultrasound, if not already performed, for further\nevaluation.\n4. Stable infrarenal abdominal aortic aneurysm, measuring up to 3.5 cm.\n5. Unchanged multiple hepatic hypodensities, better characterized on prior CT\nfrom ___, consistent with hemangiomas.\n6. Multiple bilateral renal hypodensities, incompletely characterized on this\nunenhanced examination. If desired, nonemergent renal ultrasound could be\nperformed for further evaluation.\n7. Extensive atherosclerotic disease.\n\nRECOMMENDATION(S): Dedicated ultrasound for enlarging common femoral artery\nat site of prior femoral bypass.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:15 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Heart is mildly enlarged. Aortic and mitral valves are calcified as well as\ncoronary arteries. Minor dependent changes are found at the right lung base.\n\nSubcentimeter hypoattenuating foci in the liver are too small to characterize,\nbut unchanged and doubtful in clinical significance. There is no biliary\ndilatation. Layering stones are found in the gall bladder. Gall bladder is\nnondistended. No wall thickening is found. Along the pancreatic body is a\nsmall cyst measuring up to 9 mm which shows long-term stability since at least\n___. Adrenals appear normal. In each kidney, there are again a number of\nunchanged small hypoattenuating foci, since the recent prior CT studies,\nmostly too small to characterize, but unchanged and most likely to represent\nvery small cysts. No solid masses identified. There is no hydronephrosis.\n\nA small hiatal hernia noted. There is large epigastric ventral hernia with a\nwide neck, again containing long segment of transverse colon without\nobstruction. Small bowel is unremarkable.\n\nThere is some hypervascularity along the right upper anal wall suspected to be\nassociated with internal hemorrhoids, better depicted on the prior examination\nfrom ___, however. This should be correlated with physical findings.\n\nCalcified fibroids again noted. No adnexal masses found. Bladder appears\nnormal. There is no lymph adenopathy, free air, or free Fluid.\n\nEctatic infrarenal abdominal aorta again now measures up to 35 mm in diameter,\ncompared to 31 mm in ___. Abdominal aorta is tortuous. A right common\nfemoral artery aneurysm is largely thrombosed with a calcified wall. Maximal\n___ are 34 x 31 mm in axial ___ (2:82). On the most recent study\nit measured 33 x 29 mm, so minimally increased.\n\nBones appear demineralized. Moderate degenerative changes are again\nvisualized throughout the of the thoracolumbar spine.", "output": "1. Hypervascularity along the right upper anal canal, probably reflecting\ninternal hemorrhoids, but not the optimally assessed with this technique. \nCorrelation with physical findings suggested.\n2. Similar ventral hernia containing transverse colon without obstruction.\n3 Mild increase in ectatic abdominal aorta and in a right common femoral\naneurysm. It may be appropriate to consider follow-up ultrasound for these in\n___ year." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits.\n\nABDOMEN: There is a homogeneous low-density left adrenal nodule measuring 2.4\nx 2.4 cm, compatible with a lipid rich adenoma (series 3, image 11). The\nunenhanced evaluation of the visualized liver, spleen, pancreas and right\nadrenal gland are unremarkable. No bowel obstruction in the upper abdomen. \nThe lung bases are clear. No aggressive osseous lesions.", "output": "2.4 cm left adrenal adenoma." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys have normal nephrograms bilaterally. There is no\nevidence of hydronephrosis. There is a concave cortical defect in the lower\npole of the right kidney consistent with prior partial nephrectomy. There is\nno evidence of recurrence in the surgical bed. There is no perinephric\nabnormality. Interval resolution of the previously seen 3 mm hypodense lesion\nin the left kidney. No evidence of nephrolithiasis or ureterolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears grossly unremarkable within the\nlimitations of CT technique. There are small, bilateral ovarian follicles.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are two stable sclerotic foci in the right ilium, consistent with\nenostoses. Additional sclerotic foci in the left greater trochanter and right\nischium are also consistent with enostoses.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of disease recurrence or intra-abdominal or pelvic metastases.\n2. No evidence of nephrolithiasis or ureterolithiasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 6\nmm hypodensity in left lobe of the liver and two hypodensities within segment\n6 of the liver are too small to further characterize but likely reflects a\nsmall hepatic cyst (series 4, image 14, image 26, image 37). There is\notherwise no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is\nasymmetric enlargement of the left adrenal gland with hypoenhancement of the\nleft adrenal gland and surrounding fat stranding. No discrete adrenal mass is\nidentified.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no nephrolithiasis or ureterolithiasis. There is a 1.6 cm\nhypodensity in the lower pole of the left kidney, which likely represents a\nsimple cyst. There is no hydronephrosis. There is no perinephric abnormality.\nThere is no evidence of focal renal lesions. There is no evidence of\nurothelial lesions. The distal ureters and bladder are unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable. prostate\n\nLYMPH NODES: No mesenteric lymphadenopathy is seen. There are mildly prominent\nbilateral external iliac lymph nodes. Subcentimeter para-aortic numbers are\ngreater in number than typically seen.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No nephrolithiasis or ureterolithiasis.\n2. Hypoenhancement of the left adrenal gland with surrounding fat\nstranding/haziness of the adjacent fat. Findings are concerning for left\nadrenal hemorrhage. Consider MRI fur further assessment. No underlying\nadrenal mass seen on CT.\n\n3. Mildly prominent bilateral external iliac lymph nodes. Subcentimeter\npara-aortic numbers are greater in number than typically seen. Findings are\nnon-specific.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by Dr.\n___. in person on ___ at 10:45 ___, 10 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: There is a subcentimeter homogeneous rounded nodule within the\nright lower lung, that was not visualized on the prior examination. The\npartially visualized lung bases are otherwise clear bilaterally. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a moderate amount of intrahepatic and extrahepatic\nbiliary dilatation. Otherwise, the liver demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. The gallbladder is\ndistended, but there is no evidence of cholelithiasis or cholecystitis.\n\nPANCREAS: There is a bulky appearance of the uncinate process of the pancreas\nwith a peculiar texture, but without a definite mass or invasion of the\nsurrounding vasculature. The common bile duct appears prominent up to this\npoint. There is no pancreatic ductal dilatation. There is no evidence of\ncholedocholithiasis. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a moderate-sized simple cyst within the right kidney, that\nis unchanged in comparison to the prior examination. Otherwise, the kidneys\nare of normal and symmetric size with normal nephrogram. There is no evidence\nof hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia, unchanged from the prior\nexamination. Otherwise, the stomach is unremarkable. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\npatient is status post total colectomy with a right lower quadrant ileostomy\nand no evidence of obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable appearance of mild L5 wedge compression fracture.\n\nSOFT TISSUES: There is an ileostomy within the right lower quadrant with a\nperistomal hernia containing a short segment of contrast filled small bowel,\nwhich has decreased in size in comparison to the prior examination.", "output": "1. Bulky appearance of the uncinate process of the pancreas with a peculiar\ntexture, but without a definite mass, local or vascular invasion which is\ncausing intrahepatic and extrahepatic biliary dilatation. This could\nrepresent pancreatic carcinoma or a cholangiocarcinoma. Focal pancreatitis is\nless likely considering the lack of surrounding inflammation.\n2. Subcentimeter nodule within the right lower lobe for which attention on\nfuture examinations is warranted.\n3. Status post total colectomy with right lower quadrant ileostomy and\nnonobstructed parastomal hernia.\n4. Stable simple cyst within the right kidney.\n5. Mild L5 wedge compression fracture.\n\nRECOMMENDATION(S): For further evaluation of uncinate process of the pancreas\nand biliary dilatation recommend pancreatic MR and MRCP.\n\nNOTIFICATION: Pertinent critical findings were posted by Dr. ___\n___ on ___ at 17:43 to the Department of Radiology online critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions with adjacent\ncompressive atelectasis. The heart is not enlarged. There is trace\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. The\npatient is status post placement of an internal-external biliary drain and\ncommon bile duct stent. A small amount of pneumobilia is expected, and\nsuggests patency of the stents. Assessment of persistent intrahepatic biliary\nductal dilatation is limited without intravenous contrast. There is a\nsuggestion of a small area of ductal dilatation within the left hepatic lobe. \nThe gallbladder remains markedly distended, without evidence of\ncholelithiasis. There is a small amount of mesenteric fat stranding and\nintra-abdominal free fluid, most notably surrounding the spleen and tracking\ninto the left pericolic gutter.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A 2.3 x 2.8 cm cyst is\nseen in the interpolar region of the right kidney. There is no evidence of\nfocal renal lesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status post\ncolectomy, with end ileostomy in the right lower quadrant. Visualized small\nbowel loops demonstrate normal caliber, without evidence of obstruction. Note\nis made of a parastomal hernia containing a nonobstructed loop of small bowel\nand a small amount of free fluid.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. No atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.", "output": "1. Status post placement of an internal-external biliary drain and common bile\nduct stent. Assessment of persistent intrahepatic biliary ductal dilatation\nis limited without intravenous contrast. If further evaluation of the presence\nof intrahepatic biliary ductal dilatation is necessary, ultrasound could be\nperformed.\n2. Small amount of intra-abdominal ascites, mesenteric stranding, and small\nbilateral pleural effusions with adjacent atelectasis appear new over the\ninterval." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous enhancement. There is no\nevidence of concern focal lesions. A calcified granuloma is seen in the right\nhepatic lobe unchanged compared to ___. There is mild central intrahepatic\nbiliary dilatation and dilatation of the CBD which measures 1 cm, likely\nsecondary to cholecystectomy. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Exophytic\ncysts are seen arising from the right kidney measuring up to 1.9 cm along the\ninterpolar region. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is diffuse\nwall thickening throughout the colon, most prominent along the sigmoid and\nrectum with mild surrounding fat stranding. There is diverticulosis of the\nsigmoid colon, however the process appears more diffuse suggestive of colitis.\nThe appendix is within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are unremarkable.\n\nLYMPH NODES: There are multiple small mesenteric and retroperitoneal lymph\nnodes which are not pathologically enlarged. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "Diffuse colonic wall thickening with mild surrounding fat stranding most\nprominent along the sigmoid colon and rectum, consistent with colitis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The gallbladder is decompressed, and\ncontains gallstones without wall thickening or surrounding inflammation. A 5\nmm stone is present in the gallbladder neck. There is dilatation of the\ncommon bile duct measuring up to 1.3 cm, with a 6 mm stone in the lower CBD. \nThere is mild prominence of the central intrahepatic bile ducts.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Mild thickening of the left-greater-than-right adrenal glands\nwithout frank nodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral cortical renal cysts, measuring up to 1.6 cm in the\ninterpolar region of the left kidney. There is no hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube is partially visualized, terminating in the\nstomach. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. There is uncomplicated diverticulosis of the\ndescending colon.\n\nPELVIS: A Foley catheter is present in the bladder, which contains air. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is mild thickening of the endometrium measuring 6-7\nmm. No adnexal lesions are seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Choledocholithiasis, with upstream dilatation of the common bile duct up to\n1.3 cm.\n\nCholelithiasis, with a 5 mm stone in the gallbladder neck. The gallbladder is\ndecompressed, without secondary findings of cholecystitis.\n\nMild thickening of the endometrium, measuring 6-7 mm, abnormal for the\npatient's age. Correlation with ultrasound is recommended.\n\nMild thickening of the left greater than right adrenal glands. Attention on\nfollow-up examination is advised.\n\nNo other evidence of abdominopelvic malignancy.\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n11 mm hypodensity in the lower pole of the left kidney has internal density\nvalues of 53 ___, not meeting criteria for a simple cyst. There is no evidence\nof focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix does not fill with oral\ncontrast material, however a focus intraluminal gas is seen at the tip (2:64,\n67). The appendix measures up to 7 mm (2:68). There is mild fat stranding\naround the appendix (2:65). No extraluminal air or fluid collections.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Sclerotic focus at the left femoral head is likely a bone island. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Borderline enlarged appendix measuring up to 7 mm which does not fill with\noral contrast material with mild adjacent stranding. Findings are concerning\nfor mild or early uncomplicated appendicitis. No drainable fluid collection. \nSurgical consultation is recommended.\n2. Indeterminate hypodense 11 mm lesion in the lower pole of the left kidney\nwhich does not meet criteria for a simple cyst. Nonemergent renal ultrasound\nis recommended.\n\nRECOMMENDATION(S): Nonemergent renal ultrasound.\n\nNOTIFICATION: The updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:04 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1 cm hypodensity in the lower pole of the left kidney, which was\nrecently characterized as a simple cyst on ultrasound. No other renal\nparenchymal lesions are identified. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Appendix is normal. No ascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple small mesenteric lymph nodes in the right\nlower quadrant, the largest measuring up to 0.6 cm (2:62). These appear\noverall similar compared to ___. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal process identified. Normal appendix." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No focal consolidations. There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple subcentimeter hypodensities within the left kidney are too\nsmall to characterize, but likely represent simple cysts. Otherwise, the\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nnephrolithiasis or ureterolithiasis. There is no hydronephrosis. There is no\nperinephric abnormality. There is no evidence of focal renal lesions. There\nis no evidence of urothelial lesions. The distal ureters and bladder are\nunremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is heterogeneous, lobulated, and enlarged,\nlikely due to fibroids. There is a 1.2 x 1.0 cm left adnexal cystic structure\n(series 4a, image 59), which should be followed up with a pelvic ultrasound on\na nonemergent basis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. Otherwise,\nthe abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormalities to explain abdominal pain and hematuria.\n2. 1.2 cm left adnexal cystic structure, which should be followed up with a\npelvic ultrasound on a nonemergent basis.\n3. Heterogeneous, lobulated, and enlarged uterus, likely due to fibroids,\nwhich can also be assessed with the pelvic ultrasound." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse fatty infiltration of the liver. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSub cm hypodensities in the kidneys, bilaterally are too small to characterize\nbut likely represent simple renal cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 1.5 cm subcutaneous soft tissue lesion along the\nanterior aspect of the right upper thigh approximately 5 cm inferior to the\nright hip (series 2, image 92).", "output": "1. No acute intra-abdominal abnormality.\n2. 1.5 cm subcutaneous soft tissue lesion in the anterior right upper thigh\napproximately 5 cm below right hip, likely represents a sebaceous cyst.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse hepatic steatosis. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. A small amount of excreted intravenous contrast is\nseen in the collecting system.\n\nGASTROINTESTINAL: There is a small hiatus hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post gamma nailing of the proximal left femur.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Contrast extravasation occurred during this study, consequently it was\neffectively a noncontrast examination. See OMR for the event note.\n2. No acute abdominopelvic process. No CT findings correlating to the\nreported history of a tender abdomen. No CT evidence for active pancreatitis.\n3. Diffuse hepatic steatosis." }, { "input": "LOWER CHEST: Pulmonary nodules measuring up to 4 mm (series 5, images 5, 8, 10\nand 11) in the right lower lobe and 4 mm in the left lower lobe (series 5,\nimage 7) are stable compared to CT of the abdomen/pelvis from ___,\ntherefore benign. There is mild subsegmental atelectasis in the bilateral\nlung bases. There is no pleural effusion. Pacemaker leads are visualized in\nthe right atrium and right ventricle. Heart size is mildly enlarged. There\nis no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere are multiple scattered subcentimeter hypodensities in the liver,\nmeasuring up to 3 mm, too small to characterize but not appreciably changed\ncompared to CTs of the abdomen/pelvis from ___ and ___. \nThere is no concerning liver lesion. Mild intrahepatic biliary ductal\ndilatation in the left hepatic lobe, and extrahepatic biliary ductal\ndilatation with the common bile duct measuring up to 9 mm, is stable from\nprior. The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post subtotal pancreatectomy. The remnant\npancreatic head is homogeneous in attenuation, without evidence of locally\nrecurrent pancreatic mass. There is no dilatation of the pancreatic duct\nstump.\n\nSPLEEN: The patient is status post splenectomy. There are is remnant or\nregenerated splenic tissue in the left upper quadrant.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is partially imaged. The kidneys demonstrate normal\nnephrograms. There is no evidence of focal renal lesions where visualized. \nThere is right renal pelvocaliectasis, likely secondary to a component of\nureteropelvic junction obstruction, stable. There is no frank hydronephrosis.\n\nGASTROINTESTINAL: There is a small to moderate size hiatal hernia. There are\npostsurgical changes of Roux-en-Y gastric bypass. Visualized small and large\nbowel loops are normal in caliber.\n\nLYMPH NODES: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. Extensive\natherosclerotic disease is noted.\n\nBONES: There is no suspicious osseous lesion or acute fracture. A partially\nimaged lucent lesion with sclerotic rim in the left ilium is stable from\nprior. The patient is status post posterior fusion at L1-L3. There are\nmoderate to severe degenerative changes of the visualized spine.", "output": "1. Postsurgical changes of subtotal pancreatectomy and splenectomy. No\nevidence of locally recurrent pancreatic mass.\n2. Postsurgical changes of Roux-en-Y gastric bypass. Small to moderate size\nhiatal hernia.\n3. Other stable findings as above, including scattered millimetric\nhypodensities in the liver which are too small to characterize, mild left\nintrahepatic and extrahepatic biliary ductal dilatation, right renal\npelvocaliectasis which likely reflects a component of ureteropelvic junction\nobstruction, and subcentimeter pulmonary nodules in the visualized lower\nlobes." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis multiple small sub cm hypodensities within segment 7 which likely represent\ncysts as well as a large simple cyst in segment 4 that remain unchanged from\n___ study. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There are multiple small hypodensities in the tail of the pancreas\nwhich likely represent fat versus small main branch IPMNs that remains stable.\nOtherwise the pancreas has normal attenuation throughout, without pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple small bilateral renal subcortical hypodensities\nlikely represent cysts. There is a 3.3 cm right interpolar simple cyst there\nremains unchanged. There is a 7 mm left upper pole fat density PICC is\nquestionable for an angiomyolipoma and remains unchanged. There is no\nevidence of hydronephrosis or perinephric abnormality bilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is moderate degenerative changes of the thoracic and lumbar\nspine. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of intra-abdominal or pelvic mass." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nfocal liver lesion is seen. There is no intra or extrahepatic biliary\ndilatation. The gallbladder is unremarkable without radiopaque gallstones or\nwall thickening.\n\nPANCREAS: The pancreas has normal attenuation without focal lesion or\npancreatic duct dilatation.\n\nSPLEEN: The spleen is normal in size with homogeneous attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimple cysts up to 1.2 cm in size are noted in the left kidney. A sub-5 mm\nhypodense focus in the interpolar left kidney is too small to accurately\ncharacterize, but statistically likely a cyst (5:62). No urothelial\nabnormality is identified in the renal collecting systems or proximal ureters\nin the excretory phase.\n\nBOWEL AND MESENTERY: The bowel is opacified with oral contrast through the\nsplenic flexure. The enteroenteric anastomotic junction in the left lower\nquadrant is patent in without upstream bowel dilatation (5:97). There is no\nfocal soft tissue mass or bowel wall thickening in the region of the\nanastomosis to suggest local disease recurrence. No mesenteric soft tissue\nmass or mesenteric lymphadenopathy is identified. There is no ascites.\n\nRETROPERITONEUM: The abdominal aorta is non aneurysmal throughout the\nabdomen. There is no retroperitoneal lymphadenopathy.\n\n\nPELVIS:\nThe urinary bladder has a normal appearance. Uterus and adnexa are within\nnormal limits for age. No free fluid is seen within the pelvis. There is no\npelvic or inguinal lymphadenopathy.\n\nBONES AND SOFT TISSUES: There are no lytic or blastic lesions suspicious for\nmetastatic disease. Healed midline laparotomy incision is noted.", "output": "1. No evidence of recurrent or metastatic disease in the abdomen or pelvis,\nstatus post laparotomy and partial small bowel resection.\n2. Please refer to separate dictation for intrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal solid renal lesions or hydronephrosis. There is\na stable 1.5 cm cyst in the lower pole of the left kidney. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Evidence of small\nbowel do surgery anastomosis in the pelvis noted. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus not enlarged and there is no adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative disc disease noted in the lower lumbar spine.\n\nSOFT TISSUES: There is a 1.5 cm subcutaneous nodule adjacent to the skin fold\nin the right mid back (image 5; 49 and 10; 28) which has slightly increased\nfrom 11 mm on ___.", "output": "1. No evidence of local recurrence or metastatic disease in the abdomen\npelvis.\n2. Soft tissue no nodule in the right mid back likely related to a skin fold\n\nRECOMMENDATION(S): Consider further characterization an followup with\nultrasound of soft tissue nodule in the back" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: An 8 mm nodule along the segment VI posterior liver capsule is\nnew compared to CT of the abdomen/pelvis from ___ (series 5, image 61;\nseries 8, image 32). A similar 5 mm nodule along the segment III anterior\nliver capsule is also new and suspicious (series 5, image 58; series 8, image\n10). These are suspicious for metastases. The liver parenchyma demonstrates\nhomogenous attenuation throughout.\n\nNo evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAn 1.6 cm cyst in the left lower renal pole cortex is unchanged (series 5,\nimage 58). Other hypodense cortical lesions in left kidney are also unchanged\nsince at least ___ but too small accurately characterize on CT, statistically\nmost likely cysts. No new focal renal lesions. No hydronephrosis or\nperinephric abnormality.\n\nGASTROINTESTINAL: Ingested enteric contrast is entirely within the colon at\nthe time of imaging. The stomach is unremarkable. Small bowel anastomosis in\nthe pelvis is from prior resection. Small bowel loops in the pelvis are not\nopacified with oral contrast and therefore evaluation for wall thickening is\nlimited. There is no bowel obstruction. There is mild sigmoid\ndiverticulosis. The rectum is within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are numerous small mesenteric lymph nodes in the left lower\nquadrant and midline upper pelvis, new compared to prior CT of the\nabdomen/pelvis from ___. Two more discrete lymph nodes versus soft\ntissue lesions in the region of the prior treated tumor demonstrate irregular\nmargins. The largest lesion measures 14 mm (series 5, image 72; series 8,\nimage 20). The other lesion measures 7 mm (series 5, image 77; series 8,\nimage 19). Findings are concerning for local recurrence.\n\nNo retroperitoneal lymphadenopathy. No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Sclerotic\nlesion in the left pelvis is unchanged from at least ___ (series 8, image 25)\nand likely represents a bone island. Tiny sclerotic lesion in the right pubic\nsymphysis is similar the prior exam (series 8, image 16). Multilevel\ndegenerative changes in the lumbosacral spine are mild at L4 through S1.\n\nSOFT TISSUES: A 5 mm subcutaneous nodule in the right mid back on the prior\nexam adjacent to a skin fold is smaller from the prior exam, previously 12 mm,\nbest appreciated on sagittal images (series 5, image 50; series 9, image 26).", "output": "1. Numerous small mesenteric lymph nodes in the left lower quadrant and\nmidline upper pelvis, new compared to prior CT of the abdomen/pelvis from ___. Two more discrete lymph nodes or soft tissue lesions measuring 14\nmm and 9 mm demonstrate irregular margins. Findings are concerning for local\nrecurrence.\n2. Two new subcentimeter nodules along the liver capsule are suspicious for\nmetastatic disease.\n3. Small bowel anastomosis in the pelvis from prior resection. Oral contrast\nhas already passed into colon at the time of imaging, therefore evaluation for\nsmall bowel wall thickening is limited.\n4. Interval decrease in size of a subcutaneous nodule in the right mid back,\npossibly a decompressed sebaceous cyst.\n5. Sigmoid diverticulosis.\n\nRECOMMENDATION(S): Liver lesions could be confirmed with MRI.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:43 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered hepatic lesions are not appreciably changed since the ___\nabdominal MRI. The largest lesion is located in segment II/segment III and\nmeasures up to 1.6 cm (series 2, image 17). The hepatic veins and portal\nveins are patent. Slightly more conspicuous mild intrahepatic biliary ductal\ndilation. Hyper attenuation in the gallbladder lumen may reflect vicarious\nexcretion of contrast. No gallbladder wall edema.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimple left renal cysts are unchanged, measuring up to 1.8 cm in the\ninterpolar left kidney. No suspicious renal lesion. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\ndilated with a diameter measuring up to 9.1 cm (series 601, image 18), with a\ntransition point in the pelvis, abutting the small bowel anastomosis. Anti\ndependent locules of gas in the ascending and proximal transverse colon appear\nrelated to dependent stool rather than pneumatosis. Distally, there is gas\nand stool in the distal sigmoid colon and rectum. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall volume nonhemorrhagic free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Given the extent of colonic dilation with resulting mass effect\non intra-abdominal structures, assessment for lymphadenopathy is limited. \nIncidental note is made of a possible 10 x 6 mm soft tissue nodule in the\nright lower pelvis, not seen on recent pelvic MRI (series 2, image 67).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged sclerotic lesion in the T10 vertebral body, probably a benign bone\nisland. Incidental unchanged right pubic bone island. Mild bilateral hip\ndegenerative changes. Mild lumbar spine degenerative changes\n\nSOFT TISSUES: Fibrotic changes in the midline anterior abdominopelvic wall\nreflect prior surgery.", "output": "1. Possible large bowel obstruction with a transition point in the pelvis,\nadjacent to the small bowel anastomosis. Adjacent soft tissue is difficult to\nexclude. Small volume pelvic free fluid. Enteric contrast material reaches\nthe distal ascending colon. Could consider CT with rectal contrast to further\nassess the distal colon/pelvic soft tissue.\n2. Known hepatic lesions are not appreciably changed since the ___\nabdomen/pelvis MRI. Possible 1 cm soft tissue nodule in the right lower\npelvis. Recommend attention on follow-up imaging.\n3. Slightly more conspicuous mild intrahepatic biliary ductal dilation. \nRecommend correlation with liver function tests and consider additional\nwork-up as clinically warranted." }, { "input": "LOWER CHEST: There is a small left-sided and moderate right-sided pleural\neffusion with associated compressive atelectasis in the right and left lower\nlobes. Trace pericardial fluid is likely physiologic.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple known hepatic lesions better assessed on prior MRI are grossly\nstable. Mild intrahepatic biliary dilation is stable from prior. Left portal\nvein appears slightly attenuated, grossly stable from prior. Left hepatic\nvein also appears slightly attenuated. The gallbladder is within normal\nlimits. There is by vicarious excretion of contrast within.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Simple cysts are noted in left kidney the largest of\nwhich measures 2.0 cm in the lower pole. Additional hypodense lesions are too\nsmall to characterize, but likely represent simple cysts.\n\nGASTROINTESTINAL: The esophagus is dilated and contains an air-fluid level.. \nThe stomach is unremarkable. Small bowel loops appear largely collapsed. The\nascending, transverse, descending, and sigmoid colons are markedly distended. \nThere appears to be a transition point to normal caliber in the sigmoid colon.\nThis is adjacent to a small bowel anastomosis in the low midline pelvis. This\nis slightly worsened compared to prior exam portions of the transverse colon\nmeasure up to 9.1 cm, previously measuring up to 7.3 cm. There is no evidence\nof pneumatosis. There is no free air in the abdomen. There is no portal\nvenous gas. The appendix is not visualized.\n\nPossible soft tissue nodule measuring 0.7 cm in the right hemipelvis is\nunchanged from prior (3:86). There are additional enhancing soft tissue\nnodules in the low pelvis measuring 1.8 cm and 2.3 cm (3:90) which are\nadditionally concerning for local recurrence.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is new\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Mass-effect from marked colonic dilation limits assessment of\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic lesions T10 vertebral body is stable.\n\nSOFT TISSUES: There is mild diffuse subcutaneous edema. A 2.5 cm nodule in\nthe subcutaneous fat in the right gluteal region is stable.", "output": "1. Marked, diffuse dilation of the colon slightly worsened compared to prior\nexam on ___ with transition point in the sigmoid colon concerning for\nlarge bowel obstruction. Small bowel anastomosis and soft tissue nodules\nadjacent to the transition point raise concern for local recurrence of\npreviously resected neuroendocrine tumor. No evidence of pneumatosis or\nperforation.\n2. Esophageal dilation with air-fluid level places patient at risk for\naspiration. Consider NG tube decompression.\n3. New small volume ascites.\n4. New moderate right and small left pleural effusion with associated\ncompressive atelectasis in the lower lobes bilaterally.\n5. Grossly stable liver lesions as well as mild intrahepatic biliary dilation." }, { "input": "LOWER THORAX: Linear atelectasis at the lung bases, right greater than left.\n\nHEPATOBILIARY: Multiple hypodense rim enhancing liver lesions appear increased\nin size and number from the prior examinations, for instance measuring 18 mm\nin segment 3, previously 15 mm (axial series 2, image 89) and 28 mm in segment\n2, previously 15 mm (axial series 2, image 82). No biliary ductal dilatation.\nUnremarkable gallbladder.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: Bilateral renal cortical cysts, the largest measuring 21 mm in the\nlower pole of the left kidney. Unremarkable bladder.\n\nGASTROINTESTINAL: Patient is status post total colectomy and jejunal resection\nwith end ileostomy and rectal stump. The residual small bowel is normal in\ncaliber. The stomach is unremarkable.\n\nREPRODUCTIVE ORGANS: Interval increase in size in soft tissue mass within the\nposterior cul-de-sac measuring 25 x 21 x 25 mm (axial series 2, image 124),\npreviously 23 x 20 x 20 mm in ___. Additional adjacent soft tissue\nnodule measuring 15 mm. Patient is status post left salpingo-oophorectomy and\nright salpingectomy.\n\nLYMPH NODES: Multiple enlarged retroperitoneal lymph nodes appear increased in\nsize in comparison to prior examinations, measuring up to 13 mm aortocaval\n(axial series 2, image 90) and 12 mm para-aortic (axial series 2, image 90). \nMultiple enlarged mesenteric lymph nodes are also noted measuring up to 12 mm\n(axial series 2, image 104). No pelvic or inguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Several soft tissue nodules are noted\nwithin the right hemipelvis, which appears slightly increased in size in\ncomparison to previous, measuring up to 14 mm (axial series 2, image 111),\npreviously 7 mm. There is a small volume pelvic ascites and extending up the\nright midabdomen with some associated peritoneal enhancement but no defined\nfluid collection.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic calcification.\n\nBONES: Stable sclerotic lesion within the left innominate and right pubic\nbones. No new or suspicious osseous lesion.\n\nSOFT TISSUES: Nonspecific nodule within the subcutaneous tissues of the right\ngluteal region appears minimally increased in size, measuring 18 mm,\npreviously 14 mm. Postsurgical changes of the anterior abdominal wall. \nSingle residual skin staple along the lower abdominal wall.", "output": "1. Small volume pelvic ascites tracking up the right mid abdomen with mild\nperitoneal enhancement but no defined fluid collection.\n2. Interval progression of disease with increasing size and number of hepatic\nmetastases, retroperitoneal and mesenteric adenopathy, peritoneal nodularity,\nand pelvic soft tissue masses.\n3. Nonspecific subcutaneous nodule within the right gluteal region, likely\ninjection granuloma or hematoma.\n4. Single residual skin staple along the anterior lower abdominal wall." }, { "input": "LOWER CHEST: There is linear density at the by lateral lung bases, right\ngreater than left, likely representing atelectasis. No large focal\nconsolidation or concerning pulmonary nodules identified. There is no pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense, rim enhancing liver lesions are unchanged compared to\nprior, measuring up to 2.7 cm in the left lobe (series 5; image 20). Biliary\nsystem appears unchanged without definite intra or extrahepatic biliary\ndilatation. The gallbladder shows evidence of layering intraluminal sludge\nwith prominence of the gallbladder wall without edema or definite adjacent\nstranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. There are multiple renal hypodensities in the\nleft kidney, largest in the lower pole measuring 2.0 cm consistent with simple\ncysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post total colectomy in jejunal resection\nwith end ileostomy and rectal stump. Residual small bowel remains normal in\ncaliber. Stomach is unremarkable.\n\nPELVIS: 2.5 x 2.1 cm soft tissue mass within the posterior cul-de-sac is\nunchanged compared to prior. Adjacent soft tissue nodule continues to measure\n1.5 cm in short axis. Patient is status post left salpingo-oophorectomy and\nright salpingectomy. There remains small volume, serous appearing free fluid\nin the pelvis, with adjacent mild peritoneal enhancement, similar compared to\nprior. No organizing collection is identified.\n\nLYMPH NODES: Multiple enlarged retroperitoneal lymph nodes appear similar\ncompared to prior examination, measuring up to 1.2 cm in the aortocaval region\n(series 5; image 32) and 1.0 cm in the left periaortic region (series 5; image\n28). Multiple enlarged mesenteric lymph nodes are also noted measuring up to\n1.0 cm (series 5; image 42). No pelvic or inguinal adenopathy. Several soft\ntissue nodules are noted within the right hemipelvis, similar in size compared\nto prior, measuring up to 9 mm in size in the right hemipelvis (series 5;\nimage 49).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Nonspecific soft tissue nodule in the right gluteal region is\nagain seen (series 5; image 58), measuring 1.9 x 1.1 cm, similar to prior. \nPost-surgical changes are again noted along the anterior abdominal wall with\nsingle skin staple noted, unchanged.", "output": "1. Small volume pelvic ascites persists with mild peritoneal enhancement but\nno defined fluid collection.\n2. Unchanged hepatic metastases, retroperitoneal and mesenteric adenopathy,\nperitoneal nodularity, and pelvic soft tissue masses.\n3. Nonspecific subcutaneous nodule within the right gluteal region is\nunchanged, likely injection granuloma or hematoma.\n4. Single residual skin stable along the lower anterior abdominal wall is\nunchanged." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal gland is surgically absent. The right and adrenal\ngland is normal in size and shape.\n\nURINARY: The patient is status post left nephrectomy. Soft tissue thickening\nlateral to the celiac trunk near the surgical bed is similar to study from ___, likely postsurgical in nature (2:61). The right kidney is of\nnormal and symmetric size with normal nephrogram. A 2.3 cm exophytic cyst off\nof the inferior pole is unchanged. There is no evidence of focal renal\nlesions or hydronephrosis at the right kidney.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Mild fat stranding in the lower mid abdomen\n(2:98) immediately posterior to the surgical scar likely represents\npostsurgical fat necrosis, versus sequela of above epiploic appendagitis.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Sclerotic foci at the left inferior pubic ramus, left femoral head and\nright iliac are unchanged and likely represent bone islands. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing right inguinal hernia..", "output": "1. Status post left nephrectomy and adrenalectomy with expected postoperative\nchanges and no evidence of local recurrence.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings" }, { "input": "LOWER CHEST: Please refer to the separately dictated CT of the chest for\ndetailed evaluation of the chest findings.\n\nHEPATOBILIARY: There is homogeneous hepatic enhancement with no suspicious\nlesions. Portal vein and hepatic veins are patent. There is no biliary\nductal dilatation. Gallbladder appears unremarkable.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious mass lesions.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Status post left adrenalectomy. Right adrenal gland appears\nunremarkable.\n\nURINARY:Status post total left nephrectomy. There are no suspicious residual\nsoft tissue nodules in the nephrectomy bed. There is no hydronephrosis on the\nright. There is a exophytic right inferior pole renal cortical 2.6 cm cyst.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Stomach appears\nunremarkable. Small bowel loops are normal in caliber. Appendix is normal. \nThere are colonic diverticulosis without diverticulitis.\n\nPERITONEUM: There is no free air or free fluid. There are no peritoneal\nnodules. There is mild fat stranding along the midline lower abdominal wall\nincision. There is also an area of fat with increasing rim of soft tissue\ndensity consistent with a fatty infarct.\n\nLYMPH NODES: There is no retroperitoneal adenopathy. There are prominent\nmesenteric lymph nodes of the jejunal loops in the left upper abdomen with\nmild mistiness of the mesentery, probably reactive.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches.\n\nPELVIS: Prostate demonstrates mild central calcifications. Urinary bladder is\nunremarkable.\n\nBONES:There is mild heterogeneity of the vertebral body bone marrow, with no\naggressive osseous lytic or blastic lesions. There are couple of rounded\nsclerotic lesions along the left inferior pubic ramus and left femoral head\nwhich may represent bone islands.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "Postsurgical changes related to left nephrectomy with no evidence of\nrecurrence or metastatic disease." }, { "input": "LOWER CHEST:\n\nVisualized lung bases are unremarkable without evidence of pulmonary nodule or\nmass. There is no pleural or pericardial effusion. Heart size is within normal\nlimits.\n\nABDOMEN/PELVIS:\n\nHepatic attenuation is uniform without evidence of mass. There is no\nintrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is\nsurgically absent with cholecystectomy clips in the gallbladder fossa. Spleen\nis unremarkable. There is no evidence of pancreatic mass or pancreatic ductal\ndilatation.\n\nAdrenal glands are unremarkable. There is symmetric renal enhancement and\nexcretion of intravenous contrast. There is no evidence of renal mass or\nhydronephrosis. Urinary bladder is moderately distended without gross\nabnormality.\n\nThere is moderate fat stranding surrounding the distal cecum and proximal\nascending colon. There is no additional area of fat stranding. The appendix is\nair filled and normal. There is no evidence of intraperitoneal free air or\nfree fluid. There is no bowel obstruction.\n\nThe abdominal aorta has a normal course and caliber. There are no enlarged\ninguinal, iliac chain, retrocrural, or retroperitoneal lymph nodes. There is\nno suspicious osseous lesion.", "output": "Moderate proximal ascending colitis, likely infectious or inflammatory, new\nsince the ___ study. No discrete underlying mass. No fluid\ncollection or free air.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___, ___\nNurse Practitioner on the telephone on ___ at 3:35 ___, at the time of\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for a description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Surgical clips in the gallbladder fossa\nare compatible with cholecystectomy. There is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nThere is no evidence of stones, focal renal lesions or hydronephrosis. There\nis no perinephric abnormality. The urinary bladder is not completely\ndistended, thus precluding accurate evaluation.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Fat stranding noted in the region of the cecum\nand proximal ascending colon has now resolved. The colon and rectum are\nunremarkable. The appendix is filled with air without evidence of fat\nstranding. No bowel obstruction, free air, or fluid collection.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: There is no evidence of pelvic or inguinal lymphadenopathy. There is\nno free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions. The\nabdominal and pelvic walls are within normal limits.", "output": "1. No lymphadenopathy.\n\n2. Interval resolution of colitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodensities in the liver are too small to characterize, but\nstatistically likely to represent cysts versus biliary hamartoma. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of pelvic free fluid, likely physiologic.\n\nREPRODUCTIVE ORGANS: The uterus is normal with IUD in situ. Collapsed corpus\nluteum is seen in the right ovary.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No etiology identified for right lower quadrant pain. Normal appendix. Small\namount of pelvic free fluid is likely physiologic." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\nThe psoas muscles are symmetric bilaterally and there is no evidence of\nretroperitoneal hematoma, intraperitoneal or pelvic fluid collection.\n\nHEPATOBILIARY: There is a tiny calcification within the left lobe of the liver\nin the represents a calcified granuloma. There are multiple hypodensities\nwithin the liver that are too small to characterize, but likely represent\ncysts. Otherwise, the liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small splenule medial to the splenic\nhilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality. Residual contrast from the patient's recent catheterization is\nseen within the collecting system bilaterally and within the bladder.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is mild diverticulosis\nwithout secondary signs to suggest diverticulitis. The colon and rectum are\notherwise within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. The\ncalcifications in the lower pelvis represent phleboliths.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is an infrarenal abdominal aortic aneurysm measuring up to 4.5\ncm with heavy calcification of the arterial wall. The aneurysm appears to\nextend into the iliac arteries bilaterally, with the right common iliac\nmeasuring up to 3.9 cm, and the left common iliac measuring up to 2.1 cm. \nModerate atherosclerotic disease is noted throughout the abdomen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate degenerative changes within the lumbar spine.\n\nSOFT TISSUES: There is a small hematoma and soft tissue stranding in the\nsubcutaneous tissues of the right inguinal region, likely due to the patient's\nrecent catheterization. The abdominal and pelvic wall is within normal\nlimits.", "output": "1. No evidence of retroperitoneal hematoma or abdominal/pelvic hemorrhage.\n2. Infrarenal abdominal aortic aneurysm extending into the common iliac\narteries bilaterally, right larger than left.\n3. Multiple hypodensities within the liver that are too small to characterize,\nbut likely represent cysts.\n4. Diverticulosis without diverticulitis." }, { "input": "Visualized lung bases appear clear. Coronary calcification is detected.\n\nNo suspicious focal liver lesions are identified. There is no biliary\ndilatation. The gall bladder appears normal. Pancreas is unremarkable. \nSpleen is normal in size. Adrenals appear normal.\n\nThere are patchy perfusion defects in the right kidney that are consistent\nwith pyelonephritis. On each side, there is mild to moderate hydronephrosis,\nnew since preoperative imaging. Again on each side, but left greater than\nright, there is mild wall thickening, hypernhancement and fat stranding\nincluding strong indication of pyelitis and proximal ureteritis on the left.\n\nA medium-sized hiatal hernia is present. Patient is status post interval\ndistal colectomy including proctocolectomy with an end colostomy in the left\nlower quadrant. Oral contrast flows through the whole small and large bowel,\nterminating in the ostomy bag. Pelvic loops of small bowel in the deep pelvis\nshow homogeneous wall thickening, which is suggestive of post radiation\nchange.\n\nBladder and previously identified deep pelvic mass have been resected with\nvaginectomy and pelvic externeration. There is a right lower quadrant\nurostomy. There is a rim enhancing 35 x 20 mm collection, which appear to lie\nalong the course of the urostomy however it is not definitely clear if this\ncould be adjacent to the ureteral-ileal anastamoses (05:58). Right ureter is\nmildly dilated to the pelvic brim, then collapsed until the ileal conduit. \nThe left ureter is mostly collapsed after the ureteropelvic junction.\n\nThere is no discrete lymphadenopathy, free air or free fluid. Atherosclerotic\nchanges are moderate in severity. The left renal vein is narrowed as it\npasses posterior to the superior mesenteric artery with a steep angle, but\nsince the nephrogram is not delayed, functional significance is doubted.\n\nThere are no suspicious bone lesions. Moderate degenerative changes affect\nlower lumbar facet joints. Bones are probably demineralized.", "output": "1. Findings consistent with pyelonephritis on the right and bilateral pyelo\nureteritis, likely infectious in etiology.\n2. Interval cystectomy with ileal conduit. New mild to moderate right-sided\nand mild left-sided hydronephrosis. Hydronephrosis is common after cystectomy\nand neobladder formation, often associated with reflux, but possibility\nobstruction is not excluded, particularly on the right, where the ureter is\nmildly dilated to the pelvic brim image immediately upstream of the\nureteral-ileal anastomoses.\n3. Rim enhancing 3.5 x 2.0 cm collection along the right pelvic side wall, at\nthe expected location of the ureteral-ileal anastomoses. This likely part of\nthe urostomy but it may be a collection adjacent to it; an infectious process\nremains favored rather than a necrotic node or mass.\n\nNOTIFICATION: Initial findings discussed by Dr. ___ with Dr. ___ at\n12:35 am by telephone on ___ immediately after discovery of\nfindings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Coronary calcifications are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Moderate right-sided hydronephrosis is similar prior. Perfusion\ndefects in the right kidney seen on the previous exam have resolved. There is\npersistent thickening and enhancement of the proximal left ureter, similar to\nprior exam.\n\nGASTROINTESTINAL: Moderate hiatal hernia. Stomach is otherwise unremarkable. \nProximal small bowel loops are diffusely dilated with air-fluid levels. \nTransition point is not definitively identified, but appears lie in an ileal\nloop in the pelvis. Status post proctocolectomy. Left lower quadrant end\ncolostomy is noted.\n\nPELVIS: Status post pelvic exenteration. Right lower quadrant urostomy in\nileal conduit are noted. Previously seen right pelvic sidewall collection is\nsubstantially decreased in size measuring approximately 0.5 x 1.7 cm,\npreviously up to 3.5 cm.\n\nREPRODUCTIVE ORGANS: Status post vaginectomy. Uterus is not visualized. No\nadnexal abnormalities are seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLevoconvex scoliosis and degenerative changes of the lumbar spine are noted.\n\nSOFT TISSUES: Left lower quadrant end colostomy in right lower quadrant\nurostomy are noted as above.", "output": "1. Small bowel obstruction without discrete transition point identified. \nHowever, distal ileal loops in the deep pelvis are decompressed suggesting\ntransition point in this location.\n2. Persistent moderate right hydronephrosis, possibly related to neobladder\nformation. Persistent urothelial thickening and hyperenhancement of the\nproximal left ureter suggesting possible pyelitis. Previously seen hypodense\nareas suggesting pyelonephritis of the right kidney have resolved.\n3. Near interval resolution of 1.6 cm fluid collection along the right pelvic\nsidewall." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN: The liver, spleen, pancreas, adrenal glands and kidneys are\nunremarkable except for stable hypodense renal lesions too small to\ncharacterize.\n\nGASTROINTESTINAL: Mild colitis involving the proximal colon is noted. There\nis no intestinal obstruction.\n\nNumerous omental implants have improved and most are now calcified. For\ninstance, a periappendiceal implant is now linear, previously measuring 2.5\ncm. Multiple now calcified implants in the omentum have decreased in size,\nfor instance measuring 2.4 cm, previously 3.3 cm and measuring 4 cm adjacent\nto the descending colon previously 5.2 cm. The implant along the right round\nligament now measures 1.8 cm, previously 2.4 cm and the implants involving the\nleft ovary have also decreased now difficult to measure.\n\nA few small implants adjacent to the small bowel in the deep pelvis are\ndifficult to measure. Previous small amount of ascites has improved and is\nnow trace.\n\nPELVIS: The right adnexal mass inseparable from the cecum and right corpus is\nnow predominantly necrotic and measures 5.5 cm, previously 6.8 cm. Small\nright hydrosalpinx is again noted.\n\nLYMPH NODES: Marked interval improvement of retroperitoneal adenopathy, for\ninstance left periaortic measuring 1.1 cm, previously 2 cm; 0.8 cm inter\naortocaval, previously 1.1 cm; 1 cm left common iliac, previously 1.8 cm and\n0.7 cm right internal iliac, previously 1 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm.Improved attenuation of the\nIVC by the aortocaval adenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Marked interval improvement of disease.\n2. Mild ascending colitis." }, { "input": "LOWER CHEST: Please refer to the separately dictated report of CT chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Small accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. Stable focal cortical subcentimeter\nhypodensity in the interpolar region of the right kidney. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel\nloops are normal in caliber. The appendix is normal. There is no evidence of\nascites. No discrete peritoneal or omental nodules are seen on this study. \nFurther interval decrease in size of the calcified pelvic sidewall implant\nmeasuring 6 mm (previously 12 mm) (series 5, image 101).\n\nPELVIS: The urinary bladder is partially filled. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Status post total abdominal hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES: There has been significant interval decrease in the previously\nseen prominent retroperitoneal lymph nodes, largest measuring 5 mm (series 5,\nimage 81) (previously this measured 8 mm in size).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in size of the retroperitoneal lymphadenopathy as well as\nthe partially calcified pelvic sidewall implant. No new peritoneal nodule or\nlymphadenopathy.\n2. Please refer to the separate report of CT chest for details of\nintrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Geographic hypodensity adjacent to the falciform ligament\nlikely represents focal fatty deposition. Otherwise, the liver demonstrates\nhomogenous attenuation throughout. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Small accessory spleen inferiorly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter hypodensity within the right kidney is too small to\ncharacterize, but likely represents a simple cyst (series 2, image 69). \nOtherwise, the kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of enhancing renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy and bilateral\noophorectomy. No adnexal masses are visualized.\n\nLYMPH NODES: There are multiple small periaortic retroperitoneal lymph nodes,\nunchanged compared to prior. There is no mesenteric lymphadenopathy. \nPartially calcified right external iliac lymph node is unchanged (series 2,\nimage 100). No inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Mild narrowing at the origin of the celiac may be due to\ncompression from the median arcuate ligament (series 602, image 42).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stranding within the lower anterior abdominal wall is likely\npostsurgical. Otherwise, the abdominal and pelvic wall is within normal\nlimits.", "output": "1. Unchanged small retroperitoneal lymph nodes, as well as a partially\ncalcified right external iliac lymph node.\n2. No other evidence of metastatic disease within the abdomen or pelvis.\n3. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: There is bibasilar atelectasis without focal consolidation. \nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver and gallbladder remain unremarkable. There is no biliary\nductal dilatation.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. 0.9 cm anteriorly based accessory spleen is unchanged.\n\nADRENALS: Unremarkable.\n\nURINARY: There are multiple, cortically based hypodensities, which are too\nsmall to characterize and appear similar to prior. There is a stable 1 cm\nright renal cyst. There is no hydronephrosis.\n\nGASTROINTESTINAL: There is no small bowel obstruction or ascites. The\nappendix is unremarkable.\n\nPELVIS: There is no free fluid in the pelvis. Changes of hysterectomy and\nsalpingo-oophorectomy are again noted, unchanged.\n\nLYMPH NODES: Stable calcified right external iliac lymph node dot no abdominal\nor pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Again seen is midline incision scar and rectus diastasis,\nunchanged compared to prior.", "output": "Stable examination without findings of recurrence.\n\nNo bowel obstruction. No etiology identified for abdominal pain and vomiting." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. 9 mm splenule again seen next to the lower pole\nwith no interval change.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nThere is no free fluid in the abdomen and pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: No nodules or masses seen in the abdominal and pelvic wall. As\npreviously, a lower midline incisional scar and rectus diastasis is seen\nunchanged.", "output": "1. No evidence of local recurrence or distal metastasis in the abdomen pelvis" }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder mildly distended with\ngallbladder wall edema. There is subtle loss of gallbladder wall enhancement\nmeasuring approximately 7 mm, best appreciated on the coronal projection\n(601b:25).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Large anterior\nabdominal wall hernia contains loops of large bowel and intra-abdominal fat. \nThe abdominal hernia sac measures 13.6 x 11.1 cm, not significantly changed\nfrom prior exam. The colon and rectum are within normal limits. Enhancement\nof the large bowel is within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes at L5-S1 is unchanged from ___.\n\nSOFT TISSUES: There is a large abdominal wall hernia with wide mouth,\nmeasuring up to 4.7 cm, containing intra-abdominal fat and loops of large\nbowel.", "output": "1. New gallbladder wall edema with subtle loss of wall enhancement. Finding\nis nonspecific, and may represent resolving acute cholecystitis. Further\nevaluation with right upper quadrant ultrasound in surgical consultation is\nrecommended.\n2. Large anterior abdominal wall hernia with wide. No obstruction. Normally\nenhancing bowel walls." }, { "input": "LOWER CHEST: There is bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout with\nmoderate diffuse fatty infiltration. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent. There is no fluid in the gallbladder fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal wall thickness, and enhancement throughout. There are few mildly\ndilated small intestinal loops within the mid and left abdomen with air-fluid\nlevels finding which may be seen with a mild ileus. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus and ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative disc disease is noted at L5-S1. There is a transitional\nsegment vertebra at the lumbosacral junction which will be labeled S1 for\nnumbering purposes. A subtle retrolisthesis of L5 on S1 and subtle\nanterolisthesis of L4 on L5 are noted.\n\nSOFT TISSUES: There is fat stranding, small amount of fluid, and foci of air\nin the region of the ventral hernia repair. There is associated skin\nthickening. There is no drainable fluid collection. An abdominal wall drain\ntip projects in the mid abdominal soft tissues.", "output": "Inflammatory change, skin thickening, and small amount of fluid in the region\nof the ventral hernia repair, given patient's presentation, findings are\nconcerning for cellulitis. No drainable collection." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis\nwithout evidence of diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal abnormalities. Diverticulosis without\ndiverticulitis." }, { "input": "Imaged lung bases: Heart is enlarged with a severe mitral calcifications as\nwell as coronary artery calcifications. There is a small right-sided pleural\neffusion. There is trace bibasilar atelectasis. There is a 2 mm nodule in the\nright lung base.\n\nCT abdomen without contrast: Evaluation of the solid organs is limited on this\nnoncontrast study.\n\nThe liver is grossly unremarkable without focal mass. Gallbladder is\nunremarkable. The spleen and adrenal glands are unremarkable. The pancreas is\natrophied but otherwise unremarkable.\n\nBilateral percutaneous nephrostomy tubes are in place with the pigtail loop\nappearing adequately positioned in the bilateral collecting systems. There is\na 13 mm right interpolar renal cyst. The kidneys are otherwise grossly\nunremarkable without hydronephrosis, stone or perinephric abnormality.\n\nThe stomach, duodenum and remainder of the small bowel is grossly unremarkable\nwithout obstruction. The large bowel is thin-walled and unremarkable.\n\nDense atherosclerotic calcifications are noted along a normal caliber\nabdominal aorta and its branches. There is no mesenteric or retroperitoneal\nlymphadenopathy. There is no ascites or pneumoperitoneum. There is a large\nventral abdominal hernia with defect measuring 8.9 cm containing a\nnonobstructed loops of small and large bowel. There is an additional\nparaumbilical hernia with a 1.5 cm defect containing fat.\n\nCT pelvis without contrast: The bladder is totally decompressed and not well\ncharacterized. Uterus and ovaries are not seen. The rectum is unremarkable.\nThere is no free pelvic fluid or air. There is no inguinal or pelvic sidewall\nlymphadenopathy.\n\nOsseous structures: There is no suspicious focal osseous lesion. Prominent\ndegenerative changes are noted in the thoracolumbar spine. Diffuse superficial\nsoft tissue stranding suggests anasarca.", "output": "1. Bilateral percutaneous nephrostomy catheters in adequate position with the\npigtail loop within the collecting systems. No hydronephrosis.\n2. Large ventral abdominal wall hernia containing nonobstructed loops of small\nand large bowel.\n3. Diffuse superficial soft tissue stranding suggests anasarca. Small right\npleural effusion.\n4. Severe thoracolumbar degenerative changes." }, { "input": "A moderate right-sided pleural effusion of low attenuation has moderately\nincreased with associated minor right basilar atelectasis. A 2 mm right lower\nlobe nodule (2:2) appears unchanged. A dialysis catheter is visible in the\nright atrium. The mitral annulus is heavily calcified. The heart appears\nmild to moderately enlarged. Low density of the blood pool suggests anemia.\n\nMild thickening of the gallbladder fundus may be due to a Phrygian cap that\nappears unchanged. The gallbladder is nondistended. There is no biliary\ndilatation. No focal liver lesions are identified within the limitations of a\nnon-contrast examination. The spleen is normal in size and appearance. The\nadrenal glands and pancreas appear within normal limits.\n\nThere is a nephrostomy tube within each kidney, as before. On the right there\nis no hydronephrosis but the upper ureter is mildly prominent in caliber. On\nthe left, however, although there is only minimal new left-sided\nhydronephrosis, the left ureter is tortuous and moderately dilated throughout.\nAlso when assessing its density, contents of the left ureter measure over 50\nHounsfield units which suggests hemorrhage within the ureter. Similarly, the\nupper right ureter has a hyperdense content suggesting hemorrhage.\n\nThere is a small hiatal hernia. Small bowel is unremarkable.\nSigmoid diverticulosis is moderate. There is a wide-necked ventral hernia to\nthe right of the umbilicus containing a segment of mid transverse colon as\nwell as small bowel without indication for obstruction.\n\nThe bladder is mostly empty but and there is apparently a small hemorrhagic\nfluid level within it. Vascular calcification is extensive. There are a\nnumber of small mildly prominent retroperitoneal lymph nodes but these appear\nunchanged. For example, a periaortic node measures 17 x 11 mm in axial\n___ compared to 16 x 11 mm previously, which is not significantly\nchanged.\n\nThere is a small quantity ascites in the pelvic cul-de-sac whose density is\ndifficult to measure although it appears to measure simple fluid like density\nrather than high attenuation that would be expected with hemorrhage. \nSubcutaneous fat stranding suggest sequela of anasarca.\n\nThe bones appear demineralized. There are no suspicious lytic or blastic bone\nlesions. Severe degenerative changes throughout the lumbar spine appear\nstable.", "output": "1. Acute hemorrhage within each ureter, including new left left-sided\nhydroureteronephrosis and mild distention of the right ureter, although\nnephrostomy tubes remain in place. Correlation with nephrostomy tube output\nis recommended. The possibility that the left-sided tube may be occluded\nshould be considered. Hemorrhage also layers within the bladder lumen.\n\n2. Nonobstructing ventral hernia." }, { "input": "LOWER CHEST: There are bilateral right greater than left simple appearing\npleural effusions with associated compressive atelectasis bilaterally and\nrounded atelectasis on the right. There is no pericardial effusion. There\nare numerous supradiaphragmatic lymph nodes, the largest of which measures 2.0\nx 1.1 cm (05:11).\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is an irregular, 6.0 x 4.0 cm peripherally enhancing\nmass involving the left hepatic lobe. Large confluent hypodensity extending\nfrom the posterior aspect of this mass and extending throughout the entirety\nof the right lobe is new from the first post biopsy scan and may represent\nevolving hematoma (approximately 40 Hounsfield units). Irregular enhancement\nof the right hepatic lobe is likely perfusional in etiology. There is no\ndefinite evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is unremarkable.\n\nPANCREAS: The pancreas is normal in attenuation throughout. There are no\nconcerning pancreatic lesions. There is no pancreatic ductal dilatation or\nperipancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation. No concerning lesions\nidentified.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: Bilateral kidneys are within normal limits without evidence of\nnephrolithiasis or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable, not well assessed on CT. There\nis no small bowel obstruction. The colon and rectum are unremarkable. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. A small\namount of hemoperitoneum is noted in the pelvis such as on series 3, ___ 75.\n\nREPRODUCTIVE ORGANS: No adnexal lesions. The uterus appears unremarkable, not\nwell evaluated on CT.\n\nLYMPH NODES: Scattered periaortic lymph nodes are not enlarged by CT size\ncriteria. No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate calcified and noncalcified\natherosclerotic plaque are noted about the abdominal aorta.\n\nBONES: The bones appear mildly osteopenic. A superior endplate deformity at\nthe level of L3 is unchanged from prior. No evidence of acute fracture or\nworrisome osseous lesion.\n\nSOFT TISSUES: Nonspecific 2.5 x 1.8 cm subcutaneous calcification within the\nsoft tissues posterior to the left gluteal muscles may be related to prior\ntrauma (3:81).", "output": "1. Left hepatic lobe heterogeneous enhancing mass is consistent with known\ncholangiocarcinoma correlation with prior tissue sampling is recommended.\n2. Interval development of confluent hypodensity throughout the right hepatic\nlobe likely represents development of hematoma status post biopsy. Small\namount of hemoperitoneum in the pelvis\n3. Enlarged supradiaphragmatic lymph nodes." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is a 6.1 x 3.3 cm mass in segments II and ___,\ndemonstrating progressive enhancement, capsular retraction (series 10, image\n70), and focal areas of bulging of the hepatic contour concerning for\nextracapsular extension (series 14, image 57), consistent with biopsy-proven\ncholangiocarcinoma, not significantly changed in size and appearance compared\nto CT of the abdomen/pelvis from ___. An approximately 7.2 x\n3.1 cm hypodense collection in the central right hepatic lobe, in keeping with\nknown hematoma secondary to prior biopsy, has decreased in size, previously\n10.7 x 5.1 cm. There is no new hepatic lesion. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is thickening and heterogeneity of the endometrium,\nmeasuring 15 mm (series 14, image 67), concerning for endometrial hyperplasia\nor carcinoma. The bilateral adnexa are unremarkable.\n\nLYMPH NODES: There are prominent pericardiophrenic lymph nodes measuring up to\n8 mm short axis (series 10, image 63), minimally decreased in size, previously\n10 mm. Prominent periportal lymph nodes measuring up to 0.8 cm in short axis\n(series 10, image 86) are unchanged. There is no other retroperitoneal,\nmesenteric, pelvic, or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. The medial branch of the left portal vein is not\nvisualized, likely attenuated by the hepatic mass. The remainder of the\nportal venous system is patent. The common hepatic artery arises from the\nSMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate degenerative changes at L2-3 with endplate irregularity.\n\nSOFT TISSUES: There is diastasis of the rectus abdominus. Unchanged 2.6 x 2.1\ncm coarse calcification in the subcutaneous fat of the left lateral gluteal\nregion could represent sequelae of old hematoma if there is been trauma to\nthis region (series 10, image 175).", "output": "1. No significant change in size and appearance of the 6.1 x 3.3 cm\nbiopsy-proven left hepatic lobe cholangiocarcinoma with suggestion of\nextracapsular extension. No evidence of distant metastatic disease within the\nabdomen and pelvis.\n2. Further decrease in size of the right hepatic lobe hematoma.\n3. Thickening and heterogeneity of the endometrium, measuring 15 mm,\nconcerning for endometrial hyperplasia or carcinoma. Further evaluation with\npelvic ultrasound is recommended.\n4. Please see separate report performed on the same day for detailed\nevaluation of the chest." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a focal area adjacent to the porta hepatis which shows mildly\nincreased enhancement, compatible with a transient hepatic attenuation\ndifference related to perfusion - incidental. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No focal inflammatory process or acute abnormality in the abdomen and\npelvis." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Limited evaluation of the lung bases is notable for bilateral\nlower lobe ground-glass and ___ opacities worrisome for focal\naspiration or early pneumonia. 0.3 cm left lower lobe pulmonary nodule noted\n(03:33). No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: There is diffuse pancreatic atrophy predominately involving the body\nand tail with mild pancreatic duct dilatation measuring up to 0.2 cm unchanged\nsince MRCP from ___. There is an abrupt caliber change of the\nmain pancreatic duct at the pancreatic head with an apparent 0.7 x 0.5 cm\nill-defined area of hyper enhancement worrisome for subtle mass lesion (03:56,\nsee series 10). No pancreatic calcifications noted. Additional 0.6 cm\nhypodense lesion within the pancreatic head is better characterized on MRCP\nfrom ___ and is consistent with resolving/residual small\npseudocyst. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Right adrenal gland is unremarkable. Persistent nodularity of the\nleft adrenal gland is noted without discrete nodule.\n\nURINARY: 0.1 cm hypodense lesion is noted in the interpolar region of the\nright kidney is incompletely characterized and most likely represents a cyst\n(3:58).The kidneys are otherwise of normal and symmetric size with normal\nnephrogram. There is no evidence of stones, focal renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Enteric feeding tube tip terminates within the gastric body.\nStomach is otherwise unremarkable. Small bowel loops demonstrate normal\ncaliber, wall thickness and enhancement throughout. Colon and rectum are\nwithin normal limits. Appendix is not visualized. There is no evidence of\nmesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is well distended with large volume air. No foley\ncatheter noted and correlation with recent catheter placement is recommended. \nDistal ureters are unremarkable. There is no evidence of pelvic or inguinal\nlymphadenopathy. Trace pelvic free fluid noted.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable. Within\nthe corpora cavernosa there is a rim enhancing tubular 2.5 x 0.7 x 0.3 cm\nlesion which is indeterminate and may represent a focally dilated penile\nurethra (3:169).\n\nBONES: Degenerative changes are seen in the lumbar spine. No focal lytic or\nblastic lesions worrisome for malignancy.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Chronic pancreatitis with pancreatic atrophy and resolving/residual 0.7 cm\nsmall pancreatic head pseudocyst. No acute pancreatitis or pancreatic\nnecrosis.\n2. Apparent 0.7 cm subtle hyperenhancing lesion within the pancreatic head\nwith abrupt main pancreatic duct cutoff and mild upstream pancreatic duct\ndilatation. Findings may be related to normal enhancing pancreatic parenchyma\non a background of chronic pancreatitis with associated pancreatic duct\nstricture however a small neuroendocrine tumor would be similar in appearance.\n3. 2.5 x 0.7 x 0.3 cm rim enhancing collection within the corpora cavernosa\nmay represent focal dilatation of the penile urethra.\n4. Distended bladder with large volume intraluminal air.\n5. Bilateral lower lobe ground-glass and ___ opacities, worrisome for\naspiration or early pneumonia\n6. 0.3 cm left lower lobe pulmonary nodule.\n\nRECOMMENDATION(S): 1. Recommend EUS for further evaluation if clinically\nfeasible.\n2. Clinical correlation for recent genitourinary instrumentation is\nrecommended to explain the intraluminal bladder air.\n3. For incidentally detected single solid pulmonary nodule smaller than 6 mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:02 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There is mild dependent atelectasis in bilateral lower lobes. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic but without evidence of focal lesions or\npancreatic ductal dilatation. Previously characterized hyperattenuating focus\nin the pancreatic head noted on CTA ___ is less conspicuous on\nthe study. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Percutaneous gastrostomy tube is malpositioned, terminating\nanterior to the stomach. There is a rim enhancing fluid and gas containing\ncollection extending inferiorly from the malpositioned gastrostomy tube,\nextending approximately 11.3 cm in craniocaudal dimension also abutting the\nleft hepatic lobe anteriorly. This collection measures up to 7.7 cm in\nmaximal transverse dimension and up to 9 mm in maximal AP dimension. This\ncollection likely represents an abscess.\n\nTiny collections are seen superior and inferior to the gastrostomy tube in the\nbody wall, for example on series 2, image 23 measuring 5 x 10 mm and\ninferolaterally on series 2, image 29 measuring 13 x 6 mm. Small large bowel\nloops are unremarkable without evidence of obstruction. The appendix not\nvisualized but there is no secondary sign of acute appendicitis.\n\nPELVIS: Bladder is distended. There is air in the anti dependent portion of\nbladder which could be secondary to Foley insertion. There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged. Again noted in the\ncorporal cavernosa is a rim enhancing tubular structure measuring 2.3 x 0.6 cm\n(series 2:87) which is indeterminate but could represent a focally dilated\npenile urethra.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The abdominal aorta is\ntortuous. Extensive atherosclerotic disease is noted.\n\nBONES: The multilevel degenerative changes of the lumbar spine, most severe at\nL3-L4. There is no fracture\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Malpositioned gastrostomy tube terminating anterior to the stomach. Rim\nenhancing collection, contiguous with gastrostomy tube, along the anterior\nabdominal wall containing gas and fluid is concerning for abscess formation.\n2. Distended bladder with intraluminal air may reflect recent instrumentation.\n3. Additional nonemergent findings as described above." }, { "input": "CHEST: A 2 mm nodule in the left lower lobe (4:9) is unchanged compared to\nthe prior CT of the thorax. Other previously described pulmonary nodules are\nnot imaged on this exam. Mild subsegmental atelectasis is present in the\nlingula and left lower lobe are present. There is no pleural effusion.\n\nABDOMEN: HEPATOBILIARY: The liver is normal with no focal mass lesions and\nno intra or extrahepatic bile duct dilatation. No ascitic fluid is seen in\nthe upper abdomen. No perihepatic nodes are seen. The gallbladder is normal\nwith no stones or wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric in size with normal\nexcretion of contrast material. No stones, focal renal lesions or\nhydronephrosis are identified.\n\nRETROPERITONEUM: No enlarged retroperitoneal or mesenteric lymph nodes are\nseen.\n\nVASCULAR: The abdominal aorta is normal in caliber throughout its course,\nwith a widely patent celiac axis, superior mesenteric and inferior mesenteric\nartery.\n\nThe loops of large and small bowel in the upper abdomen are normal. There is\nno intraperitoneal free air or free fluid. A small fat containing umbilical\nhernia is noted (602b:43). In the subcutaneous soft tissues overlying the left\nlower abdominal wall, there is a small amount of fat stranding and\nsubcutaneous emphysema, with slight overlying skin thickening, likely due to\nprior subcutaneous injection (02:57).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No deep\npelvic or inguinal adenopathy is present. No free fluid is present within the\npelvis. The uterus is surgically absent. No adnexal masses are seen. The\npelvic loops of large and small bowel in the low abdomen pelvis are\nunremarkable.\n\nBONES AND SOFT TISSUES: No concerning lytic or blastic lesions are seen\nthroughout the skeleton.", "output": "1. 2 mm left lower lobe pulmonary nodule is unchanged since prior CT of the\nchest. Other previously described pulmonary nodules are not imaged. Continued\nfollowup imaging is recommended, as described on the prior study.\n2. No evidence of metastatic disease in the abdomen or pelvis." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: Scarring towards the posterior portion of the left kidney consistent\nwith a previous partial nephrectomy. There is no evidence of stones, focal\nrenal lesions or hydronephrosis. There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. Appendix contains air, has normal caliber without evidence of fat\nstranding.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Heterogeneous uterus with is minimal fluid in the uterine\ncavity. New diagnosis of a leiomyosarcoma is noted. No adjacent adenopathy. No\nfree fluid.\n\nBONES AND SOFT TISSUES:\n\nLumbar scoliosis. Degenerative changes with disc space narrowing and\nsclerosis. No obvious lytic lesions..", "output": "1. Minimally bulky uterus. New diagnosis of a leiomyosarcoma noted. No obvious\nmetastases identified. No definite change from ___ CT scan." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\nPANCREAS: There is a tiny hypodense focus in the pancreatic head that likely\nrepresents interdigitating fat, and is unchanged from previous (5:75). \nOtherwise, the pancreas has normal attenuation throughout, without evidence of\nsuspicious focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: There is unchanged focal cortical thinning of the left kidney\nposteriorly, likely from prior ischemic or infectious insult (5,72). The\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nevidence of stones, focal renal lesions, or hydronephrosis. There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix is not seen. There is no evidence of mesenteric lymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The right ovary is unremarkable. The patient is status\npost left oophorectomy.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.\nAbdominal and pelvic wall is within normal limits.", "output": "Status post left oophorectomy with no evidence of disease recurrence in the\nabdomen or pelvis." }, { "input": "LOWER CHEST: Please refer to the dedicated CT chest report from the same day\nfor a description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Cortical defect and scarring in the left posterior midpole and\nsurgical clips are unchanged and compatible with history of partial left\nnephrectomy. The kidneys otherwise are of normal and symmetric size with\nnormal nephrograms. No evidence of concerning focal renal lesions or\nhydronephrosis. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. No bowel\nobstruction.\n\nPELVIS: The urinary bladder is decompressed and distal ureters are\nunremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus is better appreciated on the recent pelvic\nMR. ___ patient has had prior surgical removal of the left ovary.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Small\nsclerotic lesion in the right pelvis is unchanged (series 13, image 111).\nDegenerative changes in the lumbar spine are also unchanged, most prominent at\nL4-L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of disease recurrence in the abdomen or pelvis.\n\n2. Please refer to the dedicated CT chest report from the same day for a\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again seen is cortical defect and scarring in the posterior midpole\nof the left kidney, compatible with prior history of partial nephrectomy. \nThere is stable postsurgical changes with multiple surgical clips in the area.\nNo new soft tissue mass is seen in the surgical bed. Otherwise, the kidneys\ndemonstrate normal nephrogram. There is no evidence of hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a fibroid uterus. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Subcentimeter sclerotic foci in the right pelvis and the right femoral\nneck are unchanged from prior exam (2:124, 114). There is no evidence of a\nacute fracture. There is S shaped curvature of the spine with degenerative\nchanges of the lumbar spine, worst at L3 through 5 with severe disc space loss\nand endplate changes, unchanged from prior. There is mild retrolisthesis of\nL2 over L3 and 6 mm anterolisthesis of L4 over L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of disease recurrence in the abdomen or the pelvis.\n2. Stable partial left nephrectomy.\n3. Please refer to the dedicated CT chest report from the same day for the\nintrathoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient status post partial left nephrectomy. There is no\nevidence for tumor recurrence. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is no evidence for metastatic disease in the abdomen or pelvis. \nStatus post partial left nephrectomy." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThe main portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA cortical defect is noted along the interpolar region of the left kidney,\nlikely site of partial left nephrectomy. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. The previously described 1.0 cm left pelvic\nsidewall circumscribed lesion is unchanged since prior studies dating back to\n___.\n\nREPRODUCTIVE ORGANS: The uterus appears unremarkable without evidence of local\ntumor recurrence. Patient is status post left pelvic sidewall tumor\nresection.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is again thoracolumbar scoliosis with associated degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The patient is status post resection of a left pelvic sidewall tumor and\npartial left nephrectomy. No evidence of local recurrence or metastasis in\nthe abdomen or pelvis.\n2. Stable appearance of a 1.0 cm left pelvic sidewall circumscribed lesion\nsince prior studies dating back to ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRe-demonstrated cortical defect along the interpolar region of the left\nkidney, likely site of partial left nephrectomy is unchanged. There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. The previously described subcentimeter left pelvic\nsidewall nodule is unchanged and measures 0.6 cm (5:92).\n\nREPRODUCTIVE ORGANS: Anteverted uterus. No suspicious adnexal lesion. No\nevidence of local tumor recurrence status post left pelvic sidewall tumor\nsection.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRotatory scoliosis with degenerative change of the spine is re-demonstrated.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Patient status post partial left nephrectomy and left pelvic sidewall tumor\nsection with no evidence of local recurrence or metastatic disease in the\nabdomen or pelvis.\n2. The previously described subcentimeter left pelvic sidewall nodule is\nunchanged and measures 0.6 cm (5:92)." }, { "input": "LOWER CHEST: Other than mild bibasilar atelectasis, the visualized lower lungs\nare within normal limits. ___ evidence of pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. ___\nevidence of focal lesions. There is moderate pneumobilia of in the left lobe\nand mild pneumobilia in the right hepatic lobe, suggesting patency of the\nknown choledochoduodenostomy. There is prominence of the extrahepatic bile\nduct up to 9 mm (series 6018, image 20). The gallbladder is surgically\nabsent. ___ ascites.\n\nThere is ___ evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The patient is status-post cystgastrostomy (series 2 a, image\n___. The pancreas body and tail are severely atrophic with irregularity of\nthe main pancreatic duct distally, consistent with chronic pancreatitis,\nsimilar the prior exam. The pancreatic duct is mildly prominent, measuring up\nto 3.3 mm (series 6018, image 21). A portion of the pancreatic duct in the\nbody is not clearly traced as on prior MR. ___ peripancreatic fat stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 1.4 x 1 cm right adrenal nodule is demonstrated (series 2 a, image\n13), unchanged since ___. The left adrenal gland is normal in size and\nshape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nBilateral cortical hypodensities are overall unchanged and correspond to cysts\non the prior MRCP. ___ evidence of concerning focal renal lesions or\nhydronephrosis. There is an extrarenal right pelvis. ___ perinephric\nabnormality.\n\nGASTROINTESTINAL: A hiatal hernia is small. The patient is status\npost-gastric bypass surgery. Oral contrast is again demonstrated within the\nexcluded stomach, suggesting a gastro-gastric fistula (series 2a, image 6). \nAppearance of the gastric antrum is overall unchanged. The patient is\nstatus-post cystgastrostomy and choledochoduodenostomy as above. Small bowel\nloops are normal in caliber and wall thickness, and enhancement throughout. \nDiverticulosis without diverticulitis in the sigmoid colon is re-\ndemonstrated. The rectum is unremarkable. The appendix is normal. ___ bowel\nobstruction. ___ free air.\n___ retroperitoneal hematoma.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. ___ free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is absent. The adnexa are unremarkable.\n\nLYMPH NODES: ___ retroperitoneal or mesenteric lymphadenopathy. ___ pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: The SMV is tapered and thrombosed (series 2 a, image 11), with\nextensive collaterals throughout about the left abdomen (series 601a, image\n19), consistent with chronicity. The main portal vein and SMV are patent. ___\nabdominal aortic aneurysm. Extensive atherosclerotic disease is noted.\n\nBONES: ___ suspicious lytic or sclerotic osseous lesion. Compression deformity\nof T12 is unchanged (series 602b, image 38). Multilevel degenerative changes\nare also similar. ___ evidence of acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Post-surgical changes overall unchanged.\n2. ___ acute intra-abdominal process.\n3. Chronic thrombosis of the splenic vein with extensive collaterals.\n4. Small hiatal hernia.\n5. Contrast in excluded stomach status-post bypass, suggesting a gasto-gastric\nfistula, similar to ___.\n6. Sequelae of chronic pancreatitis.\n7. Sigmoid diverticulosis.\n8. Chronic compression deformity of T12.\n9. Stable right adrenal nodule since ___.\n\nNOTIFICATION: The findings and impression were discussed by Dr. ___\nwith Dr. ___, on the telephoneon ___ at 11:48 ___, 10 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST:\nThe visualized lung bases are clear.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: Again visualized is pneumobilia, related to the\ncholedochoduodenostomy. There is mild unchanged dilation of intrahepatic bile\nducts as before. No focal hepatic lesions identified. The portal vein and\nits branches are patent.\nThe gallbladder is surgically absent.\nPANCREAS: There is unchanged severe atrophy of the pancreatic parenchyma with\nscattered foci of punctate calcification and main duct dilation. There is\ninterval increase in size of the main pancreatic duct which now measures 6 mm\nin diameter compared to a prior measurement of 4 mm in the region of the body\nof the pancreas. There is abrupt cut off of the main duct in the region of\nthe neck/proximal body of the pancreas as seen on series 2, image 19 adjacent\nto foci of likely parenchymal calcifications, which may be related to either a\nstricture related to chronic pancreatitis or, less likely a neoplasm. \nConsider MRCP for further evaluation.\nNo peripancreatic stranding of fat or fluid collections to suggest presence of\nacute pancreatitis.\nSPLEEN: No splenomegaly or focal splenic lesions.\nADRENALS: There is an unchanged 1.1 x 1.4 cm right adrenal nodule (series 2,\nimage 21), unchanged since ___. No left adrenal nodules.\nURINARY: No hydronephrosis on either side. Unchanged bilateral renal\ncortical cysts.\nGASTROINTESTINAL: Small hiatus hernia. The patient is post gastric bypass. \nThere is oral contrast within the excluded portion of the stomach compatible\nwith the known gastro gastric fistula. No obstruction. Visualized portion of\nthe bowel is unremarkable. The appendix contains air and appears normal.\nLYMPH NODES: There are no enlarged lymph nodes in the upper abdomen..\nVASCULAR: There is extensive atherosclerotic calcification within the\nvisualized portion of the abdominal aorta, no aneurysmal dilation. The celiac\nartery and its branches, superior mesenteric artery are widely patent. There\nis chronic thrombosis of the splenic vein with extensive collaterals as\nbefore.\n\nBONES AND SOFT TISSUES:\nChronic compression deformity of T12, unchanged. Degenerative changes of the\nvisualized thoracic and upper lumbar spine noted as before.", "output": "1. Sequela of chronic pancreatitis in the form of pancreatic parenchymal\natrophy and scattered punctate parenchymal calcification. There is interval\nincrease in size of the dilated main pancreatic duct which now measures 6 mm\nin diameter and dilated all the way up to the tail. There is an abrupt\ntransition zone in the neck/proximal body of the pancreas. While this may be\nrelated to a stricture secondary to the known chronic pancreatitis, an\nunderlying neoplasm is also a consideration given the abrupt change in caliber\nof the duct and further characterization by an MRI with contrast and MRCP\nshould be considered. No peripancreatic fluid collection or evidence of acute\npancreatitis on this exam.\n2. Persistent pneumobilia related to the prior choledocho-duodenostomy.\n3. Known gastro gastric fistula at the gastric bypass.\n4. Unchanged 0.3 cm right adrenal nodule (stable since ___.\n5. Chronic splenic vein thrombosis with collateral formation and small hiatus\nhernia.\n\nRECOMMENDATION(S): MRI pancreas (with contrast) with MRCP for further\ncharacterization of impression ___ be considered.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 09:47 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: The chest will be reported separately.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: 1.2 cm cyst in the upper pole of the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nThere is a corpus luteal cyst in the left ovary.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute intra-abdominal pathology." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild left intrahepatic\nbiliary ductal dilatation. Mild dilatation of the common bile duct is likely\nrelated to postcholecystectomy change. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is moderately atrophied without suspicious focal\nlesion. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. An area of apparent fat necrosis adjacent to the\nspleen is likely postsurgical in etiology (05:50).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post esophagectomy and gastric\npull-through with the majority of the stomach above the diaphragmatic hiatus. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. A small duodenal diverticulum is incidentally noted. The colon\nand rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Status post interval esophagectomy and gastric pull-through procedure. No\nevidence of metastatic disease within the abdomen or pelvis.\n2. Please see the separately submitted report of the same day CT Chest for\nfindings above the diaphragm." }, { "input": "LOWER THORAX: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nHEPATOBILIARY: The liver is unremarkable. Mild prominence of the common bile\nduct measuring up to 8 mm, likely post cholecystectomy. The gallbladder is\nsurgically absent.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable. No splenomegaly. 11 mm accessory splenic tissue\nadjacent to the anterior pole of the spleen.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis. Unremarkable\nbladder.\n\nGASTROINTESTINAL: Status post esophagectomy and gastric pull up. Incidental\nnote is made of a duodenal diverticulum arising from the third stage of the\nduodenum. The small and large bowel are normal in caliber. The appendix is\nprominent measuring up to 10 mm in thickness without surrounding inflammatory\nchange.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly.\n\nLYMPH NODES: No retroperitoneal or mesenteric adenopathy. No pelvic or\ninguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Unremarkable.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic calcification.\n\nBONES: No suspicious osseous lesion.\n\nSOFT TISSUES: Unremarkable.", "output": "No evidence of locally recurrent or metastatic disease within the abdomen or\npelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Punctate calcified granuloma is noted in hepatic segment VI. \nThe liver demonstrates homogenous attenuation throughout. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post ___ procedure with resection of the\npancreatic head. The residual proximal main pancreatic duct is mildly dilated\nto 4 mm, decreased compared to prior examination where it measured 6 mm and\ntapers distally. The residual pancreatic body and tail are otherwise\nunremarkable without focal lesion identified. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again demonstrated are numerous right-sided cortical and parapelvic\nrenal cysts measuring up to roughly 5.4 cm in the right interpolar kidney. \nThe largest cysts again demonstrates a small amount of layering high density\nmaterial, unchanged compared to the prior examination and unchanged from the\nprior MR examination likely representing hemorrhage. A few cysts are noted on\nthe left measuring up to 2.3 cm in the left lower pole kidney. The kidneys\nare otherwise of normal and symmetric size with normal nephrogram. There is\nno evidence of focal solid renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Hiatal hernia is small. The stomach is unremarkable. \nPatient is status post Whipple procedure. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Postsurgical changes from Whipple without evidence of disease recurrence. \nMild dilatation of the proximal residual main pancreatic duct has improved\ncompared to the prior exam and the residual pancreas is unremarkable.\n2. Several right greater than left simple and hemorrhagic renal cysts." }, { "input": "LOWER CHEST: There is minimal dependent atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is dilated and fluid-filled,\nmeasuring up to 1.3 cm with thickened walls. An appendicolith is identified\nwithin. There is surrounding fat stranding and a small amount of adjacent\nfree fluid. No drainable collections or extraluminal air is identified to\nsuggest perforation.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute uncomplicated appendicitis." }, { "input": "Limited evaluation due to body habitus.\n\nLOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. A 1.7 cm right upper pole\nhypoenhancing lesion corresponds to a hyperdense cyst on the prior CT. \nHeterogeneity throughout the left kidney may likely be secondary to motion\nartifact and body habitus. Several hypodensities within the left upper pole\nare also noted. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Few diverticula\nof the sigmoid colon are noted, without evidence of wall thickening and fat\nstranding. Colon and rectum are otherwise unremarkable. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is anteflexed and unremarkable. No large adnexal\nmass. No collection.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No CT evidence to explain patient's symptoms. Specifically, no abscess or\novert signs of pyelonephritis.\n2. Hypodensities within the left kidney can be further evaluated with\nultrasound or MRI." }, { "input": "LOWER CHEST: Please refer to concurrent CT chest report for a complete\ndiscussion of the intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. IVC filter is intact.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Right breast prosthesis is intact. VP shunt courses along the\nleft anterior abdominal wall and terminates in the mid pelvis. Multiple,\nsmall soft tissue densities within the anterior abdominal wall likely reflect\nprior injection sites. Slight weakness in the upper anterior abdominal wall\nmay predispose the patient to ventral hernias. Correlate with clinical exam.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Slight weakness in the upper anterior abdominal wall may predispose the\npatient to ventral hernias. Correlate with clinical exam.\n3. Please refer to concurrent CT chest report for a complete discussion of the\nintrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout,\nhowever demonstrates slight decreased attenuation as compared to the spleen. \nThis may represent a mildly steatosis, however evaluation on contrast-enhanced\nCT is limited. . There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. A VP shunt is seen, with tip in the pelvis/left\nlower quadrant.\n\nREPRODUCTIVE ORGANS: A 1.5 cm left ovarian cyst is seen, of no concern if the\npatient is still menstruating. If the patient is no longer menstruating,\nfurther evaluation with dedicated ultrasound could be obtained.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. An IVC filter is seen below the level of the renal veins.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are multiple areas of soft tissue nodularity seen in the\nanterior abdomen, likely related to subcutaneous injection. A VP shunt is\nseen coursing in the left anterior abdominal wall.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. 1.5 cm left ovarian cyst, of no clinical implication if the patient is\nstill menstruating. If not, correlation with elective ultrasound could be\nobtained.\n3. Other findings as detailed above." }, { "input": "LOWER CHEST: The visualized lower lung fields demonstrate no abnormality. No\npleural or pericardial effusions.\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesion or laceration. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesion or laceration.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. There is no\nevidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.\n\nBONES: There is no acute fracture. No focal suspicious osseous abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abdominopelvic injuries." }, { "input": "LOWER CHEST: A large pleural effusion on the right with near complete collapse\nof the right lower lobe is progressed compared to ___. The left\natrium is mildly enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken, with nodular contour and hypertrophy of\nthe caudate, compatible with cirrhotic morphology. There is no evidence of\nfocal lesions. Portal vein is patent. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains peripherally\ncalcified gallstone but is otherwise unremarkable. A periportal node measures\nup to 1.8 cm, persistent since ___. Large volume ascites has increased since\n___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 17 cm cc and demonstrate normal\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There are diffuse retroperitoneal and mesenteric nodes, though\nnot pathologic by CT size criteria. Around the celiac axis the largest node\nmeasures up to 8 mm (2:25). Retroperitoneal lymph node measures up to 1.0 cm\nat the right renal hilum. A aortocaval node measures up to 8 mm (02:38). \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the lumbar spine at L5-S1. There are\nno suspicious osseous lesions.\n\nSOFT TISSUES: An umbilical hernia containing simple fluid has increased, now\nmeasuring up to 10.1 cm compared to 6.6 cm in ___.\nThere is diffuse fat stranding in the subcutaneous tissue, likely due to fluid\noverload.", "output": "1. Interval increase in ascites, now a large volume.\n2. Cirrhotic morphology with sequela of portal hypertension including\nsplenomegaly.\n3. Interval enlargement of fluid containing umbilical hernia, now measuring up\nto 10.1 cm.\n4. Anasarca.\n5. Cholelithiasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The hepatic parenchyma is heterogeneously hypoattenuating,\nconsistent with hepatic steatosis. There is no evidence of overt mass within\nthe limitations of an unenhanced scan. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is trace layering sludge and/or\nsmall stones in the gallbladder, without gallbladder wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas is normal in bulk and homogeneous in attenuation. \nThere is no main ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. Previously seen left hydroureteronephrosis on CT from ___ has resolved. There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The patient is status post\nright hemicolectomy. Mild descending and sigmoid sigmoid colonic\ndiverticulosis, without evidence of acute diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. The\npreviously seen left UVJ stone on CT from ___ is no longer\nvisualized. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains central gland calcifications and is\notherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes visualized throughout the imaged\nportion of the thoracolumbar spine without findings of worrisome osseous\nlesions or acute fracture. There is minimal retrolisthesis of L1 on L2 and L2\non L3.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval resolution of previously seen left hydronephrosis. No renal or\nureteral calculi.\n2. Trace layering sludge and/or small stones in the gallbladder.\n3. Colonic diverticulosis without findings of acute diverticulitis.\n4. Hepatic steatosis.\n\nRECOMMENDATION(S): Radiological evidence of fatty liver does not exclude\ncirrhosis or significant liver fibrosis which could be further evaluated by\n___. This can be requested via the ___ (FibroScan) or the\nRadiology Department with either MR ___ or US ___, in\nconjunction with a GI/Hepatology consultation\" *\n\n* ___ et al. The diagnosis and management of nonalcoholic fatty liver\ndisease: Practice guidance from the ___ Association for the Study of\nLiver Diseases. Hepatology ___ 67(1):328-357" }, { "input": "LOWER CHEST: Please refer to the separate report of the CT chest exam\nperformed on the same day for description of the thoracic findings.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no focal lesions. There is no intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is non-distended and normal-appearing, without\nstones or wall thickening. There is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without focal\nlesions, pancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout, without\nfocal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is surgically absent. No masses are demonstrated in\nthe nephrectomy bed. The right kidney is normal in size with a normal\nnephrogram. In the lower pole of the right kidney, again demonstrated is a\n1-cm well-circumscribed, thin-walled, round lesion that is unchanged compared\nto the prior CT and most consistent with a cyst. There is no evidence of\nstones, concerning focal renal lesions, or hydronephrosis in the right kidney.\nThere is no perinephric or ureteral abnormality. The right renal vessels are\npatent. The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. There is no bowel obstruction, pneumatosis, or intra-abdominal free\nair.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy or mass.\n\nVASCULAR: There is no abdominal aortic aneurysm or calcification.\n\nPELVIS: A reactive 1.2-cm left inguinal node is noted and unchanged from the\nprior CT. There is no evidence of pelvic lymphadenopathy. There is no free\nfluid in the pelvis.\n\nBONES AND SOFT TISSUES: There is no suspicious lytic or sclerotic bony\nlesion. A Schmorl's node is again noted at the L4 vertebral body. A right\nflank lipoma is also re-demonstrated. Otherwise, the abdominal and pelvic\nwalls are within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis. Please see\nthe concurrent CT chest report from the same day for details pertaining to the\nthorax.\n\n2. Reactive 1.2-cm left inguinal node, unchanged from prior CT." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nSmall tissue nodule at the posterior superior aspect of the spleen measures 3\nmm (09:39), previously 4 mm.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Status post left nephrectomy. The kidneys are of normal and\nsymmetric size with normal nephrogram. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: Soft tissue nodule adjacent to the left bladder wall measures 0.6 x\n0.5 cm (05:121), previously 1.0 x 0.7 cm. The urinary bladder and distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: 1.3 x 1.0 cm nodule (05:50) in the gastrohepatic ligament,\npreviously 1.4 x 0.8 cm. There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Left anterior abdominal wall fat containing hernia with aperture\nmeasuring 1.4 cm.", "output": "1. Stable to decreased size of previously identified scattered nodes and\nnodules in the abdomen and pelvis.\n2. No new lesions identified." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Subcm\nhypodensities in the right lobe of the liver are too small to characterize but\nare consistent a simple hepatic cysts. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post left nephrectomy. Sub cm hypodensities in\nthe right kidney are too small to characterize but likely represent simple\nrenal cysts. A tiny peripherally calcified lesion in the surgical bed likely\nrepresents fat necrosis or a torsed epiploic appendage.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: A lymph node in the gastrohepatic ligament (series 5, image 47)\nmeasures 1.0 x 0.9 cm (previously 1.3 x 1.0 cm). There is no mesenteric,\nretroperitoneal, pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nEndplate degenerative changes of the L2-L4 vertebral body are unchanged from\nmultiple prior studies.\n\nSOFT TISSUES: A left anterior abdominal wall fat containing hernia is\nunchanged.", "output": "1. A single gastrohepatic ligament lymph node is mildly decreased in size and\nis now only borderline enlarged. There is no additional lymphadenopathy. No\nadditional findings to suggest malignancy within the abdomen and pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Please see same-day CT chest for\ndetails regarding thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is post left nephrectomy. A small calcified lesion in\nthe lateral surgical bed is unchanged from previous examination and may\nrepresent fat necrosis or posttreatment changes (5:60).\n\nThe right kidney has a normal nephrogram without evidence of hydronephrosis. \nIn the lower pole of the right kidney are 2 subcentimeter hypodensities which\nare too small to characterize, unchanged from previous examination, and likely\nrepresent cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: A mildly prominent gastrohepatic ligament lymph node appears\nunchanged measuring 1.4 x 1.0 cm, previously 1.4 x 1.1 cm (5:48). A single\npelvic lymph node is slightly more prominent than on prior examination\nmeasuring 1.3 x 0.8 cm (5:114). There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted. A right-sided Port-A-Cath is present.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerate changes are present in the lumbar spine and left hip with\nsubchondral cystic change. Sclerotic foci in the right superior pubic rami\nand left femoral head are consistent with bone islands, unchanged.\n\nSOFT TISSUES: Left anterior lateral abdominal wall hernia containing fat is\nnoted.", "output": "1. Post left nephrectomy without evidence of recurrence or metastatic disease\nwithin the abdomen and pelvis.\n2. Unchanged gastrohepatic ligament lymph node and slight prominence of pelvic\nlymph node which may be reactive. Attention on follow up suggested.\n3. Please see same-day CT chest report for details regarding thoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post left nephrectomy, with no evidence of\ntumor recurrence in the surgical bed. A dystrophic calcification in the\nnephrectomy bed is unchanged, and likely reflects the sequela of fat necrosis\n(2:58). The right kidney displays normal nephrogram. Two subcentimeter\nhypodense lesions right kidney are too small to characterize, however are\nunchanged from priors and likely represent a simple cysts (601b:47). There is\nno evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: A prominent 1.1 cm gastrohepatic lymph node is not significantly\nchanged from prior (2:48). There is no retroperitoneal or mesenteric\nlymphadenopathy. A previously seen right pelvic lymph node is slightly\ndecreased in size, measuring 1.0 x 0.7 cm, compared with 1.3 x 0.8 cm\npreviously. There is no new pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes in the lumbar spine are similar to prior. There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A left anterior lateral abdominal wall hernia containing fat is\nnoted, unchanged (2:91).", "output": "1. No evidence of recurrent disease or new abdominopelvic metastasis.\n2. Unchanged prominent gastrohepatic node, and slight decrease in size of a\npreviously seen prominent right pelvic lymph node, likely reactive.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient has had prior left nephrectomy for renal cell carcinoma.\nThe right kidney is normal in size with normal nephrogram. No evidence of a\nconcerning focal renal lesion. No hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. No bowel obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size.\n\nLYMPH NODES: A 7-mm and 8-mm gastrohepatic lymph node are unchanged (series\n2, image 52, 47). A 5-mm right parailiac lymph node is unchanged (series 2,\nimage 99). There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes in the lumbar spine are moderate with Schmorl's nodes\nmost prominent at L4 and L2. Degenerative changes are noted in the hips with\na subchondral cyst in left acetabulum (series 601b, image 39), unchanged.\n\nSOFT TISSUES: A left ventral hernia containing mostly fat has increased in\nsize since the left nephrectomy (series 2, image 88). Moreover, an 8-mm\nperitoneal nodule has both increased in size and solid component over time,\nsuspicious for a peritoneal metastasis. A fat-containing umbilical hernia\nsmall (series 602 B, image 44).", "output": "1. Increasing size and solid component of an 8-mm peritoneal deposit in the\nleft ventral hernia suspicious for peritoneal metastasis.\n2. No significant change in sub-centimeter gastrohepatic nodes and right\nparailiac node." }, { "input": "LOWER CHEST: Please see separate report for intrathoracic findings from\nsame-day CT chest.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: As before, the left kidney is surgically absent. The right kidney is\nnormal in size with normal nephrogram. There is an unchanged 1 x 1 centimeter\nsimple cyst in the inferior pole of the right kidney. There are additional\nsubcentimeter hypodense lesions in the right kidney, too small to\ncharacterize. No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized, however,\nthere are no secondary signs of appendicitis. .\n\nPELVIS: The urinary bladder and right distal ureter are unremarkable. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAgain seen are multilevel degenerative changes in the visualized spine and\nhips.\n\nSOFT TISSUES: There is an unchanged left lower abdominal ventral hernia. \nThere is an unchanged 0.8 centimeter lesion in the left anterolateral corner\nof the hernia. There is increased prominence of fat in the ___ the\nlesion and a less nodular appearance. There is an unchanged partially\ncalcified 0.7 cm lesion posterior to the spleen (___), likely representing\nfat necrosis.", "output": "1. Compared to ___, there is an unchanged left lower abdominal ventral\nhernia. There is an unchanged 0.8 centimeter lesion in the left anterolateral\ncorner of the hernia. There is increased prominence of fat in the ___\nthe lesion and a less nodular appearance. Overall, findings are nonspecific,\nbut given imaging findings and no interval growth, a small focus of fat\nnecrosis is considered most likely with metastasis considered less likely.\n2. No other findings to suggest local recurrence or distant metastasis in the\nabdomen or pelvis.\n3. Please see separate report for intrathoracic findings from same-day CT\nchest." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThree 2 mm hepatic hypodensities are too small to characterize, however are\nchanged from prior and likely represent hepatic cysts or biliary hamartomas\n(5:60, 62). No new focal hepatic lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 7 mm round calcified lesion adjacent to the\nspleen is unchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post left nephrectomy, with no evidence of local\nrecurrence in the surgical bed. The right kidney is of normal size and\ndisplays normal nephrogram. A 1.2 cm hypodense lesion in the lower pole of\nthe left kidney was previously characterized as a simple cyst on MRI abdomen\n___. An additional subcentimeter hypodensity in the interpolar region\nof left kidney is too small to characterize, however is unchanged. There is\nno hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Two prominent gastrohepatic nodes, the larger measuring 9 mm,\nare not significantly changed (5:48, 52). There is no retroperitoneal or\nmesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes the lumbar spine, with Schmorl's nodes at L2 and\nL4, are not significantly changed. There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: There is a small left-sided ventral hernia containing fat and a\nperipheral 1.0 cm soft tissue nodule, unchanged (5:89).", "output": "1. No evidence of recurrent or metastatic disease in the abdomen or pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Again seen is the nodule in the right lung base (series 4, image\n37). Please refer to the separately dictated report of same day CT chest.\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas is grossly unremarkable within the limitations of an\nunenhanced scan.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. Small\ncalcification posterior to the spleen may represent a calcified lymph node or\ncalcified epiploic appendage.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Status post left nephrectomy. No recurrent mass seen in the\nnephrectomy bed. Noncontrast appearance of the left kidney is within normal\nlimits. There is no hydronephrosis. Stable appearance of the subcentimeter\nhypodensity in the lower pole of the right kidney.\n\nGASTROINTESTINAL: Small hiatus hernia, the stomach is unremarkable. Given\nlimits of an unenhanced scan the small and large bowel loops are normal in\ncaliber and wall thickness.\n\nPELVIS: The urinary bladder is partially filled. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable sclerotic focus inferiorly in T11 vertebral body. Schmorl's nodes are\nseen involving the lumbar vertebral endplates.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia. There is a small left\nspigelian hernia with the hernial neck measuring 12 mm containing herniated\nomental fat.", "output": "1. Status post left nephrectomy, no evidence of recurrent disease given\nlimitations of an unenhanced scan.\n2. Please refer to the separately dictated same day CT chest report." }, { "input": "LOWER CHEST: Please refer to separate CT chest dictation for full report\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable except for a small right hepatic\nhemangioma, as on prior. No biliary duct dilatation.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The patient is status post left nephrectomy. The right kidney\ndemonstrates a 1.3 x 1.4 cm hypodense non-enhancing lesion in the inferior\npole (3:79), which corresponds to a stable simple renal cysts seen on MR done\non ___ hydronephrosis\n\nGASTROINTESTINAL: No bowel obstruction or ascites.\n\nPELVIS: There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions .\n\nSOFT TISSUES: Right-sided fat containing ventral hernia appreciated, which\nappears stable from CT done on ___. Unchanged calcification in the\nleft upper quadrant (10:19), possibly sequela of prior epiploic appendagitis.", "output": "Stable exam without findings of metastatic disease." }, { "input": "The lung bases and intrathoracic findings are reported separately.\n\nThere is a 2.2 x 1.7 cm endoluminal mass originating from the cardia in the\nlesser curvature of the stomach near the gastroesophageal junction (04:47),\ncompatible with the polyps seen on endoscopy. The known antral nodule is not\nvisualized. There is no lmphadenopathy. There is no ascites. There is no\nbowel wall thickening or obstruction.\n\nThe liver enhances homogeneously without focal lesions. There is\ncholelithiasis without cholecystitis. There is no intra or extrahepatic\nbiliary ductal dilation. The spleen, pancreas and adrenal glands are\nunremarkable. The kidneys enhance symmetrically and show no hydronephrosis.\n\nModerate calcifications involve a normal caliber aorta. Heavy calcifications\nare seen throughout the splenic artery. The portal vein, splenic vein and\nsuperior mesenteric vein are patent.\n\nThe bladder is collapsed. There is sigmoid diverticulosis without\ndiverticulitis. There is no free pelvic fluid. There is no inguinal\nlymphadenopathy.\n\nThere are no lytic or blastic osseous lesions in the abdomen or pelvis\nconcerning for metastatic disease.", "output": "1. Nonvisualization of the endoscopically-visualized antral nodule containing\nbiopsy-proven adenocarcinoma. No evidence for metastatic disease. No local or\ndistal lymphadenopathy.\n2. 2.2 cm endoluminal polyp arising within the cardia, benign by biopsy.\n3. Cholelithiasis." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No focal consolidations. A\ncalcified granuloma is seen within the left lower lobe. No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: A single punctate calcified granuloma is seen within the spleen. \nSpleen is enlarged measuring 14.5 cm. No focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality. Note is made of a large fat plane between the ureter and the\naorta by a laterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the\ndescending colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.6 x 3.6 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted. There is an infrarenal\nabdominal aortic aneurysm measuring 5.1 x 4.9 cm.\n\nBONES: There is grade 1 anterolisthesis of L5 on S1 with bilateral pars\ndefects. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of nephrolithiasis or hydronephrosis. Although evaluation for\nan aorto-ureteric fistula is limited without IV contrast, there is a large a\nfat plane separating the ureters from the aorta bilaterally.\n2. Infrarenal abdominal aortic aneurysm measuring 5.1 x 4.9 cm, unchanged\ncompared to ___.\n3. Other incidental findings include diverticulosis, splenomegaly, and\nprostatomegaly." }, { "input": "LOWER CHEST: Calcified granuloma within the left lower lobe. Otherwise, the\nlungs are clear without focal consolidation. No pleural or pericardial\neffusion. Dense mitral annular calcifications are noted. There also coronary\ncalcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Punctate calcified granuloma. The spleen is mildly enlarged measuring\n13.6 cm. No focal splenic lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the\ndescending and sigmoid colon is noted, without evidence of wall thickening and\nfat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted. The patient is status\npost endovascular repair of an abdominal aortic aneurysm with an aorto\nbi-iliac graft. Evaluation of patency and for endoleak is limited without\nintravenous contrast. The aneurysm sac is unchanged compared to prior\nmeasuring 5.1 x 4.9 cm in maximum axial ___ (series 2, image 44).\n\nBONES: Grade I anterolisthesis of L5 on S1 due to bilateral pars defects. \nSclerotic lesion within the right iliac bone likely represents a bone island. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post EVAR with an unchanged aneurysm sac measuring up to 5.1 cm. \nEvaluation of patency and endoleak is limited without intravenous contrast.\n2. Other incidental findings include diverticulosis, mild splenomegaly, and\ngrade I anterolisthesis of L5 on S1 due to bilateral pars defects." }, { "input": "LOWER CHEST: Mild dependent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Hepatic steatosis. The liver and gallbladder are otherwise\nunremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: No hydronephrosis or nephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unchanged. The bowel is normal caliber. \nScattered colonic diverticula. Normal appendix.\n\nPELVIS: The bladder is unremarkable. Remaining pelvic contents are\nunremarkable. Calcifications within the prostate.\n\nPERITONEUM/RETROPERITONEUM: No ascites or pneumoperitoneum.\n\nLYMPH NODES: No abdominal or pelvic adenopathy.\n\nVASCULAR: Infrarenal abdominal aortic aneurysm status post endovascular\nplacement of aortobifemoral stent. There are extensive calcified and\nnoncalcified atherosclerotic plaques within the abdominal aorta. The\naneurysmal sac measures 5.2 x 4.8 cm, unchanged. No evidence of an endoleak. \nThe bilateral iliac stents are patent. Mild to moderate atherosclerotic\ncalcifications of the iliac arteries which are patent.\n\nBONES: No suspicious osseous lesions. Degenerative changes of the spine. \nGrade 1 anterolisthesis L5 on S1.\n\nSOFT TISSUES: Unremarkable", "output": "1. Status post endovascular aorto bi-iliac stent placement with unchanged\naneurysmal sac measuring 5.2 cm. No evidence of an endoleak.\n2. Additional incidental findings above." }, { "input": "Lung bases: Heart size is normal without significant pericardial fluid. \nCoronary artery and mitral valve calcifications are noted. The imaged lung\nbases are clear.\n\nCT abdomen without contrast: Liver, gallbladder, spleen, pancreas and adrenal\nglands are grossly unremarkable in the context of a noncontrast examination. \nSpleen is top normal size.\n\nObstructing 4 mm calculus is noted in the right mid ureter (02:45) with\nassociated mild right hydroureteronephrosis with a surrounding periureteral\nfat stranding. There is no left-sided hydronephrosis. The kidneys otherwise\ngrossly unremarkable without obvious mass or intrarenal calculus.\n\nStomach is unremarkable. Duodenum and small bowel loops are normal caliber\nwithout evidence of obstruction. There are few scattered diverticula without\nevidence of diverticulitis. Large bowel is otherwise thin-walled and\nunremarkable without pericolonic fat stranding or fluid collection. Normal\nappendix is visualized in the right lower quadrant.\n\nModerate to severe atherosclerotic calcifications are noted in the abdominal\naorta. Again demonstrated is a 4.7 x 4.5 cm infrarenal abdominal aortic\naneurysm, not significantly changed compared to the prior examination. There\nis no mesenteric or retroperitoneal lymphadenopathy by CT size criteria. \nThere is no ascites or pneumoperitoneum. There is no ventral abdominal\nhernia.\n\nCT pelvis without contrast: Bladder is decompressed and unremarkable. \nProstate demonstrates central calcification and is mildly enlarged. Rectum is\nunremarkable. There is no free pelvic fluid or air. There is no inguinal or\npelvic sidewall lymphadenopathy by CT size criteria.\n\nBones and Soft tissues: There is no suspicious focal bone lesion. There is\ngrade 1 anterolisthesis of L5 on S1 with bilateral pars defects with focal\nsevere degenerative change at this level.", "output": "1. Obstructing 4 mm stone at the level of the right mid ureter with associated\nmild right hydroureteronephrosis.\n2. Stable 4.7 x 4.5 cm infrarenal abdominal aortic aneurysm.\n3. L5 spondylolysis with grade 1 spondylolisthesis and advanced degeneration\nat this level." }, { "input": "Chest findings are reported separately.\n\nThe liver is hypodense relative to the spleen consistent with fatty\ninfiltration of the liver. No focal liver lesions are identified. There is\nno biliary dilatation. The gallbladder is decompressed. The spleen is normal\nin size and appearance. The pancreas appears normal. The left adrenal and\nkidney are also unremarkable. The patient is status post right adrenalectomy\nand nephrectomy. There is no evidence for local recurrence at the operative\nsite.\n\nThe stomach and small bowel appear within normal limits. The appendix appears\nnormal. Sigmoid diverticulosis is mild.\n\nThe uterus is mildly lobular but unchanged suggesting fibroids. There is no\nlymphadenopathy or ascites. The major mesenteric vessels appear patent.\n\nMild to moderate degenerative changes affect lumbosacral facets. There are\nmild degenerative changes of sacroiliac joints. No suspicious bone lesions\nare identified in the abdomen or pelvis.", "output": "No evidence for disease recurrence or distant metastases. Fibroid uterus. \nFatty infiltration of the liver.\n\nDOSE: 1035.7 mGy-cm." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple stable subcentimeter hypodensities (series 7, image\n17, 18, 32) within the liver are too small to characterize, but likely\nrepresent cysts or biliary hamartomas. Otherwise, the liver demonstrates\nhomogenous attenuation throughout. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland has been surgically removed. The left\nadrenal gland is normal in size and shape.\n\nURINARY: The patient is status post right nephrectomy. There is no evidence\nof local recurrence. The left kidney is of normal and symmetric size with\nnormal nephrogram. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and heterogeneous, but not\nsignificantly changed compared to ___, consistent with fibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post right nephrectomy with no evidence of local recurrence or\nmetastatic disease.\n2. Fibroid uterus." }, { "input": "LOWER CHEST: Scarring is noted at both lung bases from prior wedge\nresections. Please see separately dictated CT chest from the same date for\nrelevant chest findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypo attenuating structures in the liver measuring up to 5 mm,\nas seen on prior exam, too small to characterize. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal gland appears normal. The right adrenal gland is\nsurgically absent.\n\nURINARY: Patient is status post right total nephrectomy. Within left kidney\nenhances normally without evidence of focal lesion or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears lobulated and heterogeneous, most\nlikely due to uterine fibroids. Some of these appear low in attenuation which\ncould indicate degenerating fibroids/necrosis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of recurrent or metastatic disease in the abdomen and pelvis.\nPlease see separately dictated CT chest from the same date for relevant chest\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple hypodensities within the liver, which are\ntoo small to characterize, but stable since ___, and likely represent\ncysts or biliary hamartomas (series 2, image 58, 61, 63, 77). Otherwise, the\nliver demonstrates homogenous attenuation throughout. There is no evidence of\nenhancing lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is a 5 mm hyperenhancing focus within the uncinate process,\nwhich appears tubular and was likely present on the CT dated ___,\npossibly representing a small vessel. Otherwise, the pancreas has normal\nattenuation throughout, without evidence of focal lesions or pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is surgically absent. The left adrenal\ngland is normal in size and shape.\n\nURINARY: The patient is status post right nephrectomy. There is no evidence\nof recurrence within the resection bed. The left kidney is of normal and\nsymmetric size with normal nephrogram. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are a few\ncolonic diverticula. Otherwise, the colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple large fibroids are re-demonstrated, unchanged\ncompared to prior. No adnexal masses are visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia. Otherwise, the\nabdominal and pelvic wall is within normal limits.", "output": "1. Status post right total nephrectomy and adrenalectomy without definite\nevidence of local recurrence or metastatic disease within the abdomen or\npelvis.\n2. 5 mm hyperenhancing focus within the uncinate process of the pancreas,\nwhich was equivocally present on the CT dated ___, may represent a\nvessel. However, attention on follow-up examinations is warranted as this is\nnot well seen on more recent studies.\n3. Fibroid uterus.\n4. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hepatic hypodensity is too small to characterize, however is\nstable from prior and likely represents a hepatic cyst or biliary hamartoma\n(7:18). Multiple additional previously seen subcentimeter hepatic\nhypodensities are not well visualized on this exam. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: Again seen is a 5 mm hyperenhancing focus in the uncinate process,\nnot significantly changed compared with CT ___, however not definitely\nvisualized on prior examinations (7:29). There is no new focal pancreatic\nlesion. There is no pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Patient is status post right adrenalectomy. The left adrenal gland\nis normal in size and shape.\n\nURINARY: Patient is status post right nephrectomy. The left kidney is of\nnormal size with normal nephrogram. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A tiny umbilical hernia containing fat is noted.", "output": "1. A 5 mm hyperenhancing focus within the uncinate process of the pancreas is\nnot significantly changed compared with CT ___, however was not\ndefinitely visualized on other previous CTs. This may represent a small\nvessel, however attention on follow-up studies is recommended.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding. There is stable appearance of a 5 mm hyperenhancing lesion in the\nuncinate process of the pancreas that was present on multiple prior exams and\nmay represent a focal vessel or aneurysm, cannot exclude hyperenhancing\nlesion.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Status post right adrenalectomy. The left adrenal gland are normal\nin size and shape.\n\nURINARY: Status post right nephrectomy without evidence of recurrence in the\nresection bed. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No evidence of recurrent or metastatic disease in the abdomen or pelvis.\n2. Stable appearance of 5 mm enhancing focus in the uncinate process of the\npancreas; advise continued attention on followup examinations.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hyooattenuation throughout,\nconsistent with hepatic steatosis. An ill-defined 8 mm hypodensity in the\ninferior right hepatic lobe may have been present previously, but is more\nconspicuous compared with prior (3:76). There is an additional 5 mm\nhypodensity in the posterior right hepatic lobe, not definitely previously\nvisualized (3:55). There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal gland is normal in size and shape. The right\nadrenal gland is surgically absent.\n\nURINARY: Patient is status post right nephrectomy, with no evidence of local\nrecurrence in the resection bed. The left kidney is of normal size and\ndisplays normal nephrogram. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Incidental note is made of a replaced right hepatic artery arising\nfrom the SMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Two ill-defined hepatic hypodensities measuring up to 8 mm, 1 of which may\nhave been present previously, however is more conspicuous compared with prior.\nFurther evaluation with MRI or attention on follow-up CT is recommended.\n2. Status post right nephrectomy and adrenalectomy, with no evidence of local\nrecurrence.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S): MRI liver or attention on follow-up CT." }, { "input": "LOWER CHEST: Please refer to the separately dictated CT of the chest for\ndetailed evaluation of the chest finding. Again noted is trace of right-sided\npleural effusion with postsurgical changes in the right lung base and\nscarring.\n\nHEPATOBILIARY: There is homogeneous hepatic enhancement. There is\nre-demonstration of a millimetric hypodensity in the subcapsular region of\nsegment 6 (03:54) measuring 5 mm, unchanged. Portal vein and hepatic veins\nare patent. There is no biliary ductal dilatation. Gallbladder is\nunremarkable.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious masses.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Right adrenal gland is surgically removed. Left adrenal gland is\nunremarkable.\n\nURINARY:Left kidney is normal in appearance with no suspicious masses. There\nis no hydronephrosis or nephrolithiasis. Status post total nephrectomy on the\nright with no suspicious masses in the nephrectomy bed.\n\nGASTROINTESTINAL: Stomach is under distended. Small bowel loops are normal in\ncaliber. Appendix is unremarkable.\n\nPERITONEUM: There is no free air or free fluid. There is no peritoneal\nstranding.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches.\n\nPELVIS: Fibroid uterus is again demonstrated with and unchanged in appearance.\nUrinary bladder is under distended. Rectum is unremarkable. There are no\npelvic or inguinal adenopathy.\n\nBONES:There is a new right femoral faintly sclerotic lesion in the\nintertrochanteric area measuring 1.5 cm. This is concerning for osseous\nmetastatic disease.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. New right femoral 1.5 cm osseous sclerotic lesion concerning for\nmetastasis.\n2. Otherwise, abdominopelvic evaluation is clear.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on ___\nat 13:44 into the Department of Radiology critical communications system for\ndirect communication to the referring provider." }, { "input": "LOWER CHEST: Trace bilateral pleural effusions are noted. There are patchy\nopacities in the left lower lobe and to a lesser extent in the lingula and\nright lower lobe, which may represent aspiration.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 7\nmm hypodense lesion in hepatic segment III is incompletely characterized but\nunchanged from prior study. Mild enlargement of the common bile duct\nmeasuring 10 mm and central intrahepatic biliary ductal dilatation is\nunchanged. The gallbladder contains small layering gallstones without wall\nthickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size without evidence of a focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is unchanged moderate right hydronephrosis and mild proximal\nright hydroureter with perinephric and periureteral fat stranding and a\ndelayed right nephrogram. A 10 mm hypodense lesion in the superior pole of\nthe right kidney is unchanged. The urinary bladder and distal ureters are\nunremarkable.\n\nGASTROINTESTINAL: The enteric tube terminates in the body of the stomach. The\nstomach is unremarkable. Mild wall thickening of the second portion of the\nduodenum appears unchanged. There is circumferential wall thickening and\nsubcutaneous edema involving the ascending and proximal transverse colon which\nhas slightly progressed and now involves the mid transverse colon. Scattered\ncolonic diverticulosis is noted without evidence of diverticulitis. There is\nno bowel obstruction. The appendix is normal.\n\nOTHER: There is a trace amount of intraperitoneal free fluid and stranding\nwhich is not significantly changed compared to prior study.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no suspicious osseous lesion or acute fracture. Mild\nmultilevel degenerative changes are noted in the spine. There are mild\ndegenerative changes of both hips.\n\nSOFT TISSUES: A very small left inguinal hernia containing fat is noted.", "output": "1. Unchanged moderate right hydronephrosis and mild proximal hydroureter with\na delayed. No CT evidence of pyelonephritis but please note that\npyelonephritis cannot be excluded by imaging. Correlation with urinalysis is\nrecommended.\n2. Slight interval progression of the wall thickening and subcutaneous edema\nin the transverse colon, which most likely represents persistent colitis. No\nevidence of pneumatosis, bowel perforation or drainable extraluminal\ncollection.\n3. Unchanged wall thickening and surrounding stranding involving the second\nportion of the duodenum." }, { "input": "LOWER THORAX: Bibasilar subsegmental atelectasis is noted.\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation.\nUnremarkable gallbladder.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The kidneys are unremarkable. No hydronephrosis.\n\nGASTROINTESTINAL: No intestinal obstruction or ascites. The appendix is\nunremarkable.\n\nREPRODUCTIVE ORGANS: The right prostatic lobe appears diffusely enlarged and\nhyperenhancing with mild surrounding soft tissue stranding.\n\nLYMPH NODES: No abdominal or pelvic adenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic calcification.\n\nBONES: No suspicious osseous lesion.", "output": "1. No evidence of obstructive uropathy. No imaging findings of pyelonephritis\nor abdominopelvic abscess.\n2. Diffuse enlargement of the right prostatic lobe with bulging of the capsule\nand hyperenhancement. Given the clinical history and age, prostatitis is the\nmain differential consideration. Prostatic malignancy is difficult to exclude\non CT with this appearance." }, { "input": "The visualized lung bases appear clear. There are no pleural effusions.\n\nIn segment VI of the liver, a 5 mm diameter hypodense focus is too small to\ncharacterize. No other discrete liver lesions are identified. There is no\nintrahepatic or extrahepatic biliary ductal dilatation. The caudate lobe is\nmildly prominent in relative size. The spleen is normal in size.\n\nThe gallbladder is mostly contracted. Enhancement of the free segment of the\nextrahepatic biliary ducts as well as the cystic duct and gallbladder is\nmildly prominent but significance is uncertain. It is possible that this may\nbe due to an underlying inflammatory process involving biliary duct such as\nsclerosing cholangitis.\n\nThe portal vein and its main branches appear patent. Hepatic veins are also\npatent. Arteries are difficult to assess with this technique.\n\nIn the pancreatic body there is a cystic lesion measuring up to 21 x 20 mm in\naxial ___ without apparent complexity.\n\nThe adrenal glands and kidneys appear within normal limits.\n\nThe stomach and visualized portions of bowel are unremarkable aside from\nmildly prominent colonic stool.\n\nThere is no lymphadenopathy or ascites.\n\nThere are no suspicious bone lesions.", "output": "1. No evidence of biliary obstruction.\n\n2. Somewhat prominent extrahepatic biliary enhancement, significance\nuncertain, but etiologies such as sclerosing cholangitis could be considered\nor the appearance may be due to vascular alterations associated with\nparenchymal disease.\n\n3. Mildly prominent caudate, but no absolutely convincing morphological\nabnormality of the liver.\n\n4. Cystic pancreatic lesion, unlikely to explain jaundice, but evaluation\nwith MRCP is recommended when clinically appropriate." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Subcentimeter hypodensity within the right lobe of the liver is\ntoo small to characterize, but likely represents a cyst or biliary hamartoma\n(series 4, image 26). Otherwise, the liver demonstrates homogenous\nattenuation throughout. There is no evidence of enhancing lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: Cystic lesion within the body/tail of the pancreas, which is grossly\nstable, but better evaluated on the MRCP dated ___. Otherwise,\nthe pancreas has normal attenuation throughout, without evidence of pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Sigmoid ascending colonic diverticulosis. There is a short\nsegment of sigmoid colon, which demonstrates marked wall thickening and\nadjacent fat stranding, consistent with acute diverticulitis. There is\nsuggestion of 1.0 cm early intramural abscess (series 4, image 75). No\ndrainable fluid collections. No gross pneumoperitoneum. The proximal colon\nis within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple calcified fibroids are visualized. The largest\nmeasures approximately 2.3 x 2.0 cm in arises from the posterior myometrium\n(series 4, image 77). No adnexal masses visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is abnormal configuration of the superior midline sacrum, which\nis likely congenital in nature (series 6, image 34). Mild deformity of the\nsuperior endplate of T11 is chronic and stable since ___. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Tiny umbilical hernia. Otherwise, the abdominal and pelvic wall\nis within normal limits.", "output": "1. Acute sigmoid diverticulitis. There is suggestion of an early intramural\nabscess. No drainable fluid collection. No other complications. Follow-up\ncolonoscopy is recommended once the patient's acute symptoms resolve.\n2. Cystic lesion within the body/tail of the pancreas, grossly stable, but\nbetter evaluated on the MRCP dated ___. At that time, a follow-up\nMRCP was recommended in 6 months.\n3. Fibroid uterus.\n\nRECOMMENDATION(S): Follow-up colonoscopy is recommended once the patient's\nacute symptoms resolve to rule out underlying malignancy.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:35 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Bilateral pleural effusions, right greater than left, appear\nminimally improved compared to ___ and are associated with overlying\ncompressive atelectasis, more prominent on the right. Small right subpleural\nnodule and cyst in the right middle lobe are unchanged compared to prior (2:3,\n7).\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: Again demonstrated is a lobulated partially spiculated mass\ninseparable from the uncinate process of the pancreas with mesenteric\nextension and internal calcifications, some of which are vascular in nature,\nmeasuring up to 4.9 x 4.4 cm in the axial plane (2:37, 44). This is largely\nunchanged compared to ___. The mass appears to almost completely\nencase the SMV and SMA which is grossly unchanged compared to prior (2:30,\n43). The mesentery distal to this appears congested with stranding in\naddition to prominence of the mesenteric vessels. The remaining visualized\npancreas has normal attenuation throughout within the limitations of an\nunenhanced scan. There is no pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. A 2.1 x 1.2\ncm hypodense splenic lesion is unchanged compared to at least ___ and is\nincompletely characterized (02:17).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Mild prominence of small bowel\ncaliber adjacent to mass (series 2, image 52) has improved slightly compared\nto prior. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. No evidence of bowel obstruction. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal. Moderate to large volume ascites is again demonstrated.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Large volume\npelvic free fluid is again seen.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Patient is status post lymphangiogram performed ___. \nLipiodol is demonstrated in the bilateral groin lymph nodes extending\ninferiorly on the right side to the level of the proximal right thigh with\ntrace peripheral extension into the right scrotum (2:94) and superiorly to the\nlevel of L3 with trace lipiodol visualized in the left pericolic gutter\n(02:49). Multiple prominent and enlarged mesenteric, periaortic, and\nretroperitoneal lymph nodes are grossly unchanged compared to ___\nand measure up to 1.4 cm in short axis (2: 32, 40, 42, 43, 47).\n\nVASCULAR: The abdominal aorta is mildly ectatic, however there is no abdominal\naortic aneurysm. Extensive atherosclerotic disease is noted.\n\nBONES: Mild degenerative changes of the thoracolumbar spine most prominent at\nL5-S1 with narrowing of the disc space. Multiple focal areas of sclerosis in\nthe pelvis are unchanged compared to multiple priors (2:62, 71). Otherwise,\nthere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Overall similar burden of disease compared to ___, with similar\nappearance of an ill-defined partially spiculated mass inseparable from the\npancreatic uncinate process with mesenteric extension. Associated mesenteric\ncongestion.\n2. Scattered nodal lipiodol uptake in the bilateral groin with superior\nextension up to the level of the L3 vertebral body.\n3. Multiple enlarged mesenteric, periaortic, and retroperitoneal lymph nodes\nare similar in appearance compared to ___.\n4. Persistent moderate to large volume ascites.\n5. Interval improvement of bilateral small pleural effusions." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: A approximately 1.3 cm ill-defined hypodense lesion in the\nright hepatic lobe correlates findings on prior gallium scan from ___\n(2:52). Other hypodensities within the right and left lobes are nonspecific,\nbut appear unchanged from prior (02:58, 60). The liver demonstrates\nhomogeneous attenuation throughout. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is large volume ascites, which is increased in size from prior but may\nbe related to differences in timing of paracentesis.\n\nPANCREAS: In close proximity to the uncinate process of the pancreas, there is\na 5.6 x 4.9 X 8.4 cm soft tissue density mesenteric encasing mass with coarse\ncalcifications, which measured 5.5 x 4.9 x 8.8 cm in ___ and 4.5 x 5.0 x\n8.9 in ___ when measured in a similar plane. The mass encases the\nSMA and SMV. A nearby focal mesenteric lesion measures 4.0 x 3.4 cm,\npreviously 4.3 x 3.6 cm in ___ and unchanged from ___. A 1.6\ncm lesion near the neck of the pancreas (2:66) is unchanged from prior. The\nremaining pancreatic parenchyma appears within normal limits, within the\nlimitations of an unenhanced scan. There is no pancreatic ductal dilatation. \nThere is no peripancreatic stranding.\n\nSPLEEN: A 1.8 cm hypodense lesion in the posterior spleen is unchanged\ncompared to ___, incompletely characterized (02:57). The\nremainder of the spleen demonstrates normal size and attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. There is\nlarge volume pelvic ascites.\n\nLYMPH NODES: Multiple para-aortic, retroperitoneal and mesenteric lymph nodes\nmeasuring up to 1.3 cm in the short axis are re-demonstrated (2:73, 80, 87)\nand unchanged in size from ___. The 1.3 cm right periaortic mass\ndemonstrated avidity on prior gallium scan. In the mesentery of the left upper\nquadrant there is fat stranding and induration, likely secondary to third\nspacing and ascites.\n\nLipiodol is re-demonstrated within the bilateral groin lymph nodes extending\nover the right lateral pelvic walls and into the right scrotum. Distribution\nover the level of L3 as well as the left pericolic gutter is unchanged\ncompared to study from ___.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nBONES: Numerous sclerotic foci the throughout the pelvis, lumbar spine and the\nbase of the right eleventh rib are unchanged in size from prior. No new\nosseous lesions are present.", "output": "1. A 5.4 x 4.9 x 8.4 cm soft tissue mass arising from the central mesentery\nwith encasement of the SMA and SMV is overall unchanged from ___\nand ___. An adjacent mesenteric lesion measuring 4.0 x 3.4 cm is not\nsignificantly changed from ___ or ___. A 1.6 cm lesion near\nthe neck of the pancreas is unchanged from prior. Slight differences in\nmeasurements compared to prior may be due to differences in lesion orientation\nbetween studies.\n2. Interval increase in large volume ascites, which may be due to interval\nparacentesis. A ill-defined right hepatic density with correlate on gallium\nscan is unchanged from prior. Other hypodensities are nonspecific and may be\nartifactual or related to contrast differences.\n3. Redemonstration of multiple para-aortic, retroperitoneal mesenteric lymph\nnodes, which are unchanged from ___.\n4. Stable appearance of bony metastases seen throughout the pelvis, lumbar\nspine and base of the right eleventh rib. No new osseous lesions.\n5. Nonspecific 1.8 cm posterior splenic hypodensity is unchanged.\n6. Please see report from same day chest CT for full description of\nintrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is an equivocal 0.9 cm hypodense focus at the hepatic\ndome (series 5, image 49) in the location of gallium 68 DOTATATE avidity seen\non the ___ study. There is a faint foci of low attenuation within the\nright hepatic lobe (series 5, image 58) unchanged from the last contrast\nenhanced CT dated ___ which was not definitely avid on the prior\nDOTATATE study. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: Again seen is uncinate process mass measuring 5.9 x 4.8 cm on\nlargest axial dimension and 7.3 cm craniocaudal dimension, unchanged from\nprior exam. This mass encases the SMA and SMV with extension along the\nmesenteric with no significant vascular narrowing noted. There is no\npancreatic ductal dilatation.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted with multiple calcified plaques are seen throughout the\ncourse of aorta, most pronounced seen infrarenal abdominal aorta. There is\nocclusion of left common iliac artery with reconstitution of flow seen in the\nleft external and internal arteries (series 5, image 89).\n\nLYMPH NODES: Multiple retroperitoneal and mesenteric lymphadenopathy are seen,\nunchanged from prior exam, reference nodes include\n1.0 cm left para-aortic node (series 5, image 70)\n1.0 cm right para-aortic node (series 5, image 69)\n1.2 cm mesenteric node adjacent to the inferior aspect of pancreatic masses\n(5, image 79).\n\nLipiodol is again seen within the bilateral groin lymph nodes, unchanged\ncompared to prior exam.\n\nSPLEEN: 1.8 cm hypodense lesion in the posterior spleen is unchanged from\nprior exam.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is wall thickening of multiple loops of small bowel\nlikely due to edema and underlying ascites. Moderate volume ascites seen in\nthe abdomen and pelvis has slightly improved.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged (series 5, image 119).\n\nBONES: Numerous sclerotic foci in the sacrum, left iliac bone and lumbar spine\nare unchanged. No new osseous lesion seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Equivocal 0.9 cm hypodensity at the hepatic dome correlates to the location\nof prior focus of avidity on the ___ DOTATATE scan but appears much less\nconspicuous in comparison to the ___ CT.\n2. No new hepatic lesion.\n3. Unchanged uncinate mass with extension into the mesentery, stable since ___.\n4. Occlusion of the left common iliac artery, with reconstitution of flow\nwithin the left internal and exernal iliac arteries. No prior\ncontrast-enhanced study is available for comparison." }, { "input": "LOWER CHEST: Bibasilar atelectasis is noted. Small dependent bilateral\npleural effusions are seen. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Two new hypoattenuating lesions are seen in segments VII and\nVIII, and measure 0.7 cm and 0.9 cm, respectively (4: 14, 12). A 2.7 x 2.0 cm\nhypodense, lobulated exophytic mass is again seen in segment V (4:28) and is\nunchanged. A 1.3 cm hypoattenuating lesion in segment VI (4:35) is unchanged.\nHemangiomas are again seen in hepatic segments II, III and VI and measure 1.8\ncm, 2.6 cm and 1.3 cm, respectively (4:14, 22). These are similar to prior. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral subcentimeter hypoattenuating lesions are too small to characterize.\nThere is mild fullness of the bilateral renal pelvises, more prominent\ncompared to ___. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal (4:61).\n\nPELVIS: The bladder is distended and contains intraluminal anti-dependent gas.\nPatient is post radical prostatectomy. In the posterior cul-de-sac, again\nseen is a 4.4 x 3.0 cm hypoattenuating, peripherally enhancing mass that is\ninseparable from the rectum (4:80), increased in size, previously 3.5 x 2.3\ncm. Adjacent to this is a 8.6 x 2.9 cm peripherally enhancing mass noted in\nthe left obturator muscle that is also bigger, previously 6.9 x 2.8 cm.\n\nThere is new subcutaneous fat stranding and subcutaneous gas in the right\nposterior gluteal cleft (4:96), with an apparent fistulous tract communicating\nwith the rectum (4:93).\n\nLYMPH NODES: Multiple newly enlarged large para-aortic and aortocaval lymph\nnodes measure up to 2.6 x 2.6 cm (4:43). Bilateral pelvic lymph nodes are\nalso enlarged, measuring up to 3.7 x 2.1 cm on the left (4:71) and 3.3 x 1.9\ncm on the right (4:73). There is new bilateral inguinal lymphadenopathy, with\nnodes measuring up to 2.2 x 0.9 cm on the left (4:83) and 2.2 x 1.1 cm on the\nright (4:86).\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Foci of sclerotic change to the right iliac wing (4:62) and right\nsacrum at the sacroiliac joint (4:67) correspond to areas of metastatic\ndisease, as seen on prior nuclear medicine bone scan from ___. \nNo new suspicious lytic or blastic lesions are seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Compared to ___, there has been progression of local and\nmetastatic disease involving the pelvis, liver, and abdominal, pelvic and\ninguinal lymph node stations, as detailed above. The previously seen lesions\nare increased in size and there are new liver lesions and new lymphadenopathy\n2. New perianal fistula associated with subcutaneous gas and fat stranding in\nthe right posterior gluteal cleft." }, { "input": "LOWER CHEST: Small pleural effusions with associated atelectasis is again seen\nat the lung bases. Scarring is also noted at the lung bases, bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild intrahepatic biliary ductal\ndilatation is unchanged from ___. The CBD is prominent measuring up to\n1.0 cm, unchanged from ___. The gallbladder contains multiple\ngallstones and has a mildly irregular, partially calcified and thickened wall,\nhowever is unchanged from ___.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nTiny sub cm hypodensities in the kidneys bilaterally are consistent with\nsimple cysts. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Several loops of\nfluid-filled small bowel in the mid abdomen are distended up to 3.4 cm in\ndiameter with an abrupt transition point in the right lower quadrant (series\n2, image 52). Distal to the transition point there is an inguinal hernia\nwhich contains fluid and small bowel, and does not seem to be causing\nobstruction. A trace amount of fluid is seen in the right pericolic gutter\nimmediately inferior to the cecum. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\ntrace amount of free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. A pessary is incidentally\nnoted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. A common origin of the celiac axis and SMA is incidentally\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate to severe degenerative changes are seen throughout the thoracic and\nlumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Uncomplicated small bowel obstruction with a transition point in the right\nlower quadrant.\n2. Cholelithiasis and gallbladder wall calcification without evidence of\ncholecystitis.\n3. Stable prominence of the intra and extrahepatic biliary tree.\n4. Moderate hiatal hernia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones and\nhas a partially calcified wall, with a similar appearance dating back to CT\nabdomen and pelvis ___. There is no gallbladder distension or\npericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is noted. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There are redundant loops of sigmoid colon with a\nmildly distended appearance best appreciated on coronal view (4B:28). The\ncolon and rectum are otherwise unremarkable. Patient is status post\nappendectomy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A pessary is noted. Patient is status post hysterectomy\nand bilateral salpingo-oophorectomies\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate to severe\natherosclerotic disease, which is most significant in the infrarenal aorta. A\ncommon origin of the celiac and superior mesenteric arteries again noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Redundant loops of sigmoid colon with frame mildly distended appearance\nwhich may be related to patient's reported right sided abdominal pain.\n2. Small hiatal hernia.\n3. No evidence of hernia or obstruction in the large or small bowel." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is intrahepatic biliary\ndilatation as noted previously and the CBD is dilated measuring up to 1.1cm as\nsimilar to previous studies. The gallbladder contains multiple gallstones\nwith a slightly irregular wall that is partially thickened measuring up to 3.3\nmm with calcifications in the wall without significant change from previous\nand without pericholecystic fluid or fat stranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There are bilateral subcentimeter\nhypodense renal lesions that are too small to characterize but likely\nrepresent simple renal cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia as previously noted. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the colon without thickening of\nthe walls or pericolonic stranding. Moderate amount of stool in rectosigmoid\ncolon. The appendix is surgically absent. There is no evidence of bowel\nobstruction\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent with a pessary, as\npreviously noted. No adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative disease in the lumbar spine and visualized portions of the\nthoracic spine.\n\nSOFT TISSUES: There is a spigelian hernia in the right lower quadrant\ncontaining small bowel but does not appear to be obstructed or incarcerated\n(2; 54).", "output": "1. There is no evidence of small or large bowel obstruction or ischemia\n2. A spigelian hernia previously containing fat now with a loop of small bowel\nwithout evidence of obstruction\n3. Persistent cholelithiasis with stable common bile duct dilation\n4. Incidental pessary\n5. Degenerative disease in the spine" }, { "input": "LOWER CHEST: Minimal subsegmental atelectasis is identified. No suspicious\npulmonary nodules are present. No pleural effusions are seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is stable dilation of the intra\nand extrahepatic bile ducts although 80 up to the papilla. The extrahepatic\nbile duct measures up to 16 mm. The gallbladder has significant wall\nthickening and wall calcification consistent with chronic cholecystitis. \nXanthogranulomatous cholecystitis cannot be excluded.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is mild nodular thickening of the right adrenal gland, not\nsignificant changed from prior study.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a right\nabdominal wall hernia with extension of small bowel loops through the hernia\nopening. No evidence for incarceration or strangulation. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder is completely decompressed. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A pessary is identified in the proximal vagina.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence for small bowel obstruction. 2. Subsegmental atelectasis in\nboth lower lung lobes. 3. Stable bile duct dilation and wall thickening of\nthe gallbladder. 4. Stable nodular thickening of the right adrenal. 5. \nStable right anterior abdominal wall hernia without evidence of incarceration\nor strangulation." }, { "input": "LOWER CHEST: Bibasilar atelectasis is noted. There is no large pleural\neffusion or pneumothorax.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver appears unremarkable. The gallbladder contains\ngallstones without wall thickening or evidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach and duodenum appear normal. Evaluation is quite\nlimited due to lack of oral or intravenous contrast material. However, there\nare several dilated loops of small bowel in the left hemi abdomen with\nassociated mesenteric edema. Tethering of small bowel is noted in the left\nlower quadrant likely secondary to surgical adhesions. Transition point seen\non series 2, image 50 in the left lower quadrant is noted adjacent with\npossible second transition point seen on series 2, image 49. The pattern of\nsmall bowel obstruction favors internal hernia though bowel is difficult to\nthe traced reliably. In addition to mesenteric edema, there is small volume\nof free fluid.\n\nSmall bowel containing Spigelian hernia noted in the right lower quadrant\nabdominal wall without evidence of complication. Diverticulosis of the\nsigmoid colon is noted, without diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. A pessary is noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A Spigelian hernia is noted in the right lower quadrant\ncontaining decompressed small bowel loops. The abdominal and pelvic wall is\notherwise within normal limits.", "output": "Small bowel obstruction with associated mesenteric edema with a pattern\nconcerning for internal hernia. Close observation and followup advised." }, { "input": "The heart is moderately enlarged, particularly each atrium as well as the\nright ventricle. The left ventricle does not appear particularly enlarged,\nhowever. The calcifications are noted along the annulus of the aortic valve,\nperhaps also along one of the leaflets and are moderately extensive among\ncoronary arteries. There is no pericardial effusion. Small bilateral pleural\neffusions are present. Opacities at the lung bases are most consistent with\nminor atelectasis.\n\nA number of small rim-calcified stones are present within the gallbladder. \nThe liver, pancreas, spleen, and adrenal glands appear within normal limits. \nSubcentimeter hypodense foci in each kidney too small to characterize but\ndoubtful in clinical significance.\n\nMid sigmoid colon shows wall thickening over a long segment, including a\ntargetoid appearance suggesting intramural edema or inflammation. Stomach and\nsmall bowel are unremarkable.\n\nProstate is mildly enlarged. Bladder is only partly full. Seminal vesicles\nappear attenuated. There is slight ectasia of the upper abdominal aorta up to\n24 mm. Iliac arteries are tortuous. Major mesenteric arteries and veins are\npatent although a calcified plaque very mildly narrows the origin of the\nsuperior mesenteric artery.\n\nAnterior bridging osteophytes are noted along sacroiliac joints, which are\nalso largely fused. Anterior flowing osteophyte is noted along visualized\nlower thoracic and upper lumbar level and these are also noted along the\nlateral sides of the vertebral bodies. Findings suggest ankylosing\nspondylitis. Bones appear demineralized.", "output": "1. Findings consistent with colitis involving the sigmoid colon including\nwall thickening with intramural edema or inflammation.\n\n2. Cholelihiasis.\n\n3. Findings suggest history of ankylosing spondylitis." }, { "input": "LOWER CHEST: There is a small left pleural effusion with associated left\nbasilar atelectasis. There is also adjacent bronchial wall thickening in the\nleft lower lobe. There is minimal right basilar atelectasis. The heart is\nmildly enlarged. Aortic valve and coronary artery calcifications are noted. \nThere is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains several\ngallstones without gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Subcentimeter hypodensities in the lower pole and\ninterpolar region of the left kidney are too small to characterize but likely\nrepresent simple cysts.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Bladder wall appears thickened more than expected for the level\nunderdistention. There is no significant associated stranding. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged. The seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is fusiform ectasia of the infrarenal abdominal aorta\nmeasuring up to 2.6 cm. Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSpinal fusion hardware traversing the lower thoracic and upper lumbar spines\nis noted, transfixing an L1 fracture. Compression deformities of the L5\nvertebral body is stable from exam in ___.\n\nSOFT TISSUES: Soft tissue thickening is noted along the former G-tube tract\nand a T-tube fastener is noted posterior to the rectus muscle at this level. \nNo fluid collection. The abdominal and pelvic walls are otherwise\nunremarkable.", "output": "1. Induration and soft tissue thickening along the former G-tube tract within\nthe left ventral abdominal wall with residual T-tube fastener in the abdominal\nwall, posterior to the rectus muscle. No evidence of fluid collection.\n2. Small left pleural effusion and left lower lobe bronchial wall thickening.\nAspiration cannot be excluded.\n3. Bladder wall thickening for which correlation with urinalysis is\nrecommended to exclude urinary tract infection.\n4. Ectasia of the infrarenal abdominal aorta measuring up to 2.6 cm.\n5. Cholelithiasis." }, { "input": "LOWER CHEST:\nVisualized lungs are within normal limits. Please refer to dedicated chest CT\nfor full evaluation of intrathoracic contents.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas appears atrophic. There is no evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland has a 1.7 x 1.2 cm focus of hypodensity\nmeasuring 24 ___ on non-contrast images. While washout on the 3-minute delayed\nimaging does not strictly qualify for classification, this is likely an\nadrenal adenoma. An adrenal protocol CT could be combined with an oncology\nformat on follow up scans. The left adrenal gland is normal in size and\nshape.\n\nURINARY: Redemonstrated small subcentimeter hypodensity in the interpolar\nregion of the left kidney, likely a cyst. The kidneys are of normal and\nsymmetric size with normal nephrogram. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost total abdominal colectomy with J-pouch-rectal anastomosis. The appendix\nis surgically absent. The rectal J-pouch anastomosis site appears thickened\nwith apparent tumor in the rectum at and below the anastomosis and possibly\nabove the anastomosis. There is mild surrounding fat stranding and perirectal\nlymph nodes (series 3, image 117-123). Surgical clips from prior procedures\nare noted at the site. Soft tissue invasion and local lymphadenopathy is\ndifficult to fully appreciate on CT and better evaluated on same day MR study.\n\nAdditionally, several enlarged mesenteric lymph nodes are visualized, the\nlargest lymph node measures 1.4 cm (series 3, image 81) and is seen just\nanterior to the IVC, just below the third portion of the duodenum.\n\nIf the rectal carcinoma extends above the anastomosis and involves the pouch\nmucosa, there may be extension of the tumor into the portal circulation and\nthus visualized lymphadenopathy does raise the concern for mesenteric\nmetastasis. A PET-CT may be warranted for further evaluation of potential\nmetastatic spread.\n\nPELVIS: The urinary bladder is moderately distended. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate appears normal with calcifications in the\ngland, likely sequela of prior infection.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. There is no\ninguinal lymphadenopathy. There is local rectal lymphadenopathy (series 3,\nimage 118.)\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small ventral hernias are seen above and below the umbilicus,\ncontaining fat and non-occlusive small bowel. Patient is status post left\ninguinal hernia repair as denoted by surgical clips.", "output": "Post total abdominal colectomy with J-pouch-rectall reanastomosis. The\nanastomosis site appears thickened with apparent tumor in the rectum at and\nbelow the anastomosis and possibly above the anastomosis. Mild surrounding\nfat stranding and perirectal lymph nodes with the largest lymph node measuring\n1.4 cm. Please refer to same day MRI for full evaluation of soft tissue\ninvasion and local lymphadenopathy.\n\nNo definite metastatic disease within the abdomen or pelvis. Probable right\nadrenal adenoma, 1.7 cm, not definitive by strict criteria on non-contrast or\npost-contrast images.\n\nSmall ventral hernias containing fat and non-occlusive small bowel.\n\nPlease refer to same day dedicated Chest CT for evaluation of intrathoracic\ncontents.\n\nRECOMMENDATION(S): If stability of the right adrenal lesion cannot be\ndetermined from prior imaging, then adrenal protocol CT is recommended or,if\nthe patient is to have a PET-CT, then it could be assessed at that time." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is normal in attenuation, without evidence of focal\nlesions. There is no intra or extrahepatic biliary ductal dilatation. \nUncomplicated cholelithiasis again noted.\n\nPANCREAS: The pancreas is diffusely atrophic. The pancreatic duct is within\nlimits. No focal lesions identified.\n\nSPLEEN: The spleen is unremarkable in size and shape, no evidence of focal\nlesions.\n\nADRENALS: A 2.0 cm right adrenal nodule is stable since at least ___. The\nleft adrenal gland is unremarkable.\n\nURINARY: The patient is status post cystoprostatectomy after a pelvic\nexenteration, with an ileal conduit in the midline entering into a left lower\nquadrant stoma. There is moderate to severe right hydroureteronephrosis\nwithout evidence for an obstructing calculus, mildly improved from prior. \nThere is mild hydroureteronephrosis on the left, unchanged from prior. No\nevidence for perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post total colectomy. There is a\nright lower quadrant diverting ileostomy. No evidence for bowel obstruction. \nOtherwise the bowel is normal appearing in wall thickness and caliber.\n\nPELVIS: Pre-sacral soft tissue attenuation is unchanged in appearance or size\nfrom prior imaging, likely represents postsurgical change. No evidence for\ndisease recurrence.\n\nLYMPH NODES: No abdominal or pelvic lymphadenopathy.\n\nVASCULATURE: No evidence for aortic aneurysm. Mild atherosclerotic\ncalcification is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple surgical clips are noted along the anterior abdominal\nwall, unchanged in appearance from prior. Right lower quadrant ileostomy and\nleft lower quadrant ileal conduit are intact.", "output": "1. Improved moderate to severe hydroureteronephrosis the right, stable mild\nhydroureteronephrosis on the left.\n2. No new metastases or disease recurrence within the abdomen or pelvis.\n3. Stable 2 cm right adrenal nodule.\n4. Uncomplicated cholelithiasis.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings" }, { "input": "LOWER CHEST: Bibasilar atelectasis.\n\nABDOMEN: No free fluid or intra-abdominal collection is identified.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Uncomplicated cholelithiasis.\n\nPANCREAS: Pancreas appears diffusely atrophic without focal mass. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 20 mm nodule within the right adrenal gland does not meet strict\ndensity criteria for an adrenal adenoma, however is stable dating back to ___\nand statistically likely still represents a benign adenoma. The left adrenal\ngland is unremarkable.\n\nURINARY: Status post pelvic exenteration with left lower quadrant ileal\nconduit. There has been interval development of mild right-sided\nhydronephrosis and hydroureter extending to the level of the junction of the\nright ureter and the ileal conduit (coronal series 5, image 28) without\nradiopaque calculus. The right kidney appears mildly enlarged with mild\nperinephric fat stranding. There is also mild left-sided perinephric fat\nstranding without hydroureteronephrosis. No focal renal mass is identified.\n\nGASTROINTESTINAL: Patient is status post total colectomy and pelvic\nexenteration, with right lower quadrant diverting ileostomy. There has been\nadministration of oral contrast as well as contrast via the patient's\nileostomy. Oral contrast opacifies the stomach and the duodenum. Contrast\nvia stoma opacifies multiple loops of small bowel. There is no small bowel\ndistention to suggest mechanical obstruction. No definite wall thickening is\nidentified, within the limitations of an unenhanced study. There are several\nloops of bowel which demonstrate angular margins likely related to adhesions.\n\nPELVIS: Status post pelvic exenteration. There is confluent soft tissue\nwithin the presacral space which appears unchanged in comparison to the prior\nstudy and is likely postoperative. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post cystoprostatectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple surgical clips are noted along the anterior abdominal\nwall as well as within the pelvis. Right lower quadrant ileostomy and left\nlower quadrant ileal conduit as described above.", "output": "1. Interval development of mild right-sided hydroureteronephrosis without\ndefinite obstructing calculus. Mild bilateral perinephric fat stranding. \nThese findings are nonspecific and could be seen in the context of a recently\npassed calculus, urinary tract infection, or non radiopaque source of\nobstruction. Correlation with patient's clinical symptoms and urinalysis is\nrecommended.\n2. No evidence of fluid collection or abscess within the abdomen or pelvis.\n3. Confluent soft tissue within the presacral space is unchanged from previous\nand likely postsurgical." }, { "input": "CT OF THE ABDOMEN: LUNG BASES DEMONSTRATE NO ABNORMALITIES. WITHIN THE\nLIMITATIONS OF A NONCONTRAST STUDY, THE LIVER, GALLBLADDER, KIDNEYS, ADRENAL\nGLANDS, PANCREAS, VISUALIZED LOOPS OF LARGE SMALL BOWEL AND SPLEEN ALL APPEAR\nNORMAL. NO FREE FLUID IS IDENTIFIED.\n\nCT OF THE PELVIS: MINIMAL AMOUNT OF DENSE FLUID WITHIN THE PELVIS (SERIES 2,\nIMAGE 66) .\nVISUALIZED LOOPS OF LARGE SMALL BOWEL APPEAR NORMAL, BLADDER APPEARS NORMAL,\nUTERUS AND ADNEXAL STRUCTURES ALSO APPEAR NORMAL.\n\nBONE WINDOWS DEMONSTRATE NO ABNORMALITIES.", "output": "1. SMALL AMOUNT OF DENSE FLUID WITHIN THE PELVIS. NONCONTRAST CT SCAN OF THE\nABDOMEN AND PELVIS IS OTHERWISE UNREMARKABLE ." }, { "input": "LOWER CHEST: Mild atelectasis with bilateral pleural effusions, left greater\nthan right.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis or ureterolithiasis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and extends up toward the\numbilicus. A 3.9 x 3.7 cm left ovarian cyst is visualized (series 3, image\n61), and is likely physiologic.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of nephrolithiasis or ureterolithiasis.\n2. Small bilateral pleural effusions" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates a slightly nodular contour and\nheterogeneous appearance consistent with history of cirrhosis. There is no\nevidence of focal lesions. Dilated common bile duct measuring up to 1.6 cm\nwithout evidence of intrahepatic biliary ductal dilatation The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas is atrophic. There is no pancreatic ductal dilatation\nor peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Tiny renal hypodensities are seen on the left, seen as cysts on MRI. \nThe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Multifocal up clips are identified at the gastroesophageal\njunction. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. There is diffuse wall thickening and pericolonic fat\nstranding of the cecum and ascending colon, and also some wall thickening of\nthe transverse colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Changes from prior prostatectomy and bilateral iliac\nlymph node dissection.\n\nThere is small to moderate volume abdominal and pelvic ascites, increased\ncompared to prior ultrasound and MRI.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Prior anterior midline and right anterior abdominal wall\nsurgical scars.", "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. Mildly heterogeneous and nodular liver consistent with history of\ncirrhosis. No focal liver lesions identified, although this study is not\ntailored for the identification of hepatic lesions.\n3. Wall thickening and pericolonic stranding of the cecum and ascending colon,\nas well as some thickening of the transverse colon. This may be secondary to\noverall elevated fluid status, although colitis would also be in the\ndifferential.\n4. Small to moderate volume abdominal and pelvic ascites although increasing\ncompared to priors.\n5. No significant change in dilated common bile duct. No significant\nintrahepatic biliary ductal dilatation." }, { "input": "LOWER CHEST: There is mild bibasilar atelectatic change, otherwise the lung\nbases are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular hepatic contour compatible with the known underlying\ncirrhosis. No concerning hepatic lesion is seen on this nondedicated study. \nPersistent intra and extrahepatic biliary ductal dilation as seen on prior\nstudies. The patient is status postcholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The knees of jejunal feeding tube is seen with tip in the\nproximal jejunum. There is diffuse wall thickening seen within the small and\nlarge bowel loops, not significantly changed from the prior examinations and\nlikely related to portal call off of the/ enteropathy. There is a large\namount of intra-abdominal ascites.\n\nNo drainable intra-abdominal abscesses or collections are identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Large volume ascites, with no defined intra-abdominal collection.\n2. Colonic and small bowel wall thickening, not significantly changed from\nprior and likely secondary to underlying portal colopathy/enteropathy.\n3. Nodular, cirrhotic appearing liver with no definite hepatic masses seen on\nthis non dedicated study." }, { "input": "LOWER CHEST: There is a lobulated mass at the left lower lobe measuring 3.0 x\n3.1 cm with surrounding ground-glass opacity (series 2, image 5), new from the\nprevious exam and is highly concerning for malignancy. Mild atelectasis\nwithin the lower lobes bilaterally. No pleural or pericardial effusion.\n\nABDOMEN:\nThere is a small amount nonhemorrhagic ascites throughout the abdomen and\npelvis.\n\nHEPATOBILIARY: There is moderate intrahepatic biliary dilatation, progressed\ncompared to prior. The common bile duct is also dilated to the level of the\npancreatic head where there is abnormal soft tissue density noted with\nadjacent stranding (302:26). A subcentimeter hypodensity within the right\nlobe of the liver is too small to characterize (series 2, image 19), but\nunchanged compared to prior, likely a cyst or biliary hamartoma. Otherwise,\nthe liver demonstrates homogenous attenuation throughout. There is no\nevidence of new focal lesions. The gallbladder is distended with fluid,\nhowever there is no gallbladder wall thickening.\n\nPANCREAS: The lobulated hypodense pancreatic tail mass is unchanged in size,\nmeasuring approximately 1.8 x 0.9 cm on today's examination (series 2, image\n19). There is ill-defined soft tissue within the region of the pancreatic\nhead with adjacent stranding, which is concerning for an underlying pancreatic\nhead mass. The extent of upstream pancreatic ductal dilatation is unchanged\ncompared to prior, measuring up to 5 mm.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: This patient is status post right nephrectomy. Subcentimeter\nhypodensities within the left kidney are too small to characterize, but likely\nrepresent simple cysts. Otherwise, the left kidney is unremarkable in\nappearance within normal nephrogram. There is no evidence of hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There are multiple non dilated loops of small bowel\nthroughout the abdomen and pelvis, upstream of a small bowel anastomosis in\nthe right lower quadrant, which demonstrate marked circumferential wall\nthickening and edema, compatible with enteritis. Bowel wall enhancement is\npreserved. A normal appearing small bowel anastomosis is seen within the\nright hemipelvis. There is no evidence of obstruction. Patient is status\npost left hemicolectomy with a normal appearing colonic anastomosis in the\nleft hemipelvis.\n\nPELVIS: Patient is status post cystectomy. Right lower quadrant ileal conduit\nappears decompressed and unremarkable. Small amount of free fluid is noted.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. No adnexal masses\nare visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. An infrarenal IVC filter is unremarkable in appearance.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A right lower quadrant ileal conduit is unremarkable in\nappearance.", "output": "1. Extensive small bowel wall thickening and edema involving small bowel loops\nupstream to a small bowel anastomosis in the right lower quadrant compatible\nwith an enteritis, which is nonspecific, but possibly infectious or\ninflammatory in nature. No bowel obstruction.\n2. New lobulated mass at the left lower lobe measuring up to 3.1 cm highly\nsuspicious for malignancy.\n3. Moderate intra and extrahepatic biliary dilatation, which has progressed\ncompared to prior, with ill-defined soft tissue density and stranding in the\nregion of the pancreatic head, concerning for an underlying pancreatic head\nmass. Pancreatic ductal dilatation is unchanged compared to prior. Unchanged\nlobulated pancreatic tail lesion measuring up to 1.8 cm.\n4. Small volume ascites throughout the abdomen and pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hepatic hypodensity within the right lobe is too small to\ncharacterize, however likely represents a hepatic cyst or biliary hamartoma. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is\nslight thickening of the medial limb of the left adrenal gland, without focal\nnodule.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter cortical hypodensity in the left kidney is too small to\ncharacterize, however likely represents a cyst. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Oral contrast has reached the\nrectum. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix, while it does not fill with oral contrast, otherwise appears normal\n(5:61).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits, better evaluated on pelvic ultrasound performed earlier on same day. \nDominant 2.1 cm right ovarian cyst is noted (5:67).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Nonaggressive appearing sclerotic lesion in the left iliac bone likely\nrepresents a bone island. There is no evidence of worrisome osseous lesions\nor acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or pelvic process. Appendix does not fill with\noral contrast, but otherwise appears normal.\n2. Dominant 2.1 cm right ovarian cyst, likely physiologic." }, { "input": "LOWER CHEST: There are bilateral small pleural effusions. There is also a\ntrace pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder distended containing high-density material\ncompatible with sludge as noted on ultrasound.\n\nPANCREAS: There is a focus of calcification in pancreatic body (series 3,\nimage 20) likely due to prior injury. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 14.4 cm, previously measures 16 cm\nultrasound dated ___.. There is a 0.8 cm low-density lesion in\nthe spleen (series 3, image 24) too small to adequately characterize.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is mild perinephric\nstranding, nonspecific.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits.\n\nPELVIS: The urinary bladder is partially distended and appears unremarkable. \nThere is no free fluid in the pelvis. Moderate-sized bilateral fat containing\ninguinal hernias are noted.\n\nREPRODUCTIVE ORGANS: The prostate is moderately enlarged measuring 5.8 cm. \nThe seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMarked degenerative changes are seen in the included thoracic and lumbar spine\ncharacterized by anterior osteophytic lipping and loss of intervertebral disc\nheights.\n\nSOFT TISSUES: There is a small fat containing right inguinal hernia.", "output": "1. No evidence of intra-abdominal and pelvic bleeding.\n2. Bilateral small pleural effusions.\n3. Distended gall bladder containing sludge.\n4. Splenomegaly slightly improved from prior ultrasound on ___." }, { "input": "LOWER CHEST: There is a 5 mm subpleural nodule in the right lower lobe,\npreviously not imaged (02:12). Dense coronary calcifications in the RCA\ndistribution is again seen. There is no pleural effusion or pericardial\neffusion. Hypodense appearance of the blood pool relative to the\nintraventricular septum is likely due to patient is anemic state.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post double-J ureteral stent placement with the\nproximal pigtail catheter portion in the left renal pelvis and the distal\npigtail portion the bladder, appropriate positioning. The kidneys are\nsymmetric in size. Again seen are vague hyperdensity in the lower pole of\nleft kidney, measuring 8 mm, likely representing renal stone. In addition,\nthere are punctate, millimetric stones in the upper pole and interpolar of\nregion of the left kidney. Punctate hyperdensities in the right kidney and\nalso likely represent nonobstructing renal stones, unchanged from prior exam. \nThere is no hydronephrosis on either side. Compared to ___,\nthere is mildly increased fat stranding around the left kidney and further\nthickening of the anterior and posterior Gerota's fascia on the left. There\nis no fluid collection. Hypodensity in the lower pole of the right kidney was\npreviously characterized as a simple cyst.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. \nPatient is status post partial colectomy with unchanged postoperative changes.\nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Linear sclerosis in the superior aspect of the right femoral head is\nunchanged since ___ in suggest avascular necrosis.\n\nSOFT TISSUES: A supraumbilical hernia containing fat is noted.", "output": "1. Mild increase in perinephric stranding and thickening of the Gerota's\nfascia, despite interval placement of a double-J stent and decompression of\nthe hydronephrosis, now resolved. Possibility of pyelonephritis should be\nconsidered; please correlate with urinalysis or culture. Appropriate stent\nplacement.\n2. Minimally decreased stone burden on the left.\n3. Colonic diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: There is subsegmental atelectasis in both lower lobes. There is\ntrace bilateral pleural effusions cardiac enlargement, coronary artery\ncalcifications weird\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\naside from adenomyosis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.3 cm nonenhancing hypodense lesion in the interpolar region of\nthe right kidney suggestive of a cyst. There are additional subcentimeter\nhypodense lesions in the left kidney that are too small to characterize. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is small esophageal\nhiatal hernia. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is mild wall thickening of the lower\nrectum, nonspecific, consider inflammatory infectious process, neoplasm cannot\nbe excluded. Sigmoid colon is thickened, likely from diverticulosis, without\nevidence of diverticulitis, there is no adjacent hyperemia. Appendix is\nnormal.\n\nPELVIS: Note is made of gas within the urinary bladder. Please correlate with\nhistory of prior instrumentation. There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. There is a filling defect in the right common femoral vein\n(2:69) suggestive of a DVT.\n\nBONES: The patient is status post fixation of a comminuted right femoral\nfracture with postsurgical changes noted about the right hip joint. Severe\ndegenerative arthritis of the right hip with flattening of the femoral head. \nModerate to severe degenerative changes are noted in the lower lumbar spine,\nnotably in L4-L5 and L5-S1. There is mild loss of L1, L5 vertebral body\nheight, of indeterminate age, there is no paravertebral edema.\n\nSOFT TISSUES: There is small fat only containing left inguinal hernia.", "output": "1. Filling defect in the right common femoral vein, vein expansion, consistent\nwith deep vein thrombosis.\n2. Gas within the bladder is likely related to prior instrumentation. Please\ncorrelate with clinical history.\n3. Status post fixation of a comminuted right femoral fracture with\npostsurgical changes about the right hip.\n4. Wall thickening of the lower rectum, mild adjacent stranding, consider\ninflammatory or infectious process, less likely neoplasm.\n5. Mild L1, L5 compression fractures, of indeterminate age, likely chronic.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:27 pm, 5\nminutes after discovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild intra and extrahepatic biliary\ndilatation is unchanged, with CBD diameter of 1.1 cm. The gallbladder is\nwithin normal limits.\n\nPANCREAS: A cystic lesion in the pancreatic tail measuring 1 cm is minimally\nincreased in size from prior study. There is stable pancreatic ductal\ndilatation measuring 4 mm. No obstructing mass or stone is identified. There\nis no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 3.6 cm simple cyst in the upper pole of the right kidney remains unchanged\nfrom prior. Multiple hypodensities in both kidneys which are too small to\ncharacterize remain unchanged from prior, likely representing cysts. There is\nno evidence of nephrolithiasis, focal renal lesions, or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple calcified and noncalcified fibroids are noted\nwithin the uterus. There is no concerning adnexal lesion.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Moderate degenerative changes of the thoracolumbar spine. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. 1 cm cystic lesion within the tail of pancreas is minimally increased in\nsize from prior study, likely a side branch IPMN. This can followed on\nsubsequent surveillance studies.\n3. Unchanged mild intra and extrahepatic biliary ductal and pancreatic ductal\ndilatation, without obstructing stone or mass.\n4. For details regarding thoracic findings, please see dedicated report of CT\nchest performed on the same day." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted. An intrauterine device is\noriented obliquely in the endometrial canal (2:76). The bilateral ovaries\ndemonstrate normal follicular activity.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No etiology identified for the patient's symptoms.\n2. An intrauterine device is oriented obliquely in the endometrial canal. \nCannot definitively exclude penetration into the myometrium on CT. Findings\ncan be further assessed on 3D ultrasound, if indicated.\n\nNOTIFICATION: Intrauterine device findings were emailed to ED QA nurses on\n___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains\ngallstones/sludge without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSub cm hypodensity in the mid polar region of the right kidney likely a cyst. \nThere is no evidence of suspicious focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a large duodenal\ndiverticula measuring up to 2.5 x3.1 x 4.5 cm. There is circumferential wall\nthickening of the first/ second portion of the duodenum. Diverticulosis of\nthe sigmoid/descending colon is noted, without evidence of wall thickening and\nfat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nBone island noted in the right iliac bone. There are multilevel degenerative\nchanges of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Duodenal diverticulum measuring up to 4.5 cm. There is circumferential\nwall thickening of the first/ second portion of the duodenum which may be\nrelated to ulcer history. No definite mass extrinsic to the duodenum is\nappreciated, although correlation with endoscopy is recommended for exclusion\nof mucosal masses.\n2. Cholelithiasis.\n3. Diverticulosis." }, { "input": "LOWER CHEST: Bibasilar atelectasis is noted. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral renal cysts are noted, the largest in the right lower pole\nmeasuring 4.0 cm. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\nThe appendix is dilated up to 1.7 cm in diameter and contain low-density\nfluid, without evidence of stranding or other signs of inflammation (601:33).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and demonstrates calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes most notably in the lumbar spine are\nnoted. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is no containing the abdominal and pelvic wall is within\nnormal limits.", "output": "1. No acute findings in the abdomen or pelvis.\n2. Dilated fluid-filled appendix without signs of inflammation suggestive of\nappendiceal mucocele.\nSurgical consultation is recommended.\n\nNOTIFICATION: Updated findings were submitted to the EDQA nurse group." }, { "input": "LOWER CHEST: Small left pleural effusion with subsegmental atelectatic changes\nat both lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: Cirrhotic appearance of the liver with stable hypodense lesions\nin segment 8 and ___, shown to be hemangiomas on MRI. Stable 2 mm cyst in\nsegment 2. Uncomplicated gall bladder stones. Recanalized umbilical vein\nwith caput medusae, and large portosystemic shunt which connects to the right\nexternal iliac vein. There is mesenteric congestion with prominent\nhemorrhoids. Moderate to large volume of ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Globular appearance of the bilateral kidneys with hypoenhancement of\nthe medullary pyramids. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminating at the DJ junction. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cirrhotic liver with sequelae of portal hypertension and large\nportosystemic shunt. No intra-abdominal source of infection is identified.\n2. Stable liver hypodensities corresponding to cysts and hemangiomas as on\nprevious MR. ___ lesion posterior to the left hepatic vein is not clearly seen\non CT.\n3. Globular appearance of the bilateral kidneys with hypoenhancement of the\nmedullary pyramids. An underlying infiltrative process such as amyloidosis\nshould be excluded.\n4. Moderate to large volume of ascites, without evidence of organized fluid\ncollection.\n5. Other findings as above." }, { "input": "LOWER CHEST: Please refer to chest same date dictated separately.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates cirrhotic morphology. The exophytic\nnodule seen on the comparison ultrasound is not apparent or characterized on\nthis noncontrast study. Cholelithiasis is again noted. No biliary ductal\ndilatation.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The unenhanced kidneys are unremarkable. No hydronephrosis.\n\nGASTROINTESTINAL: There is no intestinal obstruction. A large amount of\nlow-density ascites is seen. There is layering debris or possible a small\nhematocrit level due to trace hemorrhage in the pelvis on series 2, image 105.\n\nPELVIS: The uterus and adnexa are unremarkable for age except for stable\nbilateral ovarian calcifications.\n\nPERITONEUM/RETROPERITONEUM: Moderate volume ascites. No pneumoperitoneum.\n\nLYMPH NODES: A few prominent periportal and peripancreatic lymph nodes\nmeasuring up to 1.2 cm are likely reactive. No additional enlarged abdominal\nor pelvic lymph nodes demonstrated.\n\nVASCULAR: Numerous portosystemic shunts and a large recanalized umbilical vein\nare again noted.\n\nBONES: No suspicious osseous lesion.\n\nSOFT TISSUES: Few foci of subcutaneous emphysema in the lower back likely\nrelated to recent lumbar puncture. There is diffuse anasarca.", "output": "1. Cirrhotic liver with sequela of portal hypertension including large amount\nof ascites and portosystemic shunts, as on prior. Minimal layering debris or\ntrace hemorrhage in the dependent pelvis.\n2. No retroperitoneal hemorrhage demonstrated." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate bibasilar atelectases. There\nis no evidence of pleural or pericardial effusion. The heart appears\ntop-normal in size. Partially visualized lower median sternotomy wires are\naligned and intact.\n\nABDOMEN:\n\nHEPATOBILIARY: The unenhanced appearance of the liver appears normal. The\ngallbladder contains hyperdense material likely sludge or stones. No CT\nevidence of acute cholecystitis.\n\nPANCREAS: The pancreas is grossly unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: No kidney stone or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal and fills with\ncontrast.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a right inguinal hernia containing fat and a small\namount of fluid.", "output": "1. Normal appendix.\n2. Top-normal heart size.\n3. Bibasilar atelectasis\n4. Small fat and fluid containing right inguinal hernia." }, { "input": "LOWER CHEST: The imaged lung bases are clear. There is a tiny hiatal hernia. \nThe imaged portion of the heart is unremarkable. No pleural or pericardial\neffusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally without focal concerning lesion. \nThere is no intrahepatic biliary ductal dilation. The main portal vein is\npatent. The gallbladder surgically absent. Mild prominence of the common\nbowel duct likely reflect prior cholecystectomy.\n\nPANCREAS: Pancreas appears normal.\n\nSPLEEN: The spleen is normal in size without focal abnormality.\n\nADRENALS: Adrenal glands appear normal bilaterally.\n\nURINARY: The kidneys enhance symmetrically with prompt excretion of contrast\nnoted. No hydronephrosis, signs of pyelonephritis or worrisome renal lesion.\n\nGASTROINTESTINAL: Patient is undergone prior Roux-en-Y gastric bypass surgery.\nThe excluded stomach contains enteric contrast suggesting a gastro gastric\nfistula. The gastrojejunal anastomosis appears patent and there is no\nadjacent fat stranding to suggest the presence of a perianastomotic ulcer. \nThe small bowel is decompressed throughout. The jejuno jejunostomy site\nappears unremarkable. The appendix is normal, seen on series 2, image 53. \nThe colon contains a mild fecal load and is thin walled without signs of\ninflammation or obstruction. Diverticulosis is present without signs of\ndiverticulitis.\n\nPELVIS: Urinary bladder is only partially distended though appears normal. \nThe distal ureters opacify normally. The uterus is surgically absent. There\nis no adnexal mass. No pelvic free fluid. No pelvic sidewall adenopathy. No\ninguinal adenopathy.\n\nLYMPH NODES: There is no adenopathy along the retroperitoneal, mesenteric,\npelvic sidewall or inguinal station.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: No worrisome osseous lesion. Transitional anatomy at the lumbosacral\njunction with partial lumbarization of S1 noted. Facet arthropathy in the\nlower lumbar spine is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Normal appendix. No findings in the right lower quadrant to account for\nreported pain at this site.\n2. Status post Roux-en-Y gastric bypass, with enteric contrast in the excluded\nstomach, suggesting gastrogastric fistula.\n3. Tiny hiatal hernia.\n4. Colonic diverticulosis without diverticulitis.\n5. Status post cholecystectomy and hysterectomy." }, { "input": "THORAX: There is minimal round atelectasis at the base of the left lung as\nwell as a trace left pleural effusion. The heart and pericardium are\nunremarkable.\n\nLIVER: The liver is normal in size and attenuation. No focal hepatic lesions\nare identified. The portal vein is patent. There is no intra or extrahepatic\nbiliary duct dilatation.\n\nGALLBLADDER: The gallbladder is normal-appearing.\n\nSPLEEN: The spleen is normal in size and enhancement.\n\nPANCREAS: The pancreas shows normal enhancement. There is no pancreatic duct\ndilatation or peripancreatic fat stranding.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys display symmetric nephrograms with no evidence of\nhydronephrosis or mass lesion in either kidney. The ureters are symmetrical\nin their course to the bladder.\n\nBOWEL: The small bowel is normal appearing with no evidence of obstruction.\nThe large bowel is filled with stool and is normal.\n\nVESSELS: The abdominal aorta is not aneurysmal. On series 5, image 72 there is\na pseudoaneurysm of the left common femoral artery measuring 12 x 9 mm. There\nis ill-defined fluid surrounding the pseudoaneurysm which most likely\nrepresents a small amount of reactive edema and hemorrhage however there is no\nsizeable hematoma identified.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria. Note is made of a few prominent\nlymph nodes in the bilateral inguinal regions.\n\nPELVIS: There is moderate scrotal edema as well as small bilateral hydroceles,\nleft greater than right, including nearly confluent ill-defined fluid along\nthe anterior part of the superficial scrotal tissues. Note is made of a 4 mm\nleft calcified scrotal pearl. The bladder is unremarkable.\n\nThere is diverticulosis of the sigmoid colon with no evidence of\ndiverticulitis. There is no evidence of pelvic sidewall lymphadenopathy.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures. Multiple small densities\nwithin the subcutaneous soft tissues of the anterior abdominal wall are most\nlikely related to injections. There is minimal soft tissue stranding in the\nbilateral anteromedial thighs with no evidence of subcutaneous gas identified.", "output": "1. 12 x 9 mm pseudoaneurysm involving the left common femoral artery (series\n5, image 72) with small surrounding hematoma.\n2. There is moderate scrotal edema, including confluent ill-defined fluid\ninferiorly, as well as small bilateral hydroceles, left greater than right.\n3. No evidence of subcutaneous gas in the subcutaneous tissues of the upper\nlegs or scrotum.\n4. Soft tissue stranding involving the bilateral antral medial thighs with no\nfocal fluid collections identified.\n\nNOTIFICATION: These findings were communicated to Dr. ___ telephone at\n15:45 on ___ by Dr. ___ 15 min after discovery." }, { "input": "LOWER CHEST: Mild dependent basilar atelectasis is noted. Visualized lung\nfields are otherwise within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is moderately enlarged measuring up to 13.9 cm (601:41). \nThe spleen shows normal attenuation throughout, without evidence of focal\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe colon is noted. There is a segment of sigmoid colon in the mid pelvis\nwhich demonstrates significant bowel wall thickening and inflammatory fat\nstranding, compatible with acute diverticulitis (2:68). No evidence of focal\ndrainable fluid collection. A locule of air adjacent to the bowel wall could\npossibly represent microperforation (2:67). The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no mesenteric lymphadenopathy. Multiple prominent\nretroperitoneal lymph nodes are not pathologically enlarged by CT size\ncriteria, likely reactive. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. Acute diverticulitis involving a segment of sigmoid colon in the mid\npelvis, which demonstrates significant bowel wall thickening and inflammatory\nfat stranding. No evidence of drainable fluid collection. A locule of air\nadjacent to the bowel wall likely represents microperforation.\n2. Moderate splenomegaly, measuring up to 13.9 cm." }, { "input": "LOWER CHEST: The imaged lung bases are notable for mild dependent atelectasis.\nThe heart is within normal limits of size though there is Coronary artery\ncalcification as well as mitral annular calcification. No pleural or\npericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a hyperenhancing lesion within segment 7 of the liver,\nmeasuring 2.0 x 2.6, increased in size from prior exam. A calcification is\nalso noted within the liver along the posterior margin. A tiny hypodensity at\nthe dome is too small to characterize best seen on series 2, image 14. No\nbiliary ductal dilation is seen. The gallbladder is mildly is ascended\nappears otherwise normal. The common bile duct is nondilated.\n\nPANCREAS: Pancreas enhances normally. No focal abnormality or signs of\ninflammation.\n\nSPLEEN: The spleen appears normal. Significant calcification of the splenic\nartery noted.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Kidneys enhance symmetrically. Numerous cortical hypodensities are\nnoted the largest arising from the interpolar right kidney measuring 5.1 x 6.2\ncm likely a simple cyst. No definite worrisome renal lesion is identified. \nNo signs of pyelonephritis or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is decompressed. The duodenum appears normal. \nLoops of small bowel demonstrate no signs of ileus or obstruction. The colon\nis thin walled containing a moderate fecal load without wall thickening or\nsigns of acute inflammation. There is diverticulosis without diverticulitis. \nSmall and large bowel loops partially enter bilateral predominately fat\ncontaining inguinal hernias without associated complication. No abdominal\nascites or free air.\n\nPELVIS: Urinary bladder is mostly decompressed though appears thickened and\nhyperemic concerning for infection. A small amount of gas within the urinary\nbladder likely reflects recent trip mentioned attempt. A malpositioned Foley\ncatheter is in place with balloon located within the posterior urethra.\n\nREPRODUCTIVE ORGANS: The prostate gland appears normal in size.\n\nLYMPH NODES: No inguinal, pelvic sidewall, retroperitoneal or intra-abdominal\nadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes within the imaged portion of the spine noted\nwith significant posterior facet arthropathy.", "output": "1. Malpositioned Foley catheter with balloon inflated within the posterior\nurethra. Repositioning is urgently advised.\n2. Mild urinary bladder wall thickening with hyperemia concerning for\ninfection. No signs of pyelonephritis.\n3. Increased size of a hyperenhancing lesion within hepatic segment 7. \nConsider MRI to further assess.\n4. Additional nonemergent findings as described above.\n\nNOTIFICATION: Malpositioned Foley catheter with balloon in urethra, discussed\nwith Dr. ___ at 9:35pm on ___" }, { "input": "LOWER CHEST: There is mild atherosclerotic disease in the coronary arteries,\nwith the heart appearing minimally enlarged (series 2 image 7). Mild mitral\nannular calcification (series 2, image 4). Small right pleural effusion with\nsmooth septal thickening at the lung bases suggestive of mild fluid overload\nstatus (series 2, image 1). There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. In\nsegment 2 of the liver there millimetric hypodensities too small to\ncharacterize on CT, (series 2, image 14) likely cysts or biliary hamartomas. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. Of\nnote, there is small amount of perihepatic fluid, and mild periportal edema\ncompatible with mild fluid overload. The gallbladder is distended with mild\ngallbladder wall edema. No radiopaque stones are demonstrated.\n\nPANCREAS: The pancreas is mildly atrophic with normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple subcentimeter, well-circumscribed hypodensities are demonstrated in\nbilateral kidneys, potentially cysts, the not completely characterized on this\nexam (series 601 image 42). There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Roux-en-Y gastric bypass with intact\nanastomoses. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Few colonic diverticula are noted. The colon and\nrectum are otherwise unremarkable. The appendix is not visualized with no\nsecondary signs of acute appendicitis. There is small amount of ascites.\n.\nPELVIS: The urinary bladder contains a Foley catheter and is decompressed. \nThe distal ureters are unremarkable. There is small amount of free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. The bilateral adnexae are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Grade 1 anterolisthesis of L4 on L5 is again demonstrated, (602 image\n46). There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse soft tissue edema is demonstrated consistent with\nanasarca. The abdominal and pelvic walls are within normal limits.", "output": "1. Distended gallbladder with mild gallbladder wall edema, which given the\npresence of ascites, periportal edema, and anasarca is likely due to fluid\noverload state. However if there is continued concern for acute\ncholecystitis, a gallbladder ultrasound may be considered.\n2. Trace right pleural effusion with small amount fluid overload in the lungs.\n3. Patient is status post Roux-en-Y gastric bypass with no evidence of bowel\nobstruction or other complication.\n\nRECOMMENDATION(S): Follow-up gallbladder ultrasound may be considered if\nthere is continued concern for acute cholecystitis." }, { "input": "LOWER CHEST: A small right pleural effusion is nonhemorrhagic (series 2, image\n3). Coronary stents are noted. Bibasilar atelectasis is mild. No\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely enlarged with a slightly more segmental\nenlargement of the caudate lobe. On this single, portal venous phase CT,\nthere is diffuse heterogeneous enhancement with more focal rounded areas of\nhypoattenuation surrounding the portal triads. There is mass effect on the\nIVC and hepatic veins, which appear moderately compressed as they traverse\nthrough the hepatic parenchyma. The liver surface contour is slightly\nnodular.\nThere is slight widening of the porta hepaticus. No evidence of intrahepatic\nor extrahepatic biliary ductal dilatation.\n\nThe gallbladder is surgically absent with surgical clips in the gallbladder\nfossa. There is a small amount of fluid at the inferior tip of the right\nhepatic lobe (series 601b, image 38). There is mild to moderate fat stranding\nalong the anterior para renal space with mild thickening of the right\npericolic fascia.\n\n The main, right, and left portal veins are patent. The SMV and splenic vein\nare patent. There has been recanalization of the umbilical vein with small\nvarices noted in the gastrohepatic ligament and in the anterior abdominal wall\nsuggestive of early portal hypertension.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen is top-normal in size, measuring up to 12.6 cm. The spleen\nhas normal attenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a subtle\nwedge-shaped area of hypo enhancement in the right upper and lower renal pole\nwith associated mild cortical thinning and fat stranding but without renal\nenlargement or edema, consistent with chronic sequelae of prior infection\nand/or reflux (series 601b, image 39, 43 ; series 2, image 47). No right\nhydronephrosis. Within the limitations of this contrast study, no obstructing\nrenal stone is identified. Other than a small hypodensity in the cortex of\nthe left lower renal pole which is too small to accurately characterize on CT\nbut statistically most likely a cyst (series 601b, image 37), the left kidney\nis grossly normal. No subcapsular renal hematomas.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. No bowel obstruction. No free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy by CT size\ncriteria. An 8 mm aortocaval node is noted, likely reactive (series 2, image\n39). No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild to moderate atherosclerotic\ndisease is noted. The patient has a duplicated IVC.\n\nBONES: There is a comminuted burst T9 fracture that appears to extend to the\nposterior aspect of the vertebral body with angulation resulting an\napproximately 4 mm of protrusion of the superior posterior aspect of the\nvertebral body into the adjacent anterior epidural space (series 602b, image\n34). No retropulsion of fracture fragments. The fracture line appears to\nextend to both the superior and inferior endplates of the T9 vertebral body. \nThere is a minimally displaced left L2 and L3 transverse process fracture\n(series 2, image 40, 35). Mild loss of anterior vertebral body height at L3\ncould reflect an acute fracture (series 602b, image 36) versus degenerative\nchange. Multi-level degenerative changes are noted throughout the visualized\nthoracic and lumbar spine with superior Schmorl's nodes demonstrated at L3,\nT11, and T12, loss of vertebral body height at several levels, and anterior\nosteophytes. No anterolisthesis or retrolisthesis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits other than\nsubcutaneous systemic venous collaterals as noted previously and mild\nanasarca.", "output": "1. Diffuse hepatic disease as described in detail above with hepatomegaly,\nmass effect on the hepatic veins; IVC and early stigmata of portal\nhypertension. Considering the age and female predilection; primary biliary\ncirrhosis is the most favored differential. Other differentials include\ncirrhosis secondary to viral or alcohol as underlying etiology. Diffuse\nhepatic metastases is less likely. Further evaluation with gastroenterology\nconsult, MRI liver and a liver biopsy are recommended. This recommendation\nwas communicated to Dr. ___ by Dr. ___ on ___ at 10:05 am.\n\n2. Sequelae of probable prior right renal infection, possibly due to reflux. \nNo acute pyelonephritis.\n\n3. T9 comminuted fracture with 4-mm posterior angulation of the superior\naspect posteriorly into the spinal canal is age-indeterminate but given the\npatient's focal symptoms in this region, acute traumatic injury cannot be\nexcluded. No associated prevertebral soft tissue swelling. MRI could be\nperformed to further evaluate.\n\n4. Left L2 and L3 transverse process fractures, minimally displaced.\n\n5. Mild anterior wedging of the L3 vertebral body may be only from\ndegenerative change, but in the setting of trauma and known adjacent\ntransverse process fractures, acute injury cannot be excluded.\n\n6. Multilevel degenerative changes in the thoracolumbar spine.\n\n7. Small right non-hemorrhagic pleural effusion.\n\nRECOMMENDATION(S): 1. Gastroenterology consult, liver MRI and a liver biopsy\n(latter as relevant) are recommended.\n2. MRI spine to evaluate vertebral fractures may be considered.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 4:20 AM, 1 minutes after\ndiscovery of the findings as well as with Dr. ___ at 5:10 am on ___.\nL3 and L2 transverse process fractures on the left were discussed with Dr.\n___ on the telephone on ___ at 529 am.\nFracture images reviewed with Dr. ___ in person on ___ at 541am.\n\n The recommendation for urgent MRI liver were discussed by Dr. ___\nwith Dr. ___ on the telephoneon ___ at 10:05 AM, 45 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. A 9 mm\nhypodensity either reflecting a cyst or hemangioma is unchanged (02:18).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral sub cm hypodensities are too small to characterize, but most likely\nrepresent cysts. A 3 cm left parapelvic cyst is noted. There is no evidence\nof suspicious renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:\n\nSmall bowel loops are dilated and fluid-filled to the level of the terminal\nileum where there is a transition point corresponding with wall thickening\njust prior to the anastomosis very similar to that seen on ___\n(2:60). A segment of obstructed small bowel also demonstrates mild wall\nthickening and mucosal hyperemia (2:64). There is mesenteric free fluid. The\ncolon and rectum are unremarkable. The stomach is unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is mildly enlarged. Seminal vesicles\nare unremarkable.\n\nLYMPH NODES: Mesenteric lymph nodes near the transition point and thickened\nbowel loops are most likely reactive. There is no retroperitoneal, pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged lucent lesion with sclerotic focus in the right ilium is again noted\n(02:59). There are changes of the lumbar spine are present with grade 1\nanterolisthesis of L4 on L5, unchanged from ___\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Small bowel obstruction with a transition point in the right lower quadrant\ndue to bowel wall thickening in a segment of ileum just prior to the\nanastomosis. This appearance is very similar to that seen on ___,\nand is concerning for an obstruction related to active inflammation of the\nterminal ileum in the setting of Crohn's disease/flare. There is adjacent\nmesenteric free fluid and reactive lymphadenopathy. No free air or\npneumatosis. No drainable fluid collection." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation. A 3 mm hypodense lesion in the head of the\npancreas is likely a side branch IPMN (2; 30). There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nArea of cortical thickening noted in the left interpolar region. A 3.3 x 3.8\ncm hypodense lesion in the right upper pole with ___ of 20 consistent with a\nsimple cyst. Multiple subcentimeter hypodensities are noted in the left\nkidney, most likely renal cysts. No hydronephrosis. Hyperdensities in the\nleft lower pole consistent with renal calculi measure up to 1.2 cm as seen on\nprior CT (2; 34). There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The infrarenal aorta is ectatic up to 2.5 cm (602; 38). Mild\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic rib fracture deformities are noted in the right seventh rib (2; 3). \nThere is a chronic left L5 pars defect.\n\nSOFT TISSUES: There is atrophy of the left rectus abdominus, similar to ___. \nThere is a small fat containing umbilical hernia. There are bilateral fat\ncontaining inguinal hernias.", "output": "1. No acute intra-abdominal findings to explain patient's abdominal pain.\n2. Nonobstructing left nephrolithiasis measuring up to 1.2 cm, similar to\nprior CT." }, { "input": "LOWER CHEST: There is a large right pleural effusion, increased in size\ncompared to previous with increased attenuation, suggestive of hemorrhage. \nThere is associated subsegmental atelectasis. There is cardiomegaly without\npericardial effusion. A pacemaker wire is again seen with its lead in the\nright ventricle. Coronary artery, aortic valve, and mitral annular\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: There is re- demonstration of a large multilobulated\nheterogeneous subcapsular collection over the superior lateral and inferior\nsurfaces of the liver. It is not significantly changed in size compared to\nprevious. The surface of the liver appears nodular, which raises the possibly\nof cirrhosis. On arterial phased images, there is mild hyper enhancement of\nthe adjacent liver parenchyma. There is no evidence of suspicious liver\nlesions. Small linear hypo densities are seen in segment 8 of the liver (3B: \n147). There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.\n\nThe gallbladder is distended, and contains stones and dense debris, not\nsignificantly changed compared to previous. There is stable apparent\nthickening of the posterior gallbladder wall, which may be secondary to\nlayering blood or sludge or true wall thickening.High attenuation fluid is\nseen extending inferior along the right paracolic gutter into the pelvis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is re- demonstration of a 2 cm left adrenal nodule, with\ninternal attenuation of -5 Hounsfield units on the noncontrast study, in\nkeeping with an adenoma. A 1.3 cm nodule in the right adrenal gland is also\nconsistent with a adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple hypodensities are again seen in the kidneys, unchanged. A 2.1 cm\nright lower pole renal lesion demonstrates a foci of enhancement on portal\nvenous phase images (3b:212). There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The visualized large and small\nbowel loops demonstrate normal caliber, wall thickness and enhancement.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. There is narrowing of the celiac artery origin. There is a\nstable calcified left renal artery aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Re- demonstration of a large subcapsular liver hematoma without evidence of\nan underlying lesion.\n2. The contours of the liver appears slightly nodular, which raises the\npossibility of cirrhosis.\n3. Stable distended gallbladder containing stones and dense internal debris. \nIn the proper clinical setting, this could reflect acute cholecystitis and can\nbe correlated with HIDA scan.\n4. A 2 cm left adrenal nodule has low attenuation of on noncontrast images,\nconsistent with an adenoma. A second adenoma is seen in the right adrenal. \nNo further workup is required.\n5. Large right-sided pleural effusion is increased in size compared to\nprevious, and appears more hyperdense, suggestive of hemorrhage.\n6. A 2 cm right lower pole renal cysts demonstrates perceptible enhancement on\nportal venous phases, in keeping with a Bosniak ___ cyst.\n This preliminary report was reviewed with Dr. ___\nradiologist.\n\nRECOMMENDATION(S): Follow up for a right lower pole renal cyst is recommended\nin 6 to 12 months.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:03 ___, 30 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: There are moderate bilateral pleural effusion with passive\natelectasis in both lower lobes. There is no pericardial effusion. Extensive\ncoronary artery calcifications are noted. Dystrophic calcifications are noted\nin the left breast.\n\nABDOMEN:\n\nHEPATOBILIARY: There is marked diffuse hepatic steatosis, which limits the\ndetection of focal hepatic lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is diffusely atrophic.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is mild thickening of the left adrenal gland. The right\nadrenal gland is normal in size and shape.\n\nURINARY: The kidneys are mildly atrophic. There are two 2 mm stones/cortical\ncalcifications in the interpolar region of the right kidney (02:30). A 1.5 cm\nhypodense exophytic lesion in the interpolar region of the right kidney\npreviously characterized as a cyst is redemonstrated. There are additional\nunchanged bilateral hypodense renal lesions suggestive of cysts. There is\nno hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is small hiatal hernia. There is no evidence of bowel\nobstruction. The colon and rectum are within normal limits.\n\nThere is large volume ascites, with multiple peritoneal nodules concerning for\nperitoneal carcinomatosis.\n\nPELVIS: The bladder is decompressed containing a Foley catheter within it.\n\nREPRODUCTIVE ORGANS: The uterus appears normal in size. Limited evaluation of\nthe adnexa given the absence of IV contrast, however the left adnexa appears\nenlarged (02:56).\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is a compression fracture of L1 vertebral body with greater than\n80% height loss. There is grade 1 anterolisthesis of L5 on S1. Otherwise\nthere are degenerative changes throughout the lumbar spine.\n\nSOFT TISSUES: There is a moderate size umbilical hernia containing fat and\nfluid.", "output": "1. Large volume ascites with multiple peritoneal nodularities highly\nconcerning for peritoneal carcinomatosis. Absence of IV contrast limits the\nevaluation, however the left adnexal region appears enlarged, raising concern\nfor ovarian origin.\n2. No evidence of sigmoid colon volvulus.\n3. Severe diffuse hepatic steatosis.\n4. Limited evaluation of the lung bases shows moderate bilateral pleural\neffusions with passive atelectasis in both lower lobes.\n5. Severe coronary artery calcifications.\n6. Dystrophic calcification in the left breast. Please correlate with prior\nmammograms.\n7. Compression fracture of L1 vertebral body with greater than 80% height\nloss.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:41 ___, 5\nminutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are three small hypodense lesions measuring up to 1.0 cm in the liver\nwhich likely correlate with the hyperechoic lesions seen on recent ultrasound\n(2:16, 22; 601:16) There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2:54; 601b:32).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. A 4.6 x 3.9 cm cystic lesion\nin the right ovary is better characterized on pelvic ultrasound performed\nearlier on same day (2:68). Follicular activity is seen in the bilateral\novaries.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of appendicitis.\n2. A 4.6 cm cystic lesion in the right ovary is better characterized on pelvic\nultrasound performed earlier on same day.\n3. Three small hypodense lesions in the liver likely correlate with\nhyperechoic lesion seen on recent ultrasound, likely hemangiomas." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia otherwise the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 4.6 x 4.3 x 5.5 cm\nwhich is slightly increased from previous study of ___ (previously\nmeasuring 4.6 x 3.7 x 4.9 cm).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Innumerable bony lucencies are less conspicuous but are relatively\nstable when compared to prior study. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Enlarged prostate slightly increased from prior study of ___.\n2. No evidence of intra-abdominal or pelvic mass." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no pericardial or\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is mild wall thickening of the\ngallbladder fundus, most consistent with adenomyomatosis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.5 cm hypodensity within the upper pole of the left kidney which\nlobe measures slightly higher than simple fluid but appeared as a simple cyst\non prior abdominal ultrasound (series 601 B, image 34). There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a large hiatal hernia containing the gastric\nfundus and cardia, similar in size to that seen on chest radiograph from ___. There is dilation of the stomach with with gastric contents\nand normal caliber duodenum and small bowel. The large bowel is also normal\nin caliber without focal wall thickening. Postsurgical changes from prior\nappendectomy are seen. There is no intra-abdominal free fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains coarse calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nL3 vertebral body hemangioma is unchanged.\n\nSOFT TISSUES: There is a moderate sized fat containing right inguinal hernia.", "output": "1. Large hiatal hernia. Normal appearance of the small and large bowel\nwithout evidence of obstruction.\n2. Focal adenomyomatosis of the gallbladder.\n3. Bibasilar atelectasis." }, { "input": "Visualized lung bases appear clear.\n\nThere are a number of liver lesions which are characterized by poorly defined\nperipheral early enhancement with central hypoattenuating areas with respect\nto the background liver, which are typical for metastases. The largest is in\nthe dome of the right lobe and measures up to 32 x 31 mm in axial ___.\n\nGall bladder is mostly collapsed. There is no biliary dilatation.\n\nMass centered at the junction between the pancreatic body and tail is the\nlikely source of metastatic disease. The mass has poorly defined borders but\nmeasures approximately 52 x 38 mm in axial ___. Upstream the tail is\natrophic with ductal dilatation. Superiorly, the mass contacts the stomach\nand focal invasion is a possibility (601:96). Mass encases the bifurcation of\nthe celiac trunk, and probably spreads posteriorly to the origin of the celiac\ntrunk, although with relative sparing at the origin. The mass fully encases\nthe proximal segment of the splenic artery which has an irregularly narrowed\nappearance. The splenic vein is occluded by the mass and there are associated\ngastro omental collaterals as well as varices along the lesser curvature of\nthe stomach.\n\nSpleen is normal in size and appearance. Adrenals appear normal. Incidental\nnote is made of a horseshoe kidney, which is otherwise unremarkable.\n\nStomach is otherwise unremarkable. Small and large bowel appear normal.\n\nA preaortic hypoattenuating lesion which shows low-level contrast-enhancement\nand suggests a focus of metastatic disease measuring up to 24 x 13 mm (05:56).\nThere is also a suspicious left retrocrural lymph node measuring up to 19 x 12\nmm in axial ___.\n\nProstate is moderately enlarged with central hypertrophy. Seminal vesicles and\nbladder appear normal.\n\nThere is mild stenosis due to atherosclerotic plaque along the proximal left\nsuperficial femoral artery but mostly atherosclerotic disease is mild. Two\ncodominant right-sided renal arteries are found. There is no ascites.\n\nThere are no suspicious bone lesions. Moderate degenerative changes affect\nL4-L5 facet joints.", "output": "Findings consistent with metastatic pancreatic adenocarcinoma with 5 cm mass\nin the body/tail of the pancreas, multiple liver lesions and retroperitoneal\nlymphadenopathy.\n\nNOTIFICATION: Dr. ___ the findings including presence of\nmetastatic pancreatic cancer with Dr. ___ at 13:40 by telephone on ___." }, { "input": "LOWER CHEST: Visualized lung fields are remarkable for bibasilar atelectasis. \nThere is no evidence of pleural or pericardial effusion. Moderate to severe\ncoronary artery and aortic calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nMultiple millimetric hepatic hypodensities at the dome of the liver are not\nfully characterize and may reflect either simple pathic cysts or biliary\nhamartomas (2:9). There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right lower pole kidney is atrophic. Simple left upper pole\nrenal cyst measures 2.4 x 2.6 cm (02:19). Bilateral renal cystic structures\nare of doubtful clinical significance (601:28). There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal\ncaliber and wall thickness throughout. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterine endometrium is markedly thickened measuring\nup to 3.9 cm (602:31). No adnexal abnormality is demonstrated.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Mild levoconvex curvature of the lower thoracic spine. Multilevel\ndegenerative changes of the lumbar spine are noted. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The uterine endometrium is markedly thickened measuring up to 3.9 cm,\nconcerning for possible endometrial malignancy. Correlation with nonurgent\npelvic ultrasound is recommended.\n2. Otherwise, no acute process in the abdomen or pelvis." }, { "input": "The visualized lung bases appear clear. There no pleural effusions.\nThe liver, gallbladder, pancreas, spleen, adrenal glands and kidneys appear\nwithin normal limits. The lower part of the left kidney is markedly atrophic\nwith fullness of an extrarenal collecting system. There is a normal nephrogram\nin remaining tissue but without opacification of the extrarenal pelvis.\nWhether there may be separate ureters for any substantial course is\naccordingly difficult to discern.\nThe stomach, small and large bowel are unremarkable.\nThe bladder appears within normal limits. There is a corpus luteum cyst in the\nright ovary consistent with recent prior ultrasonographic findings. The left\nadnexa is unremarkable. Uterus appears within normal limits. A small quantity\nof free fluid is low in density in most consistent with a physiological\namount. The major mesenteric arteries and veins appear patent. There is no\nlymphadenopathy.\nThere are no suspicious bone lesions.", "output": "1. Marked chronic appearing atrophy of the lower part of the left kidney with\na mildly prominent extrarenal pelvis. This appearance suggests there may be in\nunderlying anomaly that is not well demonstrated such as a duplicated\ncollecting system, which may be associated with reflux of the lower pole. No\nfindings suggestive of active obstruction or infection, however.\n2. Small amount of free fluid within the pelvis, within physiological range." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis is noted. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.1 cm simple hepatic cyst is noted in segment VIII (2:7). There is no\nevidence of focal suspicious lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.0 cm simple parapelvic cyst is noted in the lower pole of the left kidney.\nMultiple additional subcentimeter bilateral renal hypodensities are too small\nto characterize but likely cysts. There is no evidence of concerning focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is noted. The stomach is otherwise\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Extensive colonic diverticulosis is noted. \nAdditionally, there is a focally inflamed diverticula with surrounding fat\nstranding (02:32), compatible with acute diverticulitis. There is no evidence\nof free intraperitoneal air or fluid. No associated abscess formation. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis. Bilateral tubal ligation clips are\nnoted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Acute, uncomplicated diverticulitis involving the distal transverse colon.\n2. Simple hepatic and left renal cysts." }, { "input": "LOWER CHEST: Atelectasis is seen in the left lung base with chronic mucoid\nimpaction. There is no pleural pericardial effusion. Atherosclerotic\ncalcifications are seen in the coronary arteries. The previously described 4\nmm and 6 mm pulmonary nodules are not seen on today's exam.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense lesions are seen scattered throughout the liver the largest\nmeasuring up to 3.8 x 3.2 cm in the right hepatic lobe, unchanged since ___ compatible with hepatic cysts. There is no evidence of new focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits. There is mild reactive\npericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland appears nodular and thickened, similar to\nthe prior exam. The left adrenal gland appears unchanged.\n\nURINARY: The kidneys appear somewhat atrophic. There are multiple\nsubcentimeter cortically based hypodense lesions, too small to fully\ncharacterize but likely representing simple cysts. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Extensive\ndiverticulosis is seen throughout the colon with a focal segment sigmoid colon\nappearing minimally thickened with mild adjacent fat stranding (series 2:\nImage 76), possibly representing mild uncomplicated diverticulitis. There is\nno evidence perforation or abnormal fluid collection concerning for abscess. \nThe rectum is within normal limits. The appendix is normal. Again seen\nmesentery with scattered prominent porta hepatis and mesenteric lymph nodes,\nsimilar in appearance to the prior study in ___.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged\n\nLYMPH NODES: There are multiple prominent retroperitoneal scratch lymph nodes,\nfor example, there is a 1.1 cm right para-aortic lymph node (series 2: Image\n49). Multiple prominent mesenteric lymph nodes are noted without meeting CT\nsize criteria for lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: Patient is status post total right hip replacement. Patient is status\npost fixation of the left hip, new since ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is a mild amount of fat stranding seen adjacent to a segment of\nsigmoid colon containing diverticula, possibly representing mild\ndiverticulitis. No evidence of perforation or abnormal fluid collection\nconcerning for abscess.\n2. Misty mesentery is again seen with scattered prominent porta hepatis and\nmesenteric lymph nodes, unchanged since ___.\n3. The previously described pulmonary nodules are not seen on today's exam." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Sternotomy wires are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 6 mm\nhypodense lesion segment VI is again noted and is unchanged. No new hepatic\nlesion.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again noted is a left anterior interpolar solid enhancing renal Mass.\nThis lesion measures 3 x 3.5 cm, previously measuring 3 x 3.6 cm in ___.\nThere is 1 cm simple cyst in the inferior pole of the left kidney is\nunchanged. No hydronephrosis.\n\nIn right kidney, there is a 2.5 cm simple cortical cyst at the upper pole as\nwell as a 7 mL before hypodensity too small to be characterized. No\nhydronephrosis.\n\nThe right and left renal veins are patent.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There are 2 right renal arteries and 2 on the left.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Stable left upper pole solid renal Mass.\n2. No evidence of abdominal metastases." }, { "input": "LOWER CHEST: There are bibasilar atelectatic changes, and there is new\npericardial effusion measuring 13 mm centered over the right anterior aspect\nof the pericardium. Patient is status post median sternotomy.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 6 mm hypodense lesion in the right lobe of the liver, not readily\npresent on prior, with probable cystic densities. This could represent a cyst\nor hemangioma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: In the pancreaticoduodenal groove, there is an enhancing 1.8 x 1.1\ncm mass (series 7, image 49), that does not follow the pattern of enhancement\nof the pancreas. Differential diagnostic considerations include a collapse\nduodenal diverticulum and a hyperenhancing pancreatic mass. This should be\nfurther assessed with MRI. there is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is a 4\nmm myelolipoma in the left adrenal gland.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRedemonstration of a 3.6 x 2.9 cm interpolar and intraparenchymal left renal\nlesion, which enhances heterogeneously and less avidly than the renal cortex. \nThe left renal vein is patent. There is a 15 mm cyst at the lower pole of the\nleft kidney. Stable cysts and too small to characterize hypodense lesions,\nlikely cysts, are also seen on the right kidney. There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is mild mesenteric panniculitis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild to moderate\natherosclerotic disease is noted. There is a separate origin for the proper\nhepatic artery, the left gastric artery, and the splenic artery. There is one\nmain left renal artery, while there are 2 right renal arteries, with a right\nsuperior accessory artery.\n\n\nBONES: Degenerative changes are seen in the lower dorsal and lumbar spines. \nThere is no evidence of worrisome osseous lesion or acute fracture.\n\nSOFT TISSUES: A left paraumbilical hernia containing fat is noted.", "output": "1. Stability of the 3.6 cm mass in the left kidney highly concerning for ___.\nThere is no change when compared with prior study.\n2. 1.8 x 1.1 cm hyperenhancing focus in the pancreaticoduodenal groove\nappears slightly different in density in comparison to the remaining\npancreatic parenchyma. This could represent a focal lesion, or collapsed\nduodenal diverticulum. An MRI is recommended for further assessment.\n3. Newly visualized liver lesion, most likely benign, but this could also be\nreassessed on MRI.\n\nRECOMMENDATION(S): MRI of the abdomen (MRCP)." }, { "input": "LOWER CHEST: Subsegmental platelike atelectasis in the right lung base. There\nis no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The transplanted liver demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions within the limitations of a\nstudy with no IV contrast. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout. There is no\nperipancreatic stranding.\n\nSPLEEN: Splenomegaly up to 15.2 cm, mildly smaller since ___.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Native kidneys are atrophic, with multiple cortical cysts measuring\nup to 2.6 cm in the left interpolar region.\nRight lower quadrant transplanted kidney measures 12.5 Cm, normal in\nappearance. There is no evidence of hemorrhage in the collecting system or\nalong the ureter.\nNo free fluid surrounding the kidney, and none found in the abdomen and\npelvis.\nUrinary bladder is empty with Foley catheter balloon.\n\nGASTROINTESTINAL: Small hiatal hernia. The stomach is unremarkable. Small\nbowel loops, colon and rectum are within normal limits. The appendix is\nnormal.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Lower abdomen postsurgical scars in normal appearance.", "output": "-Right pelvic kidney demonstrate normal appearance. Urinary bladder is empty\nwith Foley catheter balloon. The large urinary bladder clot demonstrated on\nultrasound ___ is not demonstrated.\n-No intra-abdominal free fluid or any other evidence to suggest\nintra-abdominal or pelvic hemorrhage." }, { "input": "Heart size is normal. Elevation of left hemidiaphragm is chronic. Imaged lung\nbases are clear.\n\nCT abdomen contrast: The liver is diffusely hypoattenuating compatible with\nsteatosis. The liver otherwise enhances homogeneously without focal mass or\nbiliary dilatation. Gallbladder is normal. Portal vein is patent.\n\nSpleen, pancreas and adrenal glands are normal.\n\nKidneys present symmetric nephrograms and excretion of contrast without focal\nmass or hydronephrosis.\n\nStomach, duodenum and remainder of the small bowel loops are normal caliber\nwithout evidence of obstruction. Focal area of concentric wall thickening\nwithout surrounding inflammatory fat stranding in the mid sigmoid colon\n(5:66). Remainder of the large bowel is otherwise thin-walled and unremarkable\nwithout pericolonic fat stranding or fluid collection. Normal appendix is\nvisualized in the right lower quadrant.\n\nThe abdominal aorta is normal caliber. Mesenteric and retroperitoneal lymph\nnodes are not pathologically enlarged. Tiny fat containing umbilical hernia.\nNo ascites or pneumoperitoneum.\n\nCT pelvis with contrast: Bladder, uterus, adnexae and rectum are unremarkable.\nInguinal and pelvic sidewall lymph nodes are not enlarged. No free fluid or\nair.\n\nBones and soft tissues: No suspicious focal bone lesion.", "output": "1. Small segment of concentric wall thickening in the mid sigmoid colon\nwithout surrounding inflammatory stranding, indeterminate. Recommend direct\nvisualization with colonoscopy.\n2. Hepatic steatosis.\n3. Chronic elevation of the left hemidiaphragm.\n4. Otherwise no acute findings to explain pain.\n\nRECOMMENDATION(S): Further characterization of sigmoid wall thickening with\ncolonoscopy is recommended." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. The common bile duct wall is slightly prominent and tapers\nas it enters the pancreas, consistent with biliary stricture and measures\n0.9-0.97 cm upstream to the stricture consistent with extrahepatic biliary\ndilation (601 B; 23). The gallbladder is surgically absent and there is\ninterval removal of the common bile duct stent.\n\n\nPANCREAS: The pancreas has diffuse coarse calcifications throughout compatible\nwith chronic pancreatitis in appears unchanged compared to previous. \nPreviously seen cystic lesion of the pancreas in ___ is again no longer\nseen. Again, the portal vein is obliterated similar to prior in the upper SMV\nis not visualized. Extensive mesenteric collaterals are similar to previous. \nPreviously noted cystic structure anterior to the splenic hilum in ___\nis no longer visualized. There is no evidence of pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions. There is anterior\nwedge compression fracture of L1 vertebral body with loss of 45% of body\nheight anteriorly similar in appearance since ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Extrahepatic biliary dilatation upstream to area of stricture (601b, 23).\n2. Previously seen peripancreatic cystic lesions are no longer visualized.\n3. Stable appearance of portal vein and poor visualization of the SMV with\nextensive mesenteric collaterals\n4. Unchanged L1 vertebral anterior compression fracture" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates smooth contour and homogeneous\nattenuation, without evidence of cirrhosis. The patient is status post\nre-insertion of a CBD stent, with resolution of the previously seen biliary\ndilatation and new pneumobilia. Several of the hypodensities in the left lobe\nof the liver seen on CT from ___ are no longer visualized. An ill defined\nnonenhancing hypodensity in segment ___ of the liver near the dome (image\n3b:120) has increased in size, now measuring 2.0 x 1.1 cm compared to 1.1 x\n1.0 cm previously. Another small tubular hypodensity is seen just inferiorly.\n\nThe gallbladder is contracted, with heterogeneously enhancing thickened wall,\ninternal hyperdense debris, and surrounding fat stranding. On coronal\nsequences (image 60 4B: 57) there appears to be focal discontinuity of the\ngallbladder wall near the fundus, with a small collection extending into the\ngallbladder fossa, suspicious for gallbladder perforation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A small accessory spleen is noted near the hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nA 3.4 cm hyperdense cyst in the midpole of the left kidney is unchanged. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The visualized small bowel and\ncolon appear within normal limits. There is no free fluid within the abdomen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Collapsed gallbladder with apparent focal wall discontinuity near the\nfundus, concerning for perforation. There is a small fluid collection adjacent\nto the fundus in the GB fossa.\n2. Interval resolution of hypodense lesions in the left lobe of the liver, but\nincrease in size a nonenhancing lesion in the right lobe near the dome. Given\nthe rapid resolution of imaging finding, these may represent bile lakes or\nmicroabscesses.\n3. The liver is not cirrhotic. There are no liver lesions concerning for HCC." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Pacemaker lead identified.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions lesion and previously seen hypodensity\nnear the dome of the liver is no longer visualized, likely bile lakes. There\nis no evidence of intrahepatic biliary dilatation. The common bile duct stent\nis again visualized with stable pneumobilia. The gallbladder is more well\ndefined than previous studies and contains gallstones. The surrounding fat\nstranding has improved compared to the previous study. The previously\nidentified liver abscess is no longer visualized. No fluid collection is seen\nsurrounding the gallbladder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland and left adrenal glands are normal in size\nand shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There is a 3.3 x 3.4 cm hypodense\nlesion with Hounsfield units of 18 in the left interpolar region posterior\nsegment (5; 32) likely representing a renal cyst. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The visualized large and small\nbowel are unremarkable. The appendix is not visualized in this CT abdomen\nstudy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative disease of the lumbar spine.", "output": "1. Interval resolution of previously identified liver abscess with a more\nwell defined wall of the gallbladder, which still contain gallstones.\n2. Resolution of previously seen hypodensities near the dome of the liver with\nno focal liver lesions identified in this study.\n3. 3.4 cm left renal cyst" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. There is trace bibasilar\ndependent atelectasis. A pacemaker lead is partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. A stent is present in the common bile\nduct with associated mild pneumobilia. The gallbladder is surgically absent,\nwith trace fluid in the gallbladder fossa, new since prior. Few air bubbles\nof free peritoneal air and trace fluid in the anterior perihepatic space,\nlikely related to recent surgery. No organized fluid collections or enhancing\nfluid collections.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetrically small in size with normal nephrogram. \nThere is no hydronephrosis. There is benign simple cyst in the left kidney,\nas seen previously. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are multiple\nfluid-filled dilated loops of small bowel, measuring up to 5 cm in maximal\ndimension. There is no bowel wall thickening, pneumatosis intestinalis or\nportal venous gas. There is gradual transition to decompressed small bowel\nloops, and distal and terminal ileum is completely collapsed. Major abdominal\narteries, veins are patent. Small bowel wall is enhancing. There is a small\namount of free intraperitoneal air in the right upper quadrant, which may be\nrelated to recent cholecystectomy status. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: There is a small amount of air within the urinary bladder dome,\nlikely from bladder instrumentation. In the absence of bladder\ninstrumentation, consider infection, bladder enteric fistula. The distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultiple anterior osteophytes of the visualized spine are compatible with\ndiffuse idiopathic skeletal hyperostosis (DISH). A 6 mm sclerotic focus in\nthe right sacral ala likely represents a bone island, and is unchanged since\n___.\n\nSOFT TISSUES: There are fat only containing bilateral inguinal hernias. . \nSmall amount of subcutaneous air within the anterior and right lateral abdomen\nis likely related to recent laparoscopic cholecystectomy. Multiple metallic\nsurgical staples overlie the right upper abdomen.", "output": "1. Multiple loops of fluid-filled dilated small bowel are concerning for\npartial small bowel obstruction. Adynamic ileus is less likely. No\npneumatosis intestinalis or portal venous gas.\n2. Small amount of free intraperitoneal air is likely related to\ncholecystectomy status. Small volume of a perihepatic fluid.\n3. Air within the urinary bladder may be related to prior Foley catheter\nplacement. Clinical correlation is recommended." }, { "input": "LOWER CHEST: Trace bilateral pleural effusions with increased bibasilar\ndependent atelectasis, right greater than left. A 0.2 cm calcified density\nwithin the left lower lung likely reflects granuloma (3; 1) and a 0.2 cm\npulmonary nodule is seen in the left lung base (3; 2) unchanged since ___. There is no evidence of pericardial effusion.Pacemaker lead terminates\nin the right ventricle.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. Common bile duct stent is again visualized. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent. Stable fat stranding and postoperative changes in the\ngallbladder fossa from recent surgery with no organized fluid collection seen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Stable 3.3 x 3.0 cm\nhypodense lesion in the posterior left insular region consistent with a renal\ncyst (3; 35). There is no hydronephrosis. There is no nephrolithiasis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: NG tube terminates in the stomach. The stomach is\nunremarkable. Again seen are multiple fluid filled dilated loops of small\nbowel with air fluid levels measuring up to 4.2 cm, improved since the prior\nexam 2 days ago (3; 37). There is no pneumatosis or portal venous gas. The\ntransition point appears to be in the right lower quadrant just below the\nanterior abdominal wall (3; 43) and contrast seen in the colon given from the\nprior study consistent with partial small bowel obstruction. Small bowel\nloops demonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder is decompressed with a Foley catheter and distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultiple anterior osteophytes of the visualized spine again noted compatible\nwith diffuse idiopathic skeletal hyperostosis (dish).\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.", "output": "1. Partial small bowel obstruction, improving, with transition point in the\nright lower quadrant adjacent to the anterior abdominal wall.\n2. Trace bilateral pleural effusions with slightly worsened atelectasis in the\nright lung base." }, { "input": "LOWER CHEST: Please refer to the separately dictated CT of the chest for\ndetailed evaluation of the chest findings.\n\nHEPATOBILIARY: Hepatic enhancement is homogeneous with no suspicious masses. \nPortal vein and hepatic veins are patent. Status post cholecystectomy. There\nis no biliary ductal dilatation.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious masses.\n\nSPLEEN: There is no splenomegaly. High-density punctate areas within the\nspleen, likely representing calcified granulomas.\n\nADRENALS: Right adrenal nodule measuring 1.5 cm, appears stable and\nstatistically likely representing an adenoma.\n\nURINARY:Status post resection of the native kidney on the right for renal cell\ncarcinoma. There are no suspicious masses in the resection bed. There is\nre-demonstration of a hematoma that continues to shrink in size, currently\nmeasures 4.2 x 3.2 cm compared to 5.3 x 4.4 cm. Left native kidney shows no\nhydronephrosis or suspicious renal masses. There is a left renal cortical\ncyst appearing stable. Transplanted kidney in the right lower quadrant shows\nno hydronephrosis or suspicious masses.\n\nGASTROINTESTINAL: Stomach is unremarkable. Small bowel loops are normal in\ncaliber. There are scattered colonic diverticulosis without diverticulitis.\n\nPERITONEUM: There is no free air free fluid. There is no peritoneal\nstranding.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches. There is moderate atherosclerotic disease.\n\nPELVIS: Urinary bladder is under distended. Prostate radiation beads are\npresent. Rectum is unremarkable.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions.\n\nSOFT TISSUES: Postsurgical changes in the right lower abdomen and left groin. \nNo suspicious soft tissue masses.", "output": "1. Decreasing size hematoma at the resection bed.\n2. No evidence of local recurrence or distant metastatic disease." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Calcified granulomas are again seen throughout the\nspleen.\n\nADRENALS: A right adrenal nodule measuring 1.5 cm is again appreciated (2:33).\nThe left adrenal gland is normal.\n\nURINARY: The patient is status post right nephrectomy for renal cell\ncarcinoma. The hematoma adjacent to the right renal resection bed is not\nsignificantly changed. There is a transplant kidney in the right hemipelvis\nwhich demonstrates new wedge-shaped hypodensities and mild perinephric\nstranding concerning for acute pyelonephritis (___:36). The left kidney\nenhances normally. A likely cyst is again appreciated in the interpolar\nregion of the left kidney. There is no evidence of hydronephrosis.\n\nGASTROINTESTINAL: The stomach is distended, but otherwise unremarkable. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is colonic diverticulosis without evidence of acute\ndiverticulitis. The appendix is normal. Misty mesentery has been present\nsince ___, and is a nonspecific finding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The seminal vesicles are unremarkable. Brachytherapy\nseeds are appreciated within the prostate gland.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMinimal degenerative changes are noted in the spine.\n\nSOFT TISSUES: A spigelian hernia is again noted in the right lower abdominal\nwall, which contains loops of nonobstructed small bowel.", "output": "1. New peripheral hypodensities in the transplanted kidney, which are\nconcerning for acute pyelonephritis but can also be seen in the setting of\ntransplant rejection. Further evaluation with renal transplant ultrasound\nwith Doppler is recommended.\n2. Colonic diverticulosis without evidence of acute diverticulitis.\n3. Distended stomach with ingested material and oral contrast.\n4. Unchanged hematoma in the right renal surgical resection bed.\n5. Stable right adrenal nodule.\n\nRECOMMENDATION(S): Further evaluation with renal transplant ultrasound with\nDoppler is recommended.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:10 pm, immediately after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. There are\nnumerous punctate hyperdense foci throughout the spleen which may be sequela\nof prior granulomatous disease. At the inferolateral region of the spleen is\na wedge-shaped hypodense area which may be sequela of prior infarction.\n\nADRENALS: The right adrenal nodule measures up to 11 mm, (series 4, image 30)\nrelatively unchanged when compared to prior, when accounting for differences\nin measuring technique. Left adrenal gland is normal in size and shape.\n\nURINARY: The patient is status post right nephrectomy with a\nwell-circumscribed hypodense structure in the surgical bed that measures 4.1 x\n2.4 cm, (series 4, image 37) previously 4.3 x 2.9 cm.\nThe left kidney is atrophic. Again visualized is a 1.4 cm hyperdense cyst in\nthe posterior cortex, interpolar region of the left kidney (series 4, image\n39) that although incompletely characterized is unchanged in size and\nmorphology dating back to ___. Continued attention on follow-up.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nare colonic diverticulosis without evidence of acute diverticulitis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A partially visualized large spigelian hernia is again noted in\nthe right lower abdominal wall which contains nonobstructed small bowel.", "output": "1. The patient is status post right nephrectomy with minimal interval decrease\nin size of the hematoma in the posterior renal resection bed. No evidence of\nabdominal lymphadenopathy.\n2. New wedge-shaped hypodense region at the inferolateral spleen may suggest\nsequela of prior infarction. Innumerable punctate calcific densities in the\nspleen compatible with granulomatous disease.\n3. Stable right adrenal adenoma.\n4. A partially visualized large spigelian hernia contains non-obstructed small\nbowel, unchanged.\n5. Diverticulosis without evidence of diverticulitis, in the visualized\nportion of the colon." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. Left ovarian hypodensity measures up to 3.3 cm (601:24).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic abnormalities to explain patient's\nleft-sided symptom. No renal stones. No hydronephrosis.\n2. Left ovarian cyst measuring up to 3.3 cm." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSmall subcentimeter hypodensities in the kidneys are too small to characterize\nby CT but appears unchanged from prior MRI from ___ and CT from ___. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. Patient is\nstatus post right orchiectomy with appropriate postsurgical changes.\n\nLYMPH NODES: Patient is status post retroperitoneal lymph node dissection with\nresection of the previously seen hypodense retroperitoneal mass. Numerous\nsurgical clips are seen around the aorta and around the renal vessels\nbilaterally. There is no concerning soft tissue mass. The soft tissue\ndensities seen between the aorta and the IVC at the level the kidneys are\nconsistent with bowel interdigitating between the vessels in the operative\nbed. No mesenteric adenopathy is appreciated. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: In the anterior abdominal wall along the inferior margin of the\nsurgical incision site, there is an enhancing soft tissue nodule measuring 1.9\nx 1.0 cm, anterior to the left abdominal rectus muscle (02:102 and 602b:48). \nNo fluid collection is seen. There is a smaller focus of enhancement around a\nsuture (2:74). No significant subcutaneous stranding is seen at these sites. \nThere is a small fat containing umbilical hernia.", "output": "1. An enhancing soft tissue nodule measuring 1.9 x 1.0 cm anterior to the left\nabdominal rectus muscle, reportedly correlating with the patient's site of\ndiscomfort. This may simply represent postsurgical changes such as\ninflammatory changes around a suture site. Surgical site recurrence cannot be\nentirely excluded, so follow up with US is recommended.\n2. Status post retroperitoneal lymph node dissection with expected post\nsurgical changes and resection of previously seen bilobed cystic\nretroperitoneal lesion. No residual or new lymphadenopathy.\n3. Status post right orchectomy with post surgical changes.\n4. Please refer to the dedicated chest CT report for intrathoracic findings.\n\nRECOMMENDATION(S): An enhancing soft tissue nodule measuring 1.9 x 1.0 cm\nanterior to the left abdominal rectus muscle, correlating with the patient's\nsite of discomfort. This may represent postsurgical inflammatory changes,\nthough US would be recommended for follow up, or for further evaluation at the\npresent time (for example if symptoms do not suggest inflammatory change)\nsince surgical site recurrence cannot be entirely excluded.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:21 AM, 5 minutes after discovery\nof the findings.\n\n The findings and recommendation above were entered by Dr. ___ on\n___ at 12:22 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please see separate dictation performed on same day for detailed\nevaluation of the chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter cortical hypoattenuating lesion (series 2, image 74) in the\ninterpolar region of the left kidney is too small to characterize but\nunchanged. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate has coarse calcification. The patient is\nstatus post right orchiectomy.\n\nLYMPH NODES: Patient status post retroperitoneal lymph node dissection with\nnumerous surgical clips noted. There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy. Again seen\nis soft tissue density in between the aorta and IVC at the level of kidneys\nconsistent with interdigitating bowel loops.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post retroperitoneal lymph node dissection and resection of the\nretroperitoneal cystic mass with no evidence of lymphadenopathy, local\nrecurrence, or metastasis.\n2. Status post right orchiectomy.\n3. Please see separate dictation performed on the same day for detailed\nevaluation of the chest." }, { "input": "LOWER CHEST: Please see report from concurrent CT chest for detailed\ndescription of findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Punctate\nhypodensities in the bilateral kidneys are too small to characterize, but are\nunchanged from prior examinations, and likely represents simple cysts. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. Patient is\nstatus post right orchiectomy with appropriate postsurgical changes.\n\nLYMPH NODES: The patient is status post retroperitoneal lymph node dissection\nwith resection of the previously seen hypodense retroperitoneal mass. \nNumerous surgical clips are seen around the aorta and renal vasculature\nbilaterally. There is no concerning soft tissue mass. No mesenteric\nadenopathy is appreciated. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post retroperitoneal lymph node and lesion dissection with expected\npostsurgical changes and no evidence of residual or new lymphadenopathy.\n2. Status post right orchiectomy with expected postsurgical changes. No\nevidence of additional metastatic disease.\n3. Please refer to dedicated CT chest report for intrathoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES/ RETROPERITONEUM: There is increased size of bilobed\nretroperitoneal fluid collection compared to prior MRI, now measuring 7.2 x\n4.1 cm (02:27), previously 5.5 x 2.1 cm. No measurable adjacent soft tissue\ncomponent is identified on today's study. There is no new retroperitoneal or\nmesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Increased size of bilobed retroperitoneal cystic collection, however the\npreviously identified adjacent soft tissue component is no longer seen.\n2. No evidence of new lymphadenopathy or metastatic disease in the abdomen or\npelvis." }, { "input": "CTA:\n\nThere is fusiform aneurysmal dilatation of the infrarenal abdominal aorta\nwhich measures a maximal size of 7 cm. There is a moderate amount of\natherosclerosis throughout. There are 1 right and 2 left renal arteries, all\nof which are patent.\n\nThere is a high-grade stenosis of the proximal celiac trunk with post-stenotic\ndilatation measuring up to 1.4 cm (401b:37 and 3:32). The superior mesenteric\nartery is patent. The inferior mesenteric artery appears occluded at its\norigin (3:85). Calcified atheromatous plaque is identified in the common and\nexternal iliac arteries and the common femoral arteries without evidence of\nsignificant stenosis.\n\n3D Imaging Lab Measurements:\n\nSuprarenal abdominal aorta: 2.5 cm\n\nAbdominal aorta at inferior renal (right) artery takeoff: 2.5 cm\n\nAbdominal aortic (5 mm below inferior renal artery): 3.4 cm\n\nAbdominal aortic (10 mm below inferior renal artery): 4.5 cm\n\nAbdominal aortic (15mm below inferior renal artery): 5.4 cm\n\nAbdominal aortic aneurysmal sac diameter: 7 x 6.5 cm\n\nInferior renal artery to top of aneurysm: 0.7 cm\n\nInferior renal artery to aortic bifurcation: 15 cm\n\nInferior renal artery to right iliac bifurcation: 20.1 cm\n\nInferior renal artery to left iliac bifurcation: 20.7 cm\n\nAbdominal aortic ectasia: Central coronal axis is 149.4 degrees\n\nAAA volume: 372 cm 3\n\nAAA volume (including common iliac arteries): 399 cm 3\n\nCT ABDOMEN:\n\nThe liver is within normal limits. No focal liver lesions. The portal vein is\npatent. The hepatic artery is patent with conventional hepatic arterial\nanatomy. No intra or extrahepatic duct dilatation. The gallbladder is\nunremarkable. There are multiple cysts within both kidneys with the largest\nmeasuring 3.6 cm in the upper pole of the left kidney. No concerning renal\nlesions. No hydronephrosis. The adrenals and spleen are within normal limits.\nThe pancreas is unremarkable.\n\nSevere colonic diverticulosis is identified which is most marked within the\nsigmoid colon. No evidence of diverticulitis. The appendix is normal. The\nsmall bowel is within normal limits. No mesenteric or retroperitoneal\nadenopathy. Severe emphysematous changes are noted in both lung bases. There\nis minor scarring within the right lower lobe. No pleural effusion. Note is\nmade of linear pericardial calcification on the images of the heart. The\nvisualized heart and pericardium is otherwise unremarkable.\n\nCT PELVIS:\n\nThe bladder is within normal limits. The prostate gland and seminal vesicles\nare unremarkable. No pelvic adenopathy.\n\nOSSEOUS STRUCTURES:\n\nAnterior osteophytes are identified throughout the lower thoracic and lumbar\nspine. There is a bridging osteophyte at the right sacroiliac joint. No\nconcerning sclerotic or lytic lesions are identified within the osseous\nstructures of the abdomen or pelvis.", "output": "1. 7 x 6.5 cm infrarenal abdominal aortic aneurysm as described above. No\nevidence for impending rupture.\n\n2. High-grade stenosis of the proximal celiac artery with post-stenotic\ndilatation.\n\n3. Severe colonic diverticulosis without evidence of diverticulitis.\n\n4. Severe emphysematous change within both lung bases." }, { "input": "LOWER CHEST: The partially visualized lungs are clear. No pleural or\npericardial effusion. Aortic valve calcifications are moderate and mild\ncoronary artery calcifications are incompletely imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver surface contour is nodular, consistent with known\nhistory of cirrhosis. The patient is status post resection of a 19-mm segment\n8 hepatic lesion with packing with Surgicel. However, the size of the the\nresection bed has increased since ___, now measuring 10.6 x 7.8 cm,\npreviously 8.3 x 5.4 cm (series 2, image 13). The well-defined collection in\nthe resection bed also now contains a new air-fluid level (Series 2, image\n15). While some of the smaller air foci within the collection represents\nSurgicel material, the new air-fluid level and increasing size is most\nconcerning for superinfection. Just anteriorly and superiorly to this lesion\nat the dome of the liver, there are multiple new, small hypodense lesions with\nrim enhancement as well as foci of air that are also consistent with infection\n(series 2, image 8). Moderate pneumobilia, predominantly in the left hepatic\nlobe with minimal amounts in the right hepatic lobe are overall unchanged and\ncompatible with post-cholecystectomy and a patent CBD stent. The main portal\nvein appears patent. There is re- cannulization of the umbilical vein. \nExtensive collaterals throughout the abdomen are again noted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged, measuring up to 14.5 cm. The spleen\nshows attenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is colonic\ndiverticulosis without evidence of diverticulitis in the distal colon The\nrectum is normal. The appendix is normal. No bowel obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate contains coarse calcifications which may be due\nto prior inflammation.\n\nLYMPH NODES: Extensive gastrohepatic lymph nodes, likely related to liver\ndisease are also unchanged, the largest measuring up to 11 mm in AP dimension\n(series 2, image 23). A 6 mm paraesophageal lymph node is unchanged (series 2,\nimage 15). Small retroperitoneal lymph nodes are visualized but not\npathologically enlarged. No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic disease is\nmost extensive in the distal abdominal aorta, aortic bifurcation, and proximal\ncommon iliac arteries.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Moderate\ndegenerative changes of lower thoracic vertebral bodies with anterior\nosteophytes are unchanged.\n\nSOFT TISSUES: Periumbilical fat stranding is moderate, unchanged since\n___ (series 602b, image 40). There is prominence of fat in the right\ninguinal canal.", "output": "1. Interval increase in the size of the resection cavity in segment 8 with\nnew air fluid level and adjacent new hypodense foci with rim enhancement and\nair, all consistent with infection (now 10.6 x 7.8 cm, previously 8.3 x 5.4 cm\n(series 2, image 13)) since ___.\n\n2. Cirrhosis with sequelae including splenomegaly, collaterals, and some\nprominent nodes. No ascites or free fluid in the pelvis.\n\n3. Pneumobilia unchanged, compatible with CBD.\n\n4. Moderate sigmoid diverticulosis without diverticulitis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___.\n___ on the ___ ___ at 7:10 ___, 1 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains a gallstone\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There are two 7 mm accessory spleens, stable from\npriors.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is no significant change in a large left superior pole renal\ncyst, measuring 6.0 x 9.3 cm. There are multiple other subcentimeter\nhypodensities in bilateral kidneys which are too small to characterize,\nhowever are stable from previous and likely represent simple cysts. The\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nevidence of suspicious focal renal lesions, stones or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. A previously-seen hypodensity in the\nposterior anus is less conspicuous on today's exam. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple previously-seen prominent abdominal and pelvic lymph\nnodes are stable or decreased in size since prior CT ___, none\nmeeting CT size criteria for lymphadenopathy. For sample, a previously seen\nprominent right inguinal lymph noted is decrease in size, measuring 9 x 3 mm\n(9 :115). Previously seen left pelvic wall lymph node is decreased from prior\nmeasuring 9 x 3 mm (9:103). A prominent retrocaval lymph node is stable in\nsize, measuring 9 x 7 mm (9:58). A prominent aortocaval lymph node is stable\nto decreased in size, measuring 1.2 x 0.8 cm (9:58). A prominent left\nperiaortic node is decreased in size, measuring 7 mm (9:57). There is no new\nretroperitoneal or mesenteric lymphadenopathy. There is no new pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cholelithiasis without evidence of cholecystitis.\n2. No nephrolithiasis.\n3. Stable to decreased size of multiple previously-seen prominent abdominal\nand pelvic lymph nodes, which do not meet CT size criteria for\nlymphadenopathy. No new lymphadenopathy.\n4. Previously seen hypodensity along the posterior aspect of the anus is less\nconspicuous on today's exam.\n5. Please see separate CT chest dictation regarding description of\nintrathoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (601b:46).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormality in the abdomen or pelvis to explain patient's reported\nsymptoms.\n2. Appendix is normal." }, { "input": "LOWER CHEST: There is mild atelectasis bilateral lower lobes. The heart is\nnormal in size. There is tiny left pleural effusion. Trace pericardial\nfluid. The blood pool is hypodense relative to the myocardium, suggestive of\nanemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is normal in size and smooth in contour. No focal\nhepatic lesion is detected within the limits of this noncontrast examination. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is collapsed but otherwise unremarkable.\n\nPANCREAS: The pancreas is within normal limits. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size. There is a 4 mm hypodensity in the\ninferior spleen (series 3, image 19), too small to characterize.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys demonstrate diffuse cortical thinning, in keeping with\nchronic renal disease. No renal calculi are seen. There is no focal renal\nlesion, within the limits of this noncontrast study. There is no\nhydronephrosis.\n\nGASTROINTESTINAL: There is a small amount of oral contrast reflux into the\ndistal esophagus. The stomach is unremarkable. Small bowel loops are normal\nin caliber. The colon and rectum are within normal limits.\n\nPERITONEUM: There a peritoneal dialysis catheter entering the right mid\nabdomen from an anterior approach and terminating within the right pelvis. \nThere is no intraabdominal fluid collection. There is a small to moderate\namount of pneumoperitoneum. There are also scattered foci of air in the right\nretroperitoneum. Findings are presumably related to manipulation of the\nperitoneal dialysis catheter.\n\nPELVIS: The urinary bladder is fluid-filled and mildly distended. There is\nmild diffuse wall thickening, greater than expected for the degree of\ndistension, and mild fat stranding anterior to the bladder dome, raising the\npossibility of cystitis. There is a small amount of free fluid in the\ncul-de-sac.\n\nREPRODUCTIVE ORGANS: There is a ring intrauterine device within the uterine\ncavity. There is an approximately 1.4 cm cystic lesion in the right ovary\n(series 3, image 66). The left ovary is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are areas of scarring and/or old tracts in the left\nparamidline anterior abdominal wall.", "output": "1. Peritoneal dialysis catheter. Small volume free fluid in the pelvis. \nSmall to moderate amount of pneumoperitoneum, presumably related to\nmanipulation of the peritoneal dialysis catheter.\n2. Mild diffuse wall thickening of the bladder, greater than expected for the\ndegree of distension, and mild fat stranding anterior to the bladder ___\nbe reactive, consider cystitis. Correlation with urinalysis is recommended." }, { "input": "LOWER CHEST: There is dependent bibasilar atelectasis. There is no evidence\nof pericardial or pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. There is a 4\nmm hypodensity in the spleen, too small to characterize, however is stable\nfrom prior. There is a perisplenic simple fluid collection extends along the\nleft lateral wall.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic compatible with chronic renal disease. \nThere is no evidence of focal renal lesions within the limitations of an\nunenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPERITONEUM: There is an anterior approach right lower quadrant peritoneal\ndialysis catheter that terminates in the right lower quadrant. Multiple small\nmesenteric fluid collections are seen\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a ring intrauterine device within the uterine\ncavity. There is re-demonstration of a 1.2 cm cystic lesion in the ovary\nunchanged from prior study. The left ovary is normal\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of pneumoperitoneum.\n2. Left upper quadrant perisplenic simple fluid collection, unusual in\ndistribution for PD related collection.\n3. No evidence of bowel injury.\n4. Anterior approach right lower quadrant peritoneal dialysis catheter in\nappropriate position without associated complications." }, { "input": "LOWER CHEST: There is moderate dependent atelectasis bilaterally, slightly\nworse compared to prior exam.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits. There is small amount\nof perihepatic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout. Fatty lesion noted\nat the pancreatic body, unchanged from prior. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. A\nsubcentimeter hypodensity within the spleen is stable prior exams. There is\nmoderate perisplenic ascites.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys are atrophic. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small amount of contrast is noted in the distal esophagus. \nThe stomach is unremarkable. Small bowel loops demonstrate normal caliber and\nwall thickness throughout. There is an area of mild fat stranding around a\nfocal area of the proximal transverse colon (602:28). No adjacent diverticula\nseen on the current or prior exams. There is no evidence of perforation or\nabscess. The appendix is normal. Foci of intraperitoneal free air are likely\nrelated to intra peritoneal dialysis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate free fluid in the pelvis. Peritoneal dialysis catheter terminates in\nthe pelvis anterior to the bladder.\n\nREPRODUCTIVE ORGANS: The uterus contains a circular IUD. A right ovarian cyst\nseen on prior exam is difficult to measure due to surrounding free fluid, but\nis likely stable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Inflammatory changes around a focal area of the transverse colon. No\ndefinite evidence of adjacent diverticula to suggest diverticulitis though\nthis would be difficult to entirely exclude. The colonic wall in this region\nis also within normal limits.\n2. Moderate intra-abdominal fluid, increased from prior exams likely related\nto peritoneal dialysis." }, { "input": "LOWER CHEST: Moderate dependent atelectasis seen bilaterally, similar to the\nprior study in ___. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits. There is mild\nperihepatic ascites which is seen tracking into the abdomen and pelvis\ninferiorly.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic without evidence of focal renal lesion\nwithin the limitations of a nonenhanced exam. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Contrast material from a prior\nexam is seen in the colon. Otherwise, colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. A peritoneal dialysis catheter is seen coiling in\nthe right mid abdomen.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. A circular IUD is noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is moderate intra-peritoneal ascites, similar to the prior study in\n___. Otherwise, no acute CT findings in the abdomen and pelvis to\ncorrelate with patient's reported symptoms." }, { "input": "LOWER CHEST: Mild dependent atelectasis visualized bilaterally. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is submucosal fatty\nreplacement in the terminal ileum and ascending colon suggestive of prior\ninflammatory episode and likely nonacute findings. The remaining small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the descending and sigmoid colon is noted, without evidence\nof wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus and adnexae are within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nBilateral L5 spondylolysis is noted with grade 1 anterolisthesis of L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process. No evidence of appendicitis or\ndiverticulitis.\n2. Submucosal fatty replacement in the terminal ileum and ascending colon\nsuggestive of a prior inflammatory episode." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHepatic cysts measuring up to 1.8 cm in segment III are unchanged. The\nhepatic veins and portal veins are patent. The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly is slightly increased in size measuring 17.7 cm and\npreviously measuring 17.1 cm (series 8, image 34). Incidental small accessory\nspleen. No focal splenic lesions identified. Splenic vein is patent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.0 cm exophytic simple renal cyst arising from the posterior\naspect of the interpolar to lower pole of the left kidney. No suspicious\nrenal lesions identified. No hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: Abdominopelvic lymphadenopathy is minimally changed, many lymph\nnodes unchanged and some lymph nodes minimally larger. A representative\nceliac lymph node measures 1.1 cm, retro caval lymph node conglomerate\nmeasures 3.6 x 3.3 cm (3.7 x 3.3 cm when remeasured on the prior examination),\nleft periaortic lymph node measures 1.5 cm, left 2.3 x 2.2 cm, and right\nexternal iliac conglomerate measures 3.5 x 2.0 cm (3.4 x 1.7 cm when\nremeasured on the prior examination) (series 4, images 56, 67, 77, 88, and\n110).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small, fat containing inguinal hernia.", "output": "Minimally changed abdominopelvic lymphadenopathy with many nodes unchanged and\nfew nodes minimally enlarged. Splenomegaly is slightly increased, measuring\n17.7 cm and previously measuring 17.1 cm." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.8 cm hypodense lesion left lobe of the liver likely represents a cyst or\nbiliary hamartoma. Additional subcentimeter hypodense lesion in the left lobe\nof the liver measuring 0.9 cm (05:20) and in the right lobe of the liver\nmeasuring 0.5 cm (05:24) also likely represent cysts or biliary hamartomas. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged measuring 15.8 cm. There are no focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. There is a 2.4 cm simple cyst arising from the lower\npole left kidney.\n\nGASTROINTESTINAL: There is small hiatal hernia. Stomach is otherwise\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is extensive retroperitoneal lymphadenopathy. A\nconglomerate of aortocaval nodes measures approximately approximately 3.2 x\n2.0 cm (05:32). Numerous prominent and enlarged retroperitoneal nodes extend\nalong the left periaortic region. There are also numerous enlarged periportal\nlymph nodes the largest of which measures up to 2.4 cm (05:24). There are\nalso numerous small mesenteric lymph nodes which appear most prominent in the\nileocolic region, measuring up to 1.1 cm (05:46). There is also enlarged\nbilateral external iliac nodes. The largest on the left measures up to 1.4 cm\n(5:72). Largest on the right side measures up to 1.6 cm (5:75). Enlarged\nmesorectal lymph node measures up to 1.0 cm (5:65).. Prominent left inguinal\nnode measures 1.4 cm (5:82).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Fat\ncontaining umbilical hernia is noted.", "output": "1. Extensive retroperitoneal, mesenteric, and pelvic lymphadenopathy.\n2. Splenomegaly, up to 15.8 cm.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Bibasilar atelectasis is noted. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n2.8 cm hypoattenuating lesion with peripheral nodular enhancement is\ncompatible with a hemangioma centered in segment V. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.9 cm round well-circumscribed hypoattenuating structure in the interpolar\nregion of the left kidney (2:25) is likely a simple cyst. There is no\nhydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are multiple loops of\ndilated small bowel, which demonstrate mucosal hyperemia. The appendix is\nmarkedly abnormal (601: 24 through 32). It is dilated at the base up to 1.9\ncm with lack of a clearly defined enhancing wall at the base (602:25, and at\nthe tip (602:34). There is adjacent stranding. Intraluminal appendicolith is\nlikely present. There is adjacent free fluid though no discrete peripherally\nenhancing abscess. There is extraluminal air in the right lower quadrant with\ntrace foci over the liver as well. Findings are compatible with a ruptured\nappendicitis. There are marked secondary local inflammatory changes in the\nright lower quadrant, involving adjacent small bowel loops and cecum. \nOverall, the small bowel loops are relatively distended and fluid-filled\nthroughout their entire course suggesting a secondary ileus.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications are noted in the prostate. The\nseminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is an accessory right renal artery incidentally noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nTrace retrolisthesis of L5 on S1 is likely degenerative in etiology.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Ruptured acute appendicitis with free intra-abdominal fluid and air. Marked\nsecondary inflammatory changes of the adjacent small bowel loops and base of\nthe cecum with suspected ileus. There is free fluid though no discrete\nabscess.\n\nNOTIFICATION: The updated findings were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 10:06 pm." }, { "input": "LOWER CHEST: Bibasal atelectasis. Small bilateral pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 30 mm\nhypodense multilobulated lesion within segment ___ is stable in comparison to\nthe prior examination, with enhancement pattern on the prior exam suggestive\nof a hemangioma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nBilateral renal cortical cysts, the largest measuring 2.9 cm in the interpolar\nregion of the left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Again demonstrated is a dilated gas and fluid-filled\nappendix arising from the cecal pole measuring up to 1.8 cm. Arising from the\nsuperior wall of the appendix near its base, there is now a 3.1 x 3.3 x 9.3 cm\nrim enhancing collection which extends cranially the and is inseparable from\nthe appendix (axial series 2, image 50; coronal series 601, image 18). \nAdditional small collections are noted along the anterior abdominal wall\nmeasuring 1.8 x 2.8 cm (axial series 2, image 66) and 1.2 cm (axial series 2,\nimage 68).\n\nthe stomach is unremarkable. Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The bladder is moderately distended but appears otherwise\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Findings in keeping with perforated appendicitis, with interval development of\nadjacent rim enhancing collection suggestive of abscess formation. Additional\nsmaller pockets of fluid are noted along the lower anterior abdomen." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nHEPATOBILIARY: Re-demonstration of a central right hepatic lobe 3 cm\nhypoenhancing lesion with discontinuous rim of enhancement consistent with a\nhemangioma. Remainder of the liver homogeneously enhances with patent portal\nand hepatic veins. There is no biliary ductal dilatation. Gallbladder\nappears under distended.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or pancreatic masses.\n\nSPLEEN: Spleen is normal in size.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY:There is no hydronephrosis. There are bilateral renal cortical cysts\nwith the largest in the interpolar region on the left measuring 3 cm.\n\nGASTROINTESTINAL: There is no bowel obstruction. There is interval\nimprovement of the inflammatory changes around the appendix on the right with\ncomplete resolution of the multiloculated abscesses. The drain is noted along\nthe right abdominal wall. The appendix appears normal in caliber. Noted are\ncolonic diverticulosis without diverticulitis.\n\nPERITONEUM: There is no free fluid, free air or residual abscess collections.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches. Venous structures appear patent.\n\nPELVIS: Urinary bladder is distended. Prostate is mildly enlarged. Rectum is\nunremarkable.\n\nBONES:Osseous structures are unremarkable.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Complete resolution of appendiceal abscesses in the right lower quadrant.\n2. Central right hepatic lobe hemangioma.\n\nRECOMMENDATION(S): The right lower quadrant drain was removed after the CT\nimages were obtained by Dr. ___ fellow." }, { "input": "There is a 10 x 7 mm solid pulmonary nodule in the left lower lobe (3:7).\nThere are aortic valvular calcifications. The lower chest is otherwise\nunremarkable.\n\nAssessment of the solid visceral structures of the abdomen and pelvis is\nlimited without IV contrast.\n\nABDOMEN:\n\nThe anterior abdominal wall fluid collection beneath the ventral incision has\nresolved since the prior study. The fascia appears intact, although there is\nsome eventration of the peritoneal cavity in the incision.\n\nThe liver is homogeneous in attenuation, without focal lesion. The gallbladder\nis collapsed. The biliary tree is normal. The pancreas, spleen, and adrenal\nglands are normal. The kidneys are without stones, concerning solid lesion\n(within the limitation of non-contrast technique), or hydronephrosis. The\nstomach and duodenum are normal. The patient is status post partial colectomy.\nThe imaged loops of small bowel and large bowel are normal in caliber and\nthere is no mesenteric fat stranding. There is no intra- or retroperitoneal\nlymphadenopathy. There is no ascites, fluid collection, or pneumoperitoneum.\nThe abdominal aorta is normal caliber. A retroaortic left renal vein is\nnoted.\n\nMUSCULOSKELETAL:\n\nThere is no acute fracture. There is no concerning destructive osseous lesion.", "output": "1. Eventration of the fascia beneath the ventral incision, but no evidence of\nfascial discontinuity to suggest persistent hernia. Abdominal wall fluid\ncollection seen on the prior study has resolved.\n2. 10 mm left lower lobe pulmonary nodule concerning for malignancy. CT of the\nchest and oncologic workup is recommended.\n\nNOTIFICATION: Impression #2 above was entered by Dr. ___ on\n___ at 16:03 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: A small simple left pleural effusion is noted with adjacent\ncompressive lower lobe atelectasis. There is a tiny right pleural effusion as\nwell. A small hiatal hernia is noted. The imaged portion of the heart is\nunremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances homogeneously with small subcentimeter\nhypodensities in segment 3 and 6 as well as 8 likely small cysts though too\nsmall to characterize. There is no intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is unremarkable, without stones or gallbladder\nwall thickening. The main portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size with a normal enhancement pattern. \nTrace perisplenic fluid is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Both kidneys enhance symmetrically without signs of pyelonephritis\nor perinephric abscess. No hydronephrosis or focal concerning renal lesion. \nA left ureter oral stent is noted proximally coiled in the pelvis and distally\ncoiled in the bladder. There is a apparent thickening of the left ureter with\nperiureteral fluid noted. The right ureter appears relatively normal.\n\nGASTROINTESTINAL: A moderate sized axial hiatal hernia is noted. Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout.\nColon and rectum are within normal limits. Appendix contains air, has normal\ncaliber without evidence of fat stranding. Multiple prominent mesenteric lymph\nnodes are identified, none of which are pathologically enlarged by CT size\ncriteria.\n\nRETROPERITONEUM: There is no evidence of pathologic retroperitoneal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: There is marked thickening of the urinary bladder wall with hyperemia\nof the urothelium and extensive perivesical fluid. Findings are highly\nconcerning for bladder infection. The left ureteral stent terminates within\nthe urinary bladder. Hypo enhancement of portions of the prostate as seen on\nseries 2, image 80 could reflect recent laser procedure. Please correlate\nclinically. Distal portions of the colon appear normal. There is a small fat\ncontaining left inguinal hernia.\n\nBONES AND SOFT TISSUES: No worrisome bony lesion. No fracture. No\nsignificant degenerative disease.", "output": "1. Extensive mural thickening and urothelial hyperemia of the urinary bladder\nis concerning for severe cystitis. Recommend correlation with urinalysis.\n2. Left ureteral stent in place with thickening of the distal ureter and\nperiureteral fluid suggests ureteritis. No hydronephrosis or signs of\npyelonephritis.\n3. Abnormal enhancement of the prostate, likely reflects recent laser\nprocedure for which clinical correlation is advised.\n4. Small pleural effusions with compressive lower lobe atelectasis.\n5. Small hiatal hernia." }, { "input": "LOWER CHEST: Dependent and subsegmental atelectasis within the lung bases\nbilaterally. No focal consolidations. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Accessory spleen at the hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A percutaneous nephrostomy is seen on the left, which appears\nappropriate. There is no evidence of hydronephrosis bilaterally. There are\nmultiple foci of segmental hypoperfusion within the upper pole of the left\nkidney, compatible with pyelonephritis. There is a moderate amount of\nperinephric stranding surrounding the left kidney, which may be related to\nnephrostomy placement or due to infection. There is a normal nephrogram on the\nright. No focal lesions are visualized.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Bladder is decompressed by a Foley, and cannot be adequately evaluated\non this examination. Air within the bladder lumen is likely due to\ncatheterization. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Note is made of gynecomastia. The abdominal and pelvic wall is\nwithin normal limits.", "output": "1. Status post right percutaneous nephrostomy without evidence of\nhydronephrosis.\n2. Multiple foci of segmental hypoperfusion within the upper pole of left\nkidney, compatible with pyelonephritis. Moderate amount of perinephric\nstranding surrounding left kidney, which may be post procedural or due to\ninfection. No focal fluid collections or evidence of abscess formation.\n3. No other acute abnormalities within the abdomen or pelvis." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 2\nsubcentimeter hepatic hypodensities are too small to characterize, however are\nnot significantly changed, likely representing hepatic cysts or biliary\nhamartomas. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nFew tiny a cortical hypodensities in the right kidney are not significantly\nchanged, previously characterized as cysts on MRI. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is mild wall thickening and mild mucosal\nhyperenhancement of the distal/terminal ileum extending to the ileocecal valve\n(601:32, 2:67). Proximal to this segment, small bowel tapers gradually, but\nthere is there are mildly dilated loops of small bowel measuring up to 3.6 cm,\nthe more proximal of which are more prominent in caliber compared with prior. \nThe appendix is not visualized, however there are no secondary signs of acute\nappendicitis. There is no evidence of free air or free fluid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Partial or mild small-bowel obstruction proximal to a segment of distal\nileum/terminal ileum with mild wall thickening and mild mucosal\nhyperenhancement, consistent with mild active Crohn's inflammation." }, { "input": "LOWER CHEST: Small bilateral pleural effusions, along with bibasilar\natelectatic and consolidative change, worse at the right base. Please\ncorrelate clinically for underlying right lower lobe pneumonia.\n\nABDOMEN:\n\nHEPATOBILIARY: Heterogeneous appearance of the hepatic parenchyma with\ndecreased attenuation seen, specifically around the gallbladder fossa. This\nlikely represents an area of focal steatosis, which may be a response to the\nacute inflammatory episode. No definite liver lesions identified. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nThe portal, splenic, and superior mesenteric veins appear patent, although\nassessment is slightly limited by the timing of the study, especially with\nregards to the more distal superior mesenteric branches.\n\nModerate amount of ascites is noted, which appears of slightly higher density\nand more dependent areas suggestive of a hemorrhagic component.\n\nPANCREAS: There is diffuse swelling and inflammatory change seen surrounding\nthe pancreas, compatible with the known underlying pancreatitis. There is\nhypo enhancement noted at the level of the pancreatic head compatible with\nfocal pancreatic necrosis at this level.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is wall thickening and edema surrounding the second\nand third stage of the duodenum, likely reactive from the overlying pancreatic\nchanges. Mild wall thickening of the proximal jejunal loops is likely also\nreactive, or alternatively secondary to underdistention. Few uncomplicated\ndiverticula are seen in the ascending colon.\n\nA nasogastric tube is seen with tip in the antrum of the stomach.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Progression of the patient's pancreatitis, with increased ascites (portions\nof which appear slightly higher density suggesting hemorrhagic component), and\ninterval development of necrosis at the pancreatic head as detailed above. \nThe necrotic pancreatic parenchyma accounts for 5 to 10% of the gland overall.\n2. Patent portal, splenic, and superior mesenteric vein. No evidence of\nsplenic artery pseudoaneurysm. No other vascular complication.\n3. Small bilateral pleural effusions and bibasilar atelectatic change,\nespecially prominent at the right base where there are air bronchograms. Focal\nconsolidation an underlying pneumonia at this level is not excluded, and close\nclinical correlation is warranted.\n4. Geographic hypoattenuation of the hepatic parenchyma near the gallbladder\nfossa suggestive underlying steatosis, which may be reactive to the patient's\nunderlying inflammatory episode.\n5. Severe inflammatory changes of the second and third stage of the duodenum\nwhich are likely reactive, without evidence of obstruction, perforation, or\nother complication at this level." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is no calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Scarring and platelike atelectasis noted in the right lung base. \nThere is also mild dependent compressive atelectasis bilaterally. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: There is stable appearance of a heterogeneous hypodensity in the\nhead of the pancreas measuring 2.9 x 3.0 cm, compatible with known acute\nnecrotizing pancreatitis. There is interval increase in previously visualized\nhomogeneous fluid collection surrounding the pancreas with fluid seen\ndiffusely tracking along the retroperitoneum in the anterior perirenal space,\nright greater than left, and tracking inferiorly into the right pericolic\ngutter and into the pelvis. The largest homogeneous fluid collection is seen\nmeasuring 4.0 x 16.4 cm (4:94). There is no evidence of pancreatic ductal\ndilatation. No evidence of walled off rim enhancing collection.\n\nSPLEEN: The spleen is enlarged, measuring up to 15.5 cm in the craniocaudal\nprojection, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A feeding tube is noted in the stomach. Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Colon\nand rectum are within normal limits. Appendix is not definitively visualized.\nThere is no evidence of mesenteric lymphadenopathy. The rectal tube is\nidentified.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Air is noted in the decompressed bladder, due to Foley\ninstrumentation. The distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse edema is noted throughout the subcutaneous tissues,\ncompatible with anasarca. There is a small nonobstructed small bowel\ncontaining right femoral hernia.\n\n ACUTE PANCREATITIS:\n\nExtent of pancreatic non-enhancement on portal venous phase: <30%\nIs there a collection:Yes, measuring 4.0 x 16.4 Cm\nIf yes, choose one description per question:\n\n-Relation with pancreas: Intrapancreatic and adjacent to pancreas\n-Encapsulation: None\n-Content: Homogeneous\n-Mass effect: No\n-Shape: Irregular\n-Loculated gas bubbles: No\n-Air-fluid levels: No\nVascular complications: none\nPancreatic duct: Normal\nCalcifications: None\n\nConclusion:\nACUTE NECROTIC COLLECTION (heterogeneous, non-fluid, not encapsulated, <4\nweeks since pancreatitis onset) within the pancreatic head, as well as ACUTE\nPERIPANCREATIC FLUID COLLECTION (homogeneous fluid, confined by normal fascial\nplanes, no definable wall, adjacent to the pancreas, <4 weeks since\npancreatitis onset) within the anterior pararenal space, bilaterally although\nright greater than left, and tracking inferiorly along the right paracolic\ngutter into the pelvis.", "output": "1. Stable appearance of acute necrotizing pancreatitis of the pancreatic head\nwith interval increase in acute peripancreatic fluid collection since prior\nexam in ___.\n2. Support devices are identified including feeding tube, Foley catheter, and\nrectal tube.\n3. Mild splenomegaly, measuring up to 15 cm.\n4. Diffuse anasarca." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Area of heterogeneity with hypoattenuation at the head of the\npancreas remains, but is improved from the ___ CTA exam with much of\nthe head of the pancreas returning to normal attenuation. There is persistent\nfluid collection from the head of the pancreas tracking along Gerota's fascia\nand along the right pelvic wall. This has decreased in size with the largest\naxial measurements occurring at 10 cm by 3 cm decreased from 14.1 x 13.4 cm\n(series 6, image 87). This collection appears less organized as well.\n\nSPLEEN: The spleen shows increased size at 15.1 cm, yet normal attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Interval removal of a transesophageal tube that previously\nterminated in the jejunum. The stomach is unremarkable. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Resolving pancreatitis with decrease in size of associated fluid collection\nalong Gerota's fascia, which has decreased in size to 10 cm x 3 cm from 14.1\ncm x 13.4 cm.\n2. Splenomegaly" }, { "input": "LOWER CHEST: There is bilateral dependent atelectasis. Otherwise, the lung\nbases are clear. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrate normal morphology without suspicious\nfocal lesions. A subcentimeter hypoattenuating lesion in the hepatic dome\n(series 3, image 101) is too small to characterize but statistically most\nlikely representing a cyst. There is no biliary ductal dilatation.\nThere is marked mural edema of the gallbladder, unchanged from prior and\nsecondary to likely third spacing.\n\nPANCREAS: The pancreas enhances homogeneously throughout. There is no\npancreatic ductal dilatation. Again seen is an approximately 10.8 x 9.7 x\n10.1 cm fluid collection with internal complexity and enhancing rim anterior\nto the pancreas in the lesser sac and extending to the mesentery. There is\nmass effect on the pancreatic body, new from prior. No foci of air is seen in\nthe collection. Constellation of findings is consistent with walled-off\nnecrosis. When compared to ___, the walled-off necrosis is smaller in\nsize (previously approximately 14.4 x 11.2 x 11.0 cm in size when remeasured\nin similar fashion) and appears more organized. Surrounding fat stranding has\ndecreased.\n\nThe SMV near the portal confluence appears focally narrowed (series 3, image\n31 and series 602, image 38), uncertain if secondary to nonocclusive thrombus\nwithin the lumen or mass effect from adjacent walled-off necrosis, unchanged\nin appearance compared to ___. The portal veins and splenic vein are\npatent.\nSPLEEN: The spleen is normal in size and attenuation without focal lesions.\n\nADRENALS: The adrenal glands are remarkable.\n\nURINARY: The kidneys are symmetric in size with normal nephrogram. A 1.2 cm\ncyst arising from the upper pole of the right kidney is unchanged. There is\nno hydronephrosis. No suspicious renal mass. No perinephric abnormalities.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small and large bowel\ndemonstrate no obstruction. There is sigmoid diverticulosis without\ndiverticulitis. The appendix is not visualized.\n\nPELVIS: The bladder wall is circumferentially thickened, which could be due to\nunderdistention or underlying cystitis. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Scattered retroperitoneal lymph nodes are not enlarged by CT\ncriteria. No mesenteric, pelvic, or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Minimal atherosclerotic disease is\nnoted.\n\nBONES: No suspicious osseous lesions or acute fracture. There are mild\ndegenerative changes of the thoracolumbar spine and bilateral hips.\n\nSOFT TISSUES: There are small bilateral fat containing inguinal hernias,\nlarger on the left. There is a small fat containing umbilical hernia.", "output": "1. Walled-off necrosis measuring approximately 10.8 x 9.7 x 10.1 cm in the\nlesser sac and extending to the mesentery, decreased in size compared to the\nprior study from ___, and more organized appearance with less\nsurrounding fat stranding. Associated mass effect on the pancreatic body is\nnew from prior. Homogeneous enhancement of the pancreatic parenchyma.\n2. Unchanged focal narrowing of the SMV near the portal confluence, uncertain\nif secondary to nonocclusive thrombus within the lumen or mass effect from\nadjacent walled-off necrosis, unchanged in appearance compared to ___.\n3. Marked mural edema the gallbladder, unchanged from prior and likely\nsecondary to third spacing.\n4. Circumferential wall thickening of the bladder, which could be secondary to\nunderdistention or underlying cystitis. Correlation with clinical symptoms\nand urinalysis is recommended." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nfluid collection with rim enhancement along segment VI causing mass effect on\nthe adjacent liver and tracking along the lateral conal fascia measures about\n5.6 x 5.9 x 10.9 cm, and is new from ___ (6:26, 8:33) there is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis collapsed.\n\nPANCREAS: Again demonstrated is a primarily hypoattenuating collection with\nhyperattenuating material layering dependently arising from the pancreatic\nbody/tail, measuring approximately 8.0 x 10.7 x 9.9 cm (6:33, 8:15). This\nappears somewhat more organized than on the prior study. There remains mass\neffect upon the pancreatic parenchyma but no ductal dilation. The remainder\nof the pancreatic parenchyma is normally enhancing. Mass effect upon the\nporta splenic confluence causes attenuation, but not occlusion.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 13 mm right upper pole cyst is unchanged. There is no evidence of\nsuspicious renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Rim enhancing fluid collection along hepatic segment VI is new in\ncomparison with ___. This is most likely a fluid collection related\nto prior pancreatitis, likely a pseudocyst or walled-off necrosis.\n2. Walled-off necrosis anterior to the pancreatic body/tail appears more\norganized in comparison with ___, but is grossly unchanged in size. \nThere remains mass effect upon the porta splenic confluence causing\nattenuation but not occlusion of the portal and splenic veins at this level.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 20:16 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Trace bibasilar pleural effusions. Small bibasilar patchy and\nconfluent consolidations,, most likely atelectasis. Trace oral contrast\nwithin the right lower lobe is new likely reflect aspiration. Coronary artery\ncalcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is collapsed there are gallstones, and possible\nvicarious excretion of contrast.\n\nPANCREAS: There is interval increase in extensive peripancreatic stranding,\nconsistent with known pancreatitis. There are new fluid collections about\npancreas, stomach, largest component measuring 3.8 x 8.6 cm, with hyperdense\nareas,, consistent with blood products.. No intraperitoneal free air. Mild\nperitoneal thickening, likely reactive.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. Small amount of bilateral\nperinephric stranding persists.\n\nGASTROINTESTINAL: The stomach is unremarkable. Few mildly distended small\nbowel loops, suggestive mild adynamic ileus. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Moderate to\nlarge amount of intraperitoneal ascites, with fluid tracking along the right\nparacolic gutter extending into the lower pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Subtle areas of mildly increased attenuation within confluence of\nportal vein and SMV, and 1 of the SMV tributaries, partial thrombosis cannot\nbe excluded. Consider ultrasound or MR venogram.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes of the visualized spine.\n\nSOFT TISSUES: Fat only containing bilateral inguinal hernias. Tiny fat only\ncontaining periumbilical hernia.", "output": "1. Interval increase in extensive peripancreatic stranding, and fluid\ncollections, components are hyperdense, consistent with hemorrhagic\npancreatitis.\nNo evidence of extraluminal air.\n2. Mild volume intraperitoneal ascites.\n3. Cholelithiasis, possible component of vicarious contrast excretion.\n4. Small bibasilar patchy and confluent consolidations, likely atelectasis. \nThere is small area of aspirated contrast within right lower lobe. Clinically\ncorrelate to exclude infection.\n5. Subtle areas of mildly increased attenuation within confluence of portal\nvein and SMV, and 1 of the SMV tributaries, partial thrombosis cannot be\nexcluded. Consider ultrasound, CT or MR venogram.\n\nRECOMMENDATION(S): Ultrasound of the upper abdominal veins, or CT/MR\nvenogram.\n\nNOTIFICATION: The findings were discussed with ___ , M.D. by\n___, M.D. on the telephone on ___ at 11:32 pm, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild prominence of the central\nintrahepatic bile ducts and CBD are likely related to patient's post\ncholecystectomy status. There is no distal obstructive mass or calculus. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n9 mm left renal cyst is unchanged. There is no solid renal mass. No\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nextensive colonic diverticulosis, particularly in the sigmoid colon. There is\nmucosal hyperenhancement, wall thickening and peripheral mesenteric stranding\ninvolving a short segment of proximal sigmoid colon suggestive of\nacute/subacute inflammatory changes. There is no associated fluid collection\nto suggest gross perforation. There is no bowel obstruction. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia noted.", "output": "Acute/subacute diverticulitis involving a short segment of the proximal\nsigmoid colon. No associated complications.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 4:07 pm." }, { "input": "The absence of intravenous contrast administration limits the evaluation of\nthe intraabdominal solid organs and the bowel.\n\nLungs: Please see the report of the CT chest performed on the same day for\nmore details.\n\nLiver: The liver is homogeneous with a smooth contour. No suspicious liver\nlesion.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder is unremarkable.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: The kidneys are unremarkable. There is no hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nGastrointestinal: The colon is fluid-filled. There is no evidence of bowel\ndilatation or obstruction. There is no bowel wall thickening. The appendix is\nunremarkable.\n\nVascular: There are mild-to-moderate atherosclerotic calcifications of the\nabdominal aorta.\n\nLymph nodes: There is no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion. There are\nmild-to-moderate degenerative changes at L4-L5 associated with inferior\nendplate sclerosis of L4. There is lumbarization of the S1 vertebral body.", "output": "Fluid-filled colon, consistent with the patient's history of diarrhea. No\nevidence of bowel dilatation or obstruction. No bowel wall thickening.\n\nPlease see the report of the CT chest performed on the same day for more\ndetails." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 1.8 cm left adrenal nodule likely on the lateral limb\n(series 2, image 16) with ___ measurement of 14. The right adrenal gland is\nnormal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 2.3 x 3.1\ncm low-density lesion in the interpolar region of the left kidney (series 2,\nimage 26), not fully characterized on this examination. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is colonic diverticulosis\nwithout evidence of diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is soft tissue/hyperdense stranding surrounding the right\nfemoral vessels extending from the level of the inguinal canal to the\nsuperficial femoral arteries (series 2, image 74). In addition, there are\nmultiple right-sided inguinal lymph nodes which are not enlarged by CT size\ncriteria and have preserved fatty hilum.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen throughout the visualized spine. There are\ndegenerative changes at the bilateral sacroiliac joints and bilateral hip\njoints.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Soft tissue/hyperdense stranding surrounding the right femoral vessels\nlikely representing non organized small hematoma.\n2. Low-density left renal lesion, not fully characterized on this examination\nand may represent a simple cyst. Ultrasound or cross-sectional imaging with\ndedicated renal mass protocol can be obtained as clinically indicated.\n3. There is colonic diverticulosis without evidence of diverticulitis.\n4. Left adrenal nodule with Hounsfield units slightly above is expected to\ndefinitively characterize in adrenal nodule. Followup cross-sectional imaging\nwith CT or MRI with dedicated adrenal mass protocol can be obtained." }, { "input": "LOWER CHEST: Since the prior study performed approximately 2 weeks earlier,\nbilateral pleural effusions persist, marginally increased on the right and\nthere is associated consolidation in the lower lobes, inferior lingula and\nright middle lobe likely representing a combination of atelectasis and\naspiration sequelae. There is ground-glass opacity within the lungs\nconcerning for edema with background emphysema. The left axillary to right\natrial conduit is again seen projecting in unchanged position. Pacer device\nand wire less pacer tip again seen in unchanged position. Hypodense\nappearance of the intracardiac blood pool suggests anemia. Coronary artery\ncalcification as well as mitral annular calcifications are noted.\n\nABDOMEN: The study is very limited due to the lack of IV contrast and\nintra-abdominal fat. Oral contrast seen in loops of the small bowel.\n\nHEPATOBILIARY: Unenhanced appearance of the liver is normal. The gallbladder\nis distended.\n\nPANCREAS: The pancreas is suboptimally visualized.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Adrenal glands are not well visualized.\n\nURINARY: Right renal atrophy with vascular calcifications in keeping with\nknown end-stage renal disease in ongoing hemodialysis. The left kidney is not\nseen.\n\nGASTROINTESTINAL: The stomach is unremarkable containing a surgical clip,\nunchanged. Loops of the small and large bowel are decompressed. There is no\nbowel obstruction. There is small amount of ascites. Appendix not\nvisualized.\n\nPELVIS: Bladder is decompressed and not seen. There is small amount of free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Grossly unremarkable.\n\nLYMPH NODES: No definite adenopathy.\n\nVASCULAR: Heavily calcified aorta and its branches throughout.\n\nBONES: Mid sternotomy wires noted in the distal sternum and partially\nvisualized. The vertebral bodies appear diffusely dense in keeping with\nend-stage renal disease osteodystrophy. Degenerative changes seen throughout\nthe lower thoracic and lumbar spine. No acute fractures or worrisome lesions.\n\nSOFT TISSUES: Calcification in the left side of the lower abdominal wall is\nsimilar to prior.", "output": "1. No bowel obstruction.\n2. Moderate layering pleural effusions with lower lung consolidations likely\ndue to atelectasis and aspiration sequelae.\n3. Pulmonary edema as well as emphysema.\n4. Interval distention of the gallbladder without pericholecystic edema.\n5. Gallbladder distension for which clinical correlation is advised.\n6. Small volume ascites." }, { "input": "LOWER CHEST: Atelectasis is noted in the bilateral lung bases. There are\nsmall bilateral dependent, layering, nonhemorrhagic pleural effusions. There\nis no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of concerning focal lesions. Vague hypodensity\ncompatible with small amount of focal fat/transient hepatic attenuation\ndifference is seen in the hepatic segment 4A. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent with small amount stranding in the gallbladder fossa\ncompatible with recent postsurgical change. No active contrast extravasation\nis present. Hepatic arterial vasculature is patent without evidence of\nocclusion or irregularity. Portal and hepatic veins are widely patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Incidental note is made of an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The visualized small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe visualized portions of the colon appear unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Incidental note is made of a replaced right hepatic artery off the\nSMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes are seen along the midline anterior\nabdominal wall. A small fat containing ventral hernia is noted.", "output": "1. Normal appearance of the hepatic arteries without evidence for injury,\nstenosis or occlusion.\n2. Status post recent cholecystectomy with expected postsurgical changes in\nthe gallbladder fossa, but no fluid collection.\n3. Small bilateral layering, nonhemorrhagic pleural effusions." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Mild circumferential wall thickening of the distal esophagus\nis consistent with history of esophageal cancer. The stomach is unremarkable.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process.\n2. Circumferential wall thickening of the distal esophagus consistent with\nhistory of esophageal cancer." }, { "input": "LOWER CHEST: Please refer to separate CT chest report.\n\nABDOMEN: The liver, spleen, pancreas, adrenal glands and kidneys are\nunremarkable. Note is made of a small 1 x 2 cm pocket of loculated fluid\nadjacent to the upper pole of the spleen, likely postoperative.\n\nGASTROINTESTINAL: Patient is status post distal esophagectomy and gastric\npull-up. No free-air or intestinal obstruction.\nA percutaneous jejunostomy tube is in place through the left lower quadrant.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen.", "output": "Interval esophagectomy and gastric pull-up. No metastatic disease in the\nabdomen and pelvis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post esophagectomy with gastric pull\nthrough. Postsurgical changes are re-demonstrated with no focal abnormalities\nidentified. A percutaneous jejunostomy tube is re-demonstrated. The small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is re-demonstration of S shaped scoliosis with a rightward upper\nthoracic curvature and compensatory leftward lumbar curvature. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No metastatic disease or lymphadenopathy identified within the abdomen or\npelvis.\n2. Please see same day CT chest for characterization of thoracic findings." }, { "input": "LOWER CHEST: There is left basilar atelectasis. Lung bases otherwise clear. \nA small left pleural effusion and a moderate pericardial effusion, both\nslightly decreased compared to prior CT examination.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is diffuse moderate intrahepatic\nbiliary dilation, worse on the left side and worsened compared to the recent\nMRCP except in hepatic segment 6 where the CBD stent appears to terminate. \nThe gallbladder is densely opacified with contrast and contains a small amount\nof air, presumably related to recent ERCP.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding. Pancreatic duct stent is noted.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Status post distal esophagectomy and gastric pull-through\nprocedure with unremarkable appearance of the anastomosis. Intra-abdominal\nlinear soft tissue adjacent to the greater curvature of the stomach is\nunchanged from prior exam (02:17). Few subcentimeter soft tissue nodules\nalong the greater curvature of the stomach are new compared to the prior exam\n(02:21). Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nProminent ileocolic lymph nodes are not significantly changed from prior. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 1.4 x 1.9 cm faintly hyperenhancing lesion in the low\nright rectus abdominal muscle (2:61) that previously appeared only as a tiny\nfocus of hyperenhancement and was FDG avid on recent PET CT. Abdominal and\npelvic walls are otherwise within normal limits.", "output": "1. Interval placement of CBD stent and pancreatic duct stent with interval\nworsening of moderate diffuse intrahepatic biliary dilation with the exception\nof now decompressed ducts in segment 6 where the CBD stent terminates.\n2. Soft tissue implants adjacent to the greater curvature of the stomach are\nnew from prior CT and concerning for metastatic disease.\n3. Faintly enhancing 1.9 cm lesion in the right rectus abdominus muscle is\nincreased in size from prior exam and avid on recent PET-CT, concerning for\nmetastasis.\n4. Unchanged moderate pericardial effusion and small left pleural effusion." }, { "input": "LOWER CHEST: Atelectasis is also seen at the left lung base likely due to\ngastric pull-through. There is mild linear atelectasis in the right middle\nlobe. There is trace left pleural effusion and a moderate pericardial\neffusion, similar to prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is diffuse moderate intrahepatic\nbiliary dilatation, worse in the left hepatic lobe compared to the right and\nappears mildly worsened compared to the prior CT. There has been interval\nremoval of a biliary stent. The gallbladder is contracted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There has been interval\nremoval of a pancreatic duct stent. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Subcentimeter\nhypodensities in bilateral kidneys are too small to characterize but are\nlikely simple cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post distal esophagectomy and gastric\npull-through. The anastomosis is unremarkable. Subcentimeter soft tissue\nnodules are again seen along the greater curvature of the stomach (2; 14, 16).\nAdditional nodule just inferior to the left lobe of the liver (02:23) measures\napproximately 1 cm previously 0.8 cm and not seen on remote prior exam from\n___, worrisome for metastatic disease. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. Mild\ndiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is normal. There is no free air.\n\nPELVIS: The urinary bladder wall appears mildly thickened, recommend\ncorrelation with urinalysis. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is S shaped scoliosis of the thoracolumbar spine.\n\nSOFT TISSUES: There is a 1.5 x 2 cm hyperenhancing lesion in the right rectus\nabdominus muscle, similar to prior (2; 55).", "output": "1. Status post removal of a CBD and pancreatic duct stent with mild interval\nworsening of moderate diffuse intrahepatic biliary dilatation, more severe in\nthe left hepatic lobe.\n2. Stable soft tissue nodules along the stomach and enhancing right rectus\nabdominus lesion consistent with metastases.\n3. Unchanged moderate pericardial effusion and trace left pleural effusion." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:\n\nCorresponding with the ultrasound finding there is a large multilobulated,\nheterogeneously enhancing mass in the central liver measuring approximately\n18.9 x 13.0 x 17.5 cm in overall ___. This contains central\nlow-density components that are likely necrotic. A duct the dominant mass\nseems to stem from segment 4. There are few smaller enhancing nodules\nseparate from the main lesion, likely representing intrahepatic metastases. \nFor example, there is a 2.3 cm enhancing subcapsular nodule in segment 6. \nThere is marked peripheral biliary dilation due to obstruction from the mass.\n\nThe background liver appears normal with no cirrhotic morphologic changes or\nsurface nodularity.\n\nThere is no significant extrahepatic biliary dilation. Associated with the\nmass lesion is substantial moderate to severe biliary dilatation involving all\nintrahepatic ducts still visible within spared areas of the Liver parenchyma,\nwhich are mostly in the right lobe, specially posterior segments, and in the\nleft-lateral segments. The common bile duct is measured at 6 mm at the level\nof the pancreatic head. The gall bladder is unremarkable.\n\nPANCREAS: The pancreas is moderately atrophied but otherwise unremarkable. \nThere is no main pancreatic duct dilation.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: Both kidneys are unremarkable aside from diffuse small cortical\nhypodensities, likely benign cysts. There is no hydronephrosis. The bladder\nis decompressed by a Foley catheter. Evaluation of the lower pelvis is\nlimited by metal artifact from a right hip arthroplasty.\n\nGASTROINTESTINAL: The stomach is unremarkable. The small bowel is grossly\nunremarkable. There is a rectosigmoid anastomosis. The large bowel is all\notherwise unremarkable aside from distal colonic diverticulosis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is mild ectasia of the infrarenal aorta measuring up to 2.5 cm\nin AP dimension. Moderate atherosclerotic disease is noted.\n\nBONES: There is a mild anterior wedge compression fracture of the L1 vertebral\nbody, which appears nonacute. No aggressive bone lesions are identified. \nThere is grade 1 retrolisthesis of L3-L4, which appears degenerative.\n\nSOFT TISSUES: There is a small fat containing right inguinal hernia. There is\nalso a small to moderate fat containing hernia in the right anteromedial\nabdominal wall musculature with a 2.1 cm neck.", "output": "Large, heterogeneously enhancing, multilobulated liver mass is most consistent\nwith intrahepatic cholangiocarcinoma. Less likely differential may include\nhepatocellular carcinoma. There is evidence of intrahepatic biliary\nobstruction in both the left and right lobes. Satellite nodules are likely\nintrahepatic metastases." }, { "input": "LOWER CHEST: There is atelectasis at the left lung base. There is no\npericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The gallbladder surgically absent. There is pneumobilia which\nlikely relates to prior biliary intervention. There is no ductal dilation. \nNo focal liver lesion seen. The portal vein is patent.\n\nPANCREAS: There is enhancing pancreatic parenchyma identified. Surrounding\nthe pancreas are ill-defined irregular and lobulated fluid collections,\noverall similar appearance to ___ from ___. These extend from the\nsuperior aspect of the pancreas where the largest collection measures\napproximately 5.2 x 3.0 cm to the inferior aspect of the pancreas surrounding\nsuperior mesenteric vein. The largest inferior collection measures\napproximately 7.3 x 1.6 cm (transverse by CC) also not largely changed. There\nis no significant pancreatic fat stranding. The pancreatic duct is not\ndilated. Small cystic pancreatic lesions described on previous MRI are not\nseen on CT.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. An accessory spleen is present.\n\nADRENALS: The right adrenal gland is unremarkable. Mild nodularity of the\nleft adrenal gland is unchanged.\n\nURINARY: The kidneys enhance symmetrically. There is a 1.7 x 2.2 cm\nenhancing mass in the midpole of the left kidney (series 2, image 39), also\nseen on prior MRI. There is a simple cyst in the lower pole of the left\nkidney. There is no hydronephrosis.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nThe small bowel is normal in caliber without focal wall thickening. The large\nbowel is also normal in caliber without focal wall thickening. The appendix\nis well-visualized and normal. There is no intra-abdominal free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. The splenic vein and SMV are attenuated by the peripancreatic fluid\ncollections but remain patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nsclerotic lesion along the superior endplate of the T11 vertebral body is\nlikely a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of bowel obstruction.\n2. Multiple ill-defined fluid collections surrounding the pancreas, overall\nsimilar to MRCP from ___, consistent with hemorrhagic walled-off\nnecrosis.\n3. 17 mm mass in the midpole of the left kidney highly suspicious for renal\ncell carcinoma, not significantly changed from prior MRI.\n4. Status post cholecystectomy with pneumobilia." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion. Patient is status post aortic valve\nreplacement.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates heterogeneous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is borderline enlarged measuring . Stable hypodensities\nare again seen in the spleen possibly representing hemangiomas.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nCysts are seen in bilateral kidneys, the largest being a 4.6 cm cyst in the\nlower pole of the right kidney. There is no evidence of focal renal lesions\nor hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is mildly enlarged.\n\nLYMPH NODES: Again noted are enlarged retroperitoneal and pelvic sidewall\nlymph nodes, the largest measuring 2.4 cm in the right periaortic region\n(02:36), unchanged in size. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate to severe multilevel degenerative changes of the lower thoracic and\nlumbar spine are noted.\n\nSOFT TISSUES: Mesh tacks are seen along the anterior abdominal wall compatible\nwith prior hernia surgery. Again seen are fat containing supraumbilical\nhernias. Fat containing right inguinal hernia is also noted with clips likely\nrepresenting prior surgery.", "output": "1. Gallbladder wall thickening with mucosal hyperenhancement with moderate\ngallbladder distension. No intra or extrahepatic biliary ductal dilation. \nFindings may reflect early acute cholecystitis. Further evaluation with\ngallbladder ultrasound is advised.\n2. Prominent lymph nodes and borderline splenomegaly likely reflect known\nhistory of lymphoma.\n\nRECOMMENDATION(S): US of the gallbladder.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:28 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: A small simple appearing right pleural effusion is noted. Mild\ninterstitial edema is suspected with septal thickening noted at the right lung\nbase. The imaged portion of the heart is unremarkable. No pericardial\neffusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally containing no focal concerning\nlesion. Mild focal fat deposition is seen along the margin of segment 4B. \nMain portal vein is patent. No intrahepatic or extrahepatic biliary ductal\ndilation.\n\nPANCREAS: The pancreas enhances normally. There is no evidence of\npancreatitis or focal concerning lesion.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: Both right and left adrenal glands appear normal.\n\nURINARY: There is a fat containing lesion arising from the upper pole of the\nleft kidney unchanged from prior measuring 18 x 18 mm most likely representing\nan angiomyolipoma. Otherwise the kidneys appear normal with symmetric\nenhancement and prompt excretion.\n\nGASTROINTESTINAL: The stomach is unremarkable as is the duodenum. Small bowel\nloops demonstrate no signs of ileus or obstruction. Though the appendix is\nnot definitively visualized, there are no secondary signs of appendicitis in\nthe right lower quadrant. The colon is thin walled containing only a minimal\nfecal load. No free air or fluid collection.\n\nPELVIS: The urinary bladder is decompressed. The uterus and adnexal regions\nappear normal. Trace free fluid is likely physiologic. There is no pelvic\nsidewall or inguinal adenopathy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild soft tissue thickening is seen at the level of the\numbilicus without discrete fluid collection. Please correlate clinically. No\nhernia is seen. A lower abdominal incision line is noted without\ncomplication.", "output": "1. Mild soft tissue thickening at the level of the umbilicus, without discrete\nfluid collection, or hernia.\n2. Small right pleural effusion, mild interstitial edema at the right lung\nbase." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. Again seen, at the superior pole of\nthe of the left kidney is fat containing lesion consistent with an\nangiomyolipoma measuring 1.8 x 1.8 cm, (series 601, image 29). There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnot visualized, there are no secondary signs of acute appendicitis in the\nright lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis that is most likely physiologic..\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nThere is a 1.2 cm corpus luteal cyst in the right adnexa, (series 5, image\n58).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stable mild soft tissue thickening at the level of the\numbilicus, without discrete fluid collection (series 5, image 37).", "output": "1. No bowel obstruction.\n2. Unchanged, mild soft tissue thickening at the level of the umbilicus,\nwithout discrete fluid collection." }, { "input": "LOWER CHEST: Bases of the lungs are clear. There is no pleural effusion..\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Stable 1.5 x 1.4 cm fat containing lesion with central solid\ncomponent in the left upper pole of the kidney is compatible with the known\nangiomyelolipoma. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Diffuse pneumoperitoneum and small amount of subcutaneous\nemphysema in the abdominal wall, in keeping with recent laparoscopic surgery. \nThe stomach is unremarkable. Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small amount\nof free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Postsurgical changes from recent hysterectomy and\nbilateral salpingectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild degree of umbilical soft tissue thickening, unchanged since\nprior CT. Small amount of subcutaneous emphysema along the abdominal wall,\nparticularly on the left.", "output": "Post surgical changes seen in the pelvis in this patient with recent\nhysterectomy, with no drainable collection. Small volume free residual free\nair reflect postop status." }, { "input": "LOWER CHEST: Visualized lung fields are notable for bilateral basilar\natelectasis. A 5 mm nodule is noted in the left lower lobe, and 2 millimetric\nnodules are noted in the right lower lobe, all unchanged from prior. There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic biliary dilatation. Prominence of\nthe proximal common bile duct is similar in appearance to prior. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes the lumbar spine. Grade 1 retrolisthesis L5\non S1 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intraabdominal process to explain the patient's symptoms.\n2. 5 mm nodule in the left lower lobe and multiple millimetric nodules in the\nright lower lobe are unchanged from prior." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple tiny hepatic hypodensities are noted, too small to characterize but\nlikely representing cysts or biliary hamartomas. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is mildly thickened, which may reflect\nesophagitis from recent vomiting. The patient is status post tumor resection\nfor a GIST tumor performed on ___. Expected postoperative changes\nare noted, including a midline incision site and surgical suture material\nalong the distal stomach with mild adjacent stranding along the surgical bed\nand slight wall thickening within the lesser curvature. The gastric fundus is\ndilated with fluid with a transition point noted in the caliber of the stomach\nat the antrum in the region of the resection bed. Oral contrast material is\nidentified distal to the stomach within the small bowel. There is no evidence\nof extraluminal contrast extravasation.\n\nOn today's examination, the duodenum is not seen to cross midline, although\nthis may be postsurgical. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is normal. No free air or free fluid is present.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Fibroid\nuterus is demonstrated without adnexal masses. There is no free fluid in the\npelvis.\n\nLYMPH NODES: Prominent gastrohepatic ligament lymph nodes are seen, the\nlargest measuring up to 10 mm in greatest short axis dimension (02:16). There\nis no retroperitoneal lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. There is grade 1 anterolisthesis of L5 on S1 with bilateral\nL5 pars interarticularis defects, unchanged from ___.", "output": "1. Distention of the proximal stomach with fluid with transition point in the\ndistal stomach in the region of the resection bed. Passage of oral contrast\ninto the small bowel distally suggests subtotal, postoperative gastric outlet\nobstruction.\n2. Status post GIST tumor resection with postoperative changes and no\nevidence of extraluminal contrast extravasation or focal fluid collection.\n3. Mildly thickened distal esophageal wall suggestive of esophagitis which\nmay be due to recent vomiting.\n4. Fibroid uterus." }, { "input": "LOWER CHEST: Small bilateral pleural effusions. Extensive consolidative\nchange at the left lower lobe suggestive of focal pneumonia/ aspiration.\n\nABDOMEN:\n\nHEPATOBILIARY: Shrunken, dysmorphic hepatic contour in keeping with the known\nunderlying cirrhosis. A 1.5 cm hypodense lesion is seen in segment 8 of the\nliver, incompletely characterized but suspicious given the underlying history.\nNew further characterization with dedicated MRI is recommended. There are no\nother focal lesions within the limitations of an unenhanced scan. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\ncontains gallstones without wall thickening or evidence of inflammation.\n\nLarge amount of simple density ascites is seen in the abdomen and pelvis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Wall thickeningof the ascending and proximal transverse\ncolon is likely on the basis of third spacing/portal colopathy. Otherwise the\nvisualized small and large bowel loops are unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Uterus and adnexal structures are unremarkable in\nappearance.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is subcutaneous edema seen compatible with\nanasarca/third-spacing. There is no evidence of retroperitoneal hematoma.", "output": "1. No evidence of retroperitoneal hematoma, no definite cause for patient's\nhemoglobin and hematocrit drop identified.\n2. Cirrhotic appearing liver with 1.5 cm hypodense lesion in segment ___. \nFurther evaluation with dedicated MRI is recommended.\n3. Left lower lobe consolidation, compatible with underlying pneumonia or\naspiration. For continued follow-up with chest radiographs.\n4. Wall thickening involving the ascending and proximal transverse colon is\nlikely a reflection of third spacing/ portal colopathy." }, { "input": "For a full report on the chest component of this examination, please refer to\nseparate CT report performed on the same day.\n\nCT of the abdomen: There is a tiny hypodensity in the right hepatic lobe which\nis too small to further characterize (series 2, image 54). The liver otherwise\nenhances homogeneously without focal hepatic lesions identified. There is no\nintrahepatic biliary ductal dilatation. The gallbladder is normal. The\nadrenal glands, pancreas and spleen are normal. Incidental note is made of a\n10 mm accessory spleen. The kidneys enhance symmetrically and excrete contrast\nwithout evidence of hydronephrosis or renal masses.\n\nThe stomach, small and large bowel are grossly unremarkable. The appendix is\nnormal. There is no retroperitoneal or mesenteric lymph node enlargement by\nCT size criteria. There is no free fluid. There is no free air.\n\nCT of the pelvis: The urinary bladder and terminal ureters are normal. There\nis a 2.1 x 1.5 cm cyst in the left adnexa. The rectum is normal. There is no\npelvic free fluid. There is no inguinal or pelvic lymph node enlargement by\nCT size criteria.\n\nOsseous structures: No blastic or lytic lesion concerning for malignancy\nidentified.", "output": "No acute intra-abdominal findings, specifically no evidence for malignancy." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of solid focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid focal renal lesions or hydronephrosis. \nEnlarged, 9.7 cm, exophytic cyst is present arising from the lower pole of the\nright kidney with no interval change since previous exams. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. Extensive pelvic lymph node\nresection seen as evidence by numerous pelvic clips.\n\nVASCULAR: Again intra-aortic EVAR is seen with no interval changed position\nsince the previous exam. A 2.5 cm in diameter infrarenal saccular aneurysm.is\nagain seen with no interval change and no evidence of endoleak.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nPELVIS: Post prostate resection. Post pelvic wall nodal dissection\n\nBLADDER: There is asymmetric thickening and enhancement in right\nposterior/inferior bladder wall. Artifacts from surgical clips obscure detail\nbut there is no significant perivesical extension in the pelvic soft tissues.\n\nSKELETAL: No blastic or lytic lesions in the visualized bones of the abdomen\nand pelvis.", "output": "1. Thickened and the enhancing right posterolateral urinary bladder wall which\nmay correspond to the known bladder neuroendocrine tumor.\n2. Post prostate resection and pelvic node dissection with no evidence of\nlocal recurrence or distal metastasis." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No focal consolidations. No pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild central intrahepatic biliary\ndilatation, unchanged. No extrahepatic biliary dilatation. The gallbladder\nis surgically absent.\n\nPANCREAS: There is near complete fatty replacement of the pancreas. No focal\nlesions. No ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is moderate hydronephrosis on the left due to UPJ obstruction,\nnew compared to prior. The etiology appears to be a crossing renal artery\n(series 601, image 32). Multiple simple cysts are seen within the left\nkidney. Additional subcentimeter hypodensities within the kidneys bilaterally\nare too small to characterize. Otherwise, the kidneys are of normal and\nsymmetric size with normal nephrogram. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is either absent or atrophic. Within the left\nadnexa, there is a predominantly cystic but multi septated lesion with solid\ncomponents measuring 5.7 x 5.0 cm in maximum axial ___, which is\nconcerning for an epithelial neoplasm, and should be evaluated with a pelvic\nultrasound or MRI.\n\nLYMPH NODES: A peripherally calcified lesion within the left mesentery may be\nsequela of epiploic appendagitis or fat necrosis (series 2, image 44). There\nis no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted. Infrarenal abdominal\naorta is mildly ectatic, however there is no evidence of aneurysm.\n\nBONES: Lower most sternotomy wires appear intact. Severe degenerative changes\nthroughout the lumbar spine with S shaped scoliosis. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild diffuse subcutaneous edema. The abdominal and pelvic wall\nis within normal limits.", "output": "1. Left UPJ obstruction with moderate hydronephrosis, new compared to prior,\nlikely due to a crossing renal artery.\n2. Multiseptated solid and cystic lesion within the left adnexa measuring up\nto 5.7 cm, concerning for an epithelial neoplasm, and should be evaluated with\na pelvic ultrasound or MRI on a nonemergent basis.\n3. Other incidental findings include a small hiatal hernia, diverticulosis,\nand an ectatic infrarenal abdominal aorta.\n\nRECOMMENDATION(S): Pelvic ultrasound or MRI on a nonemergent basis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. A small right\npleural effusion and trace left pleural effusion with associated bibasilar\nsubsegmental atelectasis. The distal esophagus is dilated and shows diffuse\nconcentric wall thickening measuring approximately 7 mm in maximum thickness\n(series 5, image 1).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nFocal hypodensities along the falciform ligament represent focal areas of\nfatty infiltration. There is no suspicious liver lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal size with normal nephrogram. Multifocal\nareas of cortical scarring are seen involving both kidneys, more pronounced on\nthe right. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The appendix is\nnormal. There is a focal area of mild wall thickening involving the mid\ntransverse colon spanning over a length of 2.9 cm (series 5, image 33) with\nmaximum wall thickness measuring 8 mm. The entire colon is filled with\nmoderate amount of fecal matter.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted involving the abdominal aorta with diffuse calcific atherosclerotic\nchanges involving bilateral common iliac, external and internal iliac\narteries..\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative disc disease at L4-L5 level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No significant abnormality to explain the patient's symptoms.\n\n2. Focal area of mild diffuse wall thickening involving the transverse colon,\nthis may be related to underdistention however this can be further evaluated\non colonoscopy if clinically indicated.\n3. Diffuse concentric wall thickening involving the distal esophagus, this can\nbe further evaluated on an upper GI endoscopy if clinically indicated.\n4. Multifocal areas of cortical scarring involving both kidneys, worse on the\nright, this could be secondary to an ischemic insult versus prior infectious\ninsults." }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for a description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous hypodensities of different size and shape are again\ndemonstrated throughout the liver parenchyma, compatible with metastatic\ndisease. Since the prior exam, there is significant improvement in the\nappearance of the left lobe, best appreciated on the coronal images.\nHyperenhancement of the parenchyma surrounding the metastatic hypodensities is\nno longer readily apparent in the left lobe, and the size and contour of the\nleft lobe is more normal appearing compared to the prior exam (e.g, Series\n601b, Image 11 today and Series 7, Image 15 on ___. Remaining, largely\nconfluent hypodensities in the left lobe may reflect a combination of residual\nmetastatic tumor and post-treatment changes. The metastatic lesions in the\nright lobe are overall stable from the prior exam. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\ncontracted and overall unremarkable. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without focal\nlesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout, without\nfocal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nThere is no evidence of stones, focal renal lesions, hydronephrosis, or\nperinephric abnormality. The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. The colon and rectum are within normal\nlimits. No bowel obstruction, free air, or intraabdominal fluid collection.\n\nRETROPERITONEUM: No retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No calcium burden in the abdominal\naorta and great abdominal arteries.\n\nPELVIS: No pelvic or inguinal lymphadenopathy. No free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: No evidence of worrisome lesions. Levoconvex\nscoliosis of the lumbar spine is stable. Multi-level degenerative changes are\nalso stable. Mild grade 1 anterolisthesis of L4 on L5 is unchanged. \nSchmorl's nodes at T11-T12 are also unchanged. Other than post-surgical\nappearance from prior flap surgery, the abdominal/pelvic wall is unremarkable.", "output": "1. Significant interval improvement in the left hepatic metastases as\ndetailed above.\n\n2. Overall minimal change in the multiple scattered hepatic metastases in the\nright lobe.\n\n3. No additional intra-abdominal or pelvic lesions identified on CT.\n\n4. Please refer to the CT chest report from the same day for thoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hypoenhancing hepatic lesions throughout the liver\nare again seen, including wedge-like diffuse involvement of the left hepatic\nlobe, in particular segment III, demonstrating improvement since ___ but with minimal change from the ___ study. Reference right\nhepatic lobe lesions include:\n- Segment VI subcapsular lesion measuring 1.7 x 2.0 cm (05:54), not\nsignificantly changed since ___.\n- Segment V lesion measuring 1.8 x 1.7 cm (05:56), not significantly changed\nsince ___.\nThe left hepatic appears slighlty more atrophic since the ___ study.\n\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries. Hepatic artery\noriginates off the aorta.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nMinimal L4-5 anterolisthesis. Abdominal and pelvic wall is within normal\nlimits. Small umbilical fat containing hernia.", "output": "1. Continued left hepatic lobe atrophy. Unchanged right hepatic metastases\nsince ___, decreased from ___.\n2. No new abdominopelvic metastasis or lymphadenopathy." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The previously identified hypodense lesions within the liver\nare stable in size, measuring 14 x 13 mm (02:51) 17 x 9 mm (02:54) 15 x 19 mm\n(02:60) and 15 x 18 mm (02:63). There is new diffuse heterogeneity of the\nhepatic parenchyma with increased nodularity of the liver contours (series 5,\nimage 17). There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is sigmoid\ndiverticulosis. The colon and rectum are otherwise within normal limits. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Incidental note is made of duplicated right renal arteries,\nduplicated right renal veins, and an accessory left hepatic artery arising\nfrom the left gastric artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild lumbar scoliosis is and grade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New widespread heterogeneity of the hepatic parenchyma with increased\nnodularity of the liver contour since ___, concerning for increased\nmetastatic burden versus chemotherapy toxicity. Correlate with tumor markers\nand LFTs.\n2. Please refer to separate report for same-day CT chest for complete\ndescription of the thoracic findings.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 19:54 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please see same day separately dictated CT chest report for\nthoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Compared to ___, similar appearance of nodular\ncontours with irregular enhancement, compatible with pseudocirrhosis status\npost treatment of breast cancer metastases. No new lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows an unchanged subcentimeter hypodense lesion in the\nanterior portion (___), too small to characterize.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis. The colon and rectum are otherwise within normal limits. The\nappendix is not visualized, however, there are no secondary signs to suggest\nappendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post TAH-BSO.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nof the left internal iliac artery is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is partial sacralization of L5. There is grade 1 anterolisthesis of L4\non L5. There are mild multilevel degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Compared to ___, unchanged appearance of the liver with nodular\ncontours and irregular enhancement, compatible with pseudocirrhosis status\npost treatment of breast cancer metastases. No new hepatic lesions. No\nevidence of distant metastases. No lymphadenopathy." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Compared with CT ___, the appearance of the liver, with\nnodular contours and irregular enhancement consistent with pseudo cirrhosis\nstatus post breast cancer metastases treatment, is not significantly changed. \nThere are no new focal hepatic lesions. The gallbladder is within normal\nlimits. The right portal vein is narrowed by surrounding fibrosis, however\nthe portal vein, SMV and splenic vein are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. A\nsubcentimeter hypodense lesion along the anterior spleen is incompletely\ncharacterize, however is similar to prior (2:51).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is sacralization of L5. Mild anterolisthesis of L4 on L5 is not\nsignificantly changed. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No significant change in appearance of the heterogeneous and nodular liver,\nconsistent with pseudo cirrhosis status post breast cancer metastases\ntreatment. No new focal hepatic lesions.\n2. No additional evidence of metastatic disease in the abdomen or pelvis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "Lung bases: Minimal bibasilar atelectasis. Right middle lobe and lingular\nscarring is similar to ___. The visualized heart is unremarkable.\nNo pericardial or pleural effusion.\n\nAbdomen: Evaluation of the abdominal organs is limited without administration\nof IV contrast. Subcentimeter hepatic lesions are too small to characterize\nbut appear unchanged since ___. The nonenhanced liver is otherwise\nunremarkable. The spleen and right adrenal gland are unremarkable. There is an\nindeterminate lesion in the left adrenal gland, similar in size and morphology\nto ___. The gallbladder contains a 4 mm hyperdensity consistent with a\ngallstone. No gallbladder wall thickening. The stomach is unremarkable.\n\nThe common bile duct appears grossly within normal limits measuring 6 mm in\ndiameter. The head of the pancreas appears expanded with a poorly defined\nhypodense area worrisome for an underlying lesion. A 2.1 cm pleomorphic cystic\nlesion was present in this region in ___. No pancreatic duct dilatation or\natrophy.\n\nPelvis: There is a large complex cystic and solid mass measuring approximately\n19.5 x 12.7 x 20.6 cm (transverse by AP by caudal cranial ___\nappearing to arise from the pelvis and extending into the mid abdomen.\nMultiple internal solid appearing components are present, most prominent in\nthe left lower portion of this lesion. A 2.8 cm left adnexal solid lesion\npreviously seen on ___ is no longer identified. There is\nextrinsic compression of adjacent structures including bowel as well as the\ndistal ureters.\n\nThe lesion has associated mass effect upon the bowel resulting in a few\nsegments of distended small and large bowel. There are several mildly dilated\nloops of small bowel without evidence of complete bowel obstruction. Oral\ncontrast is seen within distal colon. However, there is partial bilateral\nurinary tract obstruction with bilateral hydronephrosis, severe on the right\nand mild on the left. The kidneys are otherwise unremarkable.\n\nNo omental or peritoneal nodularity. No retroperitoneal or mesenteric\nlymphadenopathy. There is scattered calcification along the abdominal aorta. \nThe unenhanced appearance of the intra-abdominal systemic vasculature is\notherwise unremarkable. No abdominal wall hernia or pneumoperitoneum. The\nbladder is unremarkable. No pelvic side-wall or inguinal lymphadenopathy. No\nfree pelvic fluid or inguinal hernia.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy. Lack of sagittal reformats limits evaluation of the spine.", "output": "1. Complex cystic and solid mass arising from the pelvis extending into the\nmid abdomen measuring up to 20.6 cm. This mass is concerning for a primary GYN\nmalignancy and biopsy is advised.\n\n2. Ill-defined hypoattenuating pancreatic head lesion, enlarged since ___\nand incompletely characterized. MRCP is recommended for further evaluation.\n\n3. New bilateral hydronephrosis, right greater than left, secondary to\nextrinsic compression of the ureters by the pelvic mass. Surgical or\ninterventional decompression should be considered.\n\n4. Indeterminate left adrenal gland lesion, not fully characterized but\nstable in morphology since ___. Further evaluation via MRI may be performed." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.\n\nMild periportal edema and gallbladder wall edema may represent third spacing\nfrom IV fluid hydration.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSub center hypodensities are noted in the interpolar regions of bilateral\nkidneys are too small to characterize but likely represent renal cysts. No\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nTransitional anatomy noted at the lumbosacral junction.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal finding to explain patient's abdominal pain.\n2. Mild periportal edema and gallbladder wall edema may represent third\nspacing from IV fluid hydration" }, { "input": "LOWER CHEST: There is mild dependent atelectasis of the left lung base,\notherwise the visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n1.2 cm hypodensity is seen upper pole of the left kidney, likely a simple\ncyst. There is no evidence of focal renal lesions or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small volume\nof free fluid in the pelvis, which is likely physiologic in a patient of this\nage.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. Bilateral adnexae are within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a L5 right pars defect.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "No acute intra-abdominal process, specifically no hydronephrosis or\nobstructing calculi." }, { "input": "LOWER CHEST: Bilateral pleural effusions with bibasilar atelectasis is noted. \nMild coronary artery calcifications are also noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality. A 1.3 cm simple cyst is noted in the lower pole of the right\nkidney (series 2; image 37). A 1.1 cm hemorrhagic cyst is noted in the\ninterpolar region of the right kidney (series 2; image 37).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal. VP shunt is noted to terminate in the\nleft upper quadrant. No fluid collection along the shunt tract or at the\nshunt tip.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. 2.0 x\n1.8 cm calcified soft tissue mass is noted posterior to the left paraspinal\nmuscles at the level of T12. This finding is likely benign although given the\npatient's clinical history differential includes sebaceous cysts versus\nmetastatic disease. Targeted ultrasound to further characterize including\ninternal vascularity recommended if clinically appropriate.", "output": "1. VP shunt noted to terminate in the left upper quadrant without surrounding\nfluid collection.\n2. No evidence of small-bowel obstruction or ileus.\n3. 2.0 x 1.8 cm soft tissue mass with calcification located within the\nsubcutaneous fat of the left back at the level of T12. This finding is\nlikely benign, differential includes a sebaceous cyst. A metastatic lesion is\nunlikely , however a targeted ultrasound to further characterize this is\nrecommended .\n\nRECOMMENDATION(S): Dedicated ultrasound of the left posterior back to better\ncharacterize the subcutaneous lesion." }, { "input": "LOWER CHEST: There is a trace right pleural effusion. There is no evidence of\nleft pleural effusion or pericardial effusion. There is bibasilar atelectasis\nin the lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are unchanged hypodense lesions in the right kidney, which are\nincompletely characterized but most likely represent renal cysts. Peripelvic\ncysts are seen in the inferior pole of the left kidney. There is no evidence\nof hydronephrosis. There is no perinephric abnormality. There is concentric\nthickening of the bladder and mild surrounding fat stranding.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.\nScattered diverticulosis of the colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is normal.\n\nOTHER: There is no free fluid or air in the abdomen or pelvis.\n\nREPRODUCTIVE ORGANS: There are brachytherapy seeds in the prostate gland.\n\nLYMPH NODES: There is no lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no suspicious osseous lesion or acute fracture. There are\nmild degenerative changes at L5-S1. Mild to moderate degenerative changes are\nalso noted within the bilateral hips.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.", "output": "1. Mild bladder wall thickening and trace surrounding fat stranding, which may\nrepresent under distension or developing cystitis. Correlation with\nurinalysis is recommended.\n2. No urinary stone, hydronephrosis or hydroureter.\n3. Colonic diverticulosis without evidence of diverticulitis.\n4. Moderate hiatal hernia.\n5. Trace right pleural effusion." }, { "input": "LOWER CHEST: There is a 2.8-mm nodule in the anterior right lower lung\n(Series 2, Image 5; Series 602b, Image 15). There is a 2.7-mm subpleural\nnodule in the posterior lower right lung (Series 2, Image 12). The visualized\nleft lung is clear. There is no pleural or pericardial effusion.\n\nHEPATOBILIARY: There is congenital enlargement of the right lobe with\nextension of the inferior tip below the inferior pole of the right kidney. The\nliver surface contour is smooth, and there is homogenous attenuation\nthroughout the liver parenchyma. There is no focal lesion. There is no\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is not\nmarkedly distended and appears normal, without stones or wall thickening.\nThere is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without focal\nlesions, pancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout, without focal\nlesions. There are two sub-centimeter, round lesions anterior and superior to\nthe spleen, most likely splenules.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nIn the lower pole of the right kidney, there is a 3.2 x 3.1 x 3.6-cm\nwell-circumscribed, thin-walled, round lesion with fluid attenuation of 19 ___,\ncorresponding to the 2.7 x 2.6 x 2.5-cm simple renal cyst demonstrated on\nprior US that is increased in size as expected. There is no evidence of\nstones, concerning focal renal lesions, hydronephrosis, or perinephric\nabnormality. The ureters are unremarkable, without a filling defect. The\nurinary bladder is partially distended with contrast and urine and appears\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The colon and rectum are within normal limits.\nStool is seen throughout the colon. The appendix is not visualized, but no\nsecondary signs of appendicitis are noted. There is no evidence of\ndiverticulitis. There is no bowel obstruction, pneumatosis, intra-abdominal\nfree air or fluid collection.\n\nRETROPERITONEUM: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm or calcification.\n\nPELVIS: There is no pelvic or inguinal lymphadenopathy. There is no free fluid\nin the pelvis. The uterus is within normal limits.\n\nBONES AND SOFT TISSUES: There is no suspicious lytic or sclerotic bony lesion.\nThere is a small, fat-containing, ___ umbilical hernia (Series\n602b, Image 33). Otherwise, the abdominal and pelvic walls are within normal\nlimits. No hernia is identified.", "output": "1. No specific CT finding to explain the patient's right-sided abdominal pain.\nSpecifically, no evidence of appendicitis, colitis, or diverticulitis.\nIncidental stool-filled colon.\n\n2. Expected interval increase in the size of the right simple renal cyst, now\n3.6-cm in maximum dimension.\n\n3. Incidental 2.7-2.8-mm right lung nodules. Correlation with patient risk\nfactors and symptoms, and consideration of dedicated chest imaging is\nrecommended. According the ___ Guidelines for pulmonary nodules\n<= 4 mm, if the patient is high risk, follow-up CT is recommended in ___ year,\nand if the patient is low risk, no additional follow-up imaging is needed.\n\n4. Incidental ___ umbilical hernia.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 18:23 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "Heart size is normal with small pericardial effusion. There is severe 3\nvessel coronary artery calcification. There is a small left-sided pleural\neffusion with mild left base atelectasis. There is a trace right-sided\npleural effusion.\n\nCT abdomen without contrast: Gallbladder is distended containing cholesterol\nstones and high density material. There is no pericholecystic stranding. The\nliver is grossly unremarkable. The spleen and adrenal glands are grossly\nunremarkable. Pancreas is diffusely atrophied. 1.6 cm and 1.1 cm cystic\nlesions of the mid pancreatic body are unchanged compared to the prior\nexamination with associated dilatation of the main pancreatic duct to 5 mm,\nunchanged.\n\n2.4 cm simple interpolar right renal cyst is noted. Kidneys are otherwise\ngrossly unremarkable without obvious mass, stone or hydronephrosis.\n\nA clip is noted within the gastric cardia. The stomach is otherwise grossly\nunremarkable. Duodenum and small bowel loops are normal caliber without\nevidence of obstruction. Sigmoid predominant diverticulosis is noted without\nevidence of diverticulitis. The large bowel is otherwise grossly unremarkable\nwithout pericolonic fat stranding or fluid collection.\n\nSevere atherosclerotic calcification is noted along a normal caliber abdominal\naorta. Suprarenal IVC filter is noted. There is no mesenteric or\nretroperitoneal lymphadenopathy by CT size criteria. There is no ascites or\npneumoperitoneum. There is a ventral abdominal hernia with defect measuring\n5.0 cm containing the anti mesenteric portion of the transverse colon\ncompatible with Richter's hernia.\n\nCT pelvis without contrast: Evaluation is limited by streak artifact from\nbilateral total hip replacement. Calcified uterine fibroids are noted. \nWithin these limitations, the latter and rectum are grossly unremarkable. \nThere is no free pelvic fluid or air. There is a another low ventral\nabdominal wall hernia containing fat (2:70). There is no inguinal or pelvic\nsidewall lymphadenopathy by CT size criteria.\n\nBones and soft tissues: Bilateral total hip replacements are in place. There\nis no suspicious focal bone lesion. Moderate superior endplate compression\ndeformity of the L1 vertebral body is unchanged. Grade 1 anterolisthesis of\nL4 on L5 is unchanged.", "output": "1. No acute findings in the abdomen or pelvis.\n2. Small left and trace right-sided pleural effusion.\n3. Cholelithiasis without evidence of cholecystitis.\n4. Unchanged pancreatic cystic lesions and main pancreatic ductal dilatation.\n5. Sigmoid predominant diverticulosis.\n6. 2 ventral abdominal wall hernias with the superior hernia containing the\nanti mesenteric transverse colonic wall compatible with Richter's hernia.\n7. Unchanged moderate superior endplate compression deformity of the L1\nvertebral body." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. There is a 6 mm nodule in the left\nlower lobe (2:9). No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is either a markedly atrophic left hepatic lobe or\nfindings of prior head left hepatectomy, however no sutures or clips are\nvisualized and the gallbladder is within normal limits.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are within normal limits.\n\nURINARY: There is mild UPJ obstruction on the left as well as mild to moderate\nbilateral hydronephrosis, worse on the left both ureters are moderately\ndilated throughout their entire intra-abdominal course, and seen entering into\nthe left inguinal hernia. No significant delayed nephrogram is seen.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia. An enteric tube\nterminates within the body of the stomach. There are multiple dilated,\nfluid-filled loops of small bowel and a decompressed terminal ileum,\nconsistent with a small-bowel obstruction. Please note there is fluid\nthroughout the proximal colon. The transition point is seen in the right\nlower quadrant in the distal ileum. There is a redundant sigmoid colon is\nredundant and crosses the midline. Changes of appendectomy are seen. \nApparent 6 mm right omental nodule on series 2, image 74 is likely dense\ncontents within a diverticulum.\n\nPELVIS: The distal ureters and urinary bladder are partially located within\nthe left inguinal hernia and there is asymmetric bladder wall thickening\nmeasuring up to 8 mm. There is a small amount of ascites extending into the\nleft inguinal hernia. Soft tissue stranding within the omentum contained\nwithin the hernia is nonspecific in the setting of ascites.\n\nLYMPH NODES: No abdominal or pelvic lymphadenopathy.\n\nVASCULAR: The right hepatic vasculature is patent.\n\nBONES: There is no evidence of worrisome osseous lesions. A hypodensity in\nthe left posterior aspect of the L2 vertebral body is consistent with a\nhemangioma.\n\nSOFT TISSUES: There is a large left inguinal hernia which contains part of the\nbladder in the distal ureters, as well as some ascites. No bowel is seen\nwithin the hernia. There is a fat containing right inguinal hernia.", "output": "1. Small-bowel obstruction with transition point in the right lower quadrant. \nPlease note there is a moderate amount of fluid in the ascending colon. \nAlthough the oral contrast is not seen past the transition point, the bowel\nobstruction could be partial given the moderate amount of fluid in the colon.\n2. Left inguinal hernia containing the distal ureters and part of the bladder\nwith bilateral hydroureteronephrosis. The asymmetric bladder wall thickening\nmay be due to inflammation/infection or neoplastic. The omentum within the\nleft inguinal hernia demonstrates diffuse haziness which is nonspecific in the\nsetting of small amount ascites.\n3. Findings of either a left hepatectomy or chronic diffuse atrophy of the\nleft hepatic lobe.\n4. 6 mm left lower lobe nodule. Please see ___ recommendations below.\n\nRECOMMENDATION(S): CT chest in ___ months to reassess the left lower lung\nnodule.\n\n\nNOTIFICATION: The preliminary findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 10:15 am." }, { "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple ill-defined hypoenhancing hepatic lesions. Representative lesions\nmeasure 2.5 x 1.9 cm in segment IV, 1.6 x 1.5 cm in segment IV/segment V, and\n1.4 x 1.2 cm in segment II. Incidental transient hepatic attenuation\ndifference adjacent to the groove of the falciform ligament. The portal veins\nare patent. No evidence of intrahepatic or extrahepatic biliary dilatation. \nThe gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic. No focal lesions or pancreatic ductal\ndilation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Incidental accessory spleens.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA simple left renal cyst measures 3.9 x 3.4 cm. A 1.4 lesion in the left\nkidney is intermediate in attenuation. A hypoattenuating lesion in the left\nkidney is too small to completely characterize, but probably reflects an\nadditional simple cyst. No hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops are unremarkable. No bowel obstruction. \nThe colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable for patient age.\n\nLYMPH NODES: Extensive retroperitoneal lymphadenopathy. The largest aggregate\nof retroperitoneal lymph nodes located in the lower abdomen spans up to 9.6 x\n8.8 cm, encasing the infrarenal abdominal aorta and extending into the left\npsoas muscle. Left external iliac lymphadenopathy measures up to 2.0 cm in\nshort axis. Morphologically abnormal retrocrural lymph nodes measure up to\n8.2 cm short axis. Some lymph nodes appear heterogeneous, compatible with a\ndegree of necrosis. Enhancing soft tissue nodules are seen superficial and\nsuperior to the left iliacus musculature measuring up to 1.7 x 1.1 cm (series\n2, image 57). Mesenteric lymph nodes are subcentimeter in size. There is\nmild nonspecific mesenteric fat stranding.\n\nVASCULAR: No abdominal aortic aneurysm. No significant atherosclerotic\ndisease.\n\nBONES/SOFT TISSUES: There is no aggressive osseous lesion or acute fracture.\nIncidental mid to lower thoracic spine hemangioma.", "output": "1. Findings most likely represent neoplasm of unknown primary with hepatic\nmetastases, extensive retroperitoneal lymphadenopathy including involvement of\nthe left external iliac chain, encasement of the aorta, and invasion of the\nleft psoas muscle, and enhancing soft tissue nodules adjacent and superior to\nthe left iliacus muscle. Differential considerations include carcinoma,\nlymphoma, or a left lower extremity malignancy such as melanoma given\nasymmetric left pelvic lymphadenopathy. Recommend correlation for left lower\nextremity lesions including skin lesions. Lymphadenopathy would be amenable\nto percutaneous biopsy.\n2. Small, round, well-circumscribed intermediate attenuation right renal\nlesion, possibly hemorrhagic or proteinaceous cyst. This could be further\nassessed with nonemergent renal ultrasound.\n\nRECOMMENDATION(S):\n1. Malignancy of unknown primary with hepatic metastases, extensive\nretroperitoneal lymphadenopathy including involvement of the left external\niliac chain, encasement of the aorta, and invasion of the left psoas muscle,\nand enhancing soft tissue nodules adjacent and superior to the left iliacus\nmuscle. Differential considerations include carcinoma, lymphoma, or a left\nlower extremity malignancy such as melanoma given asymmetric left pelvic\nlymphadenopathy. Recommend correlation for left lower extremity lesions\nincluding skin lesions. Lymphadenopathy would be amenable to percutaneous\nbiopsy.\n2. Small, round, well-circumscribed intermediate attenuation right renal\nlesion, possibly hemorrhagic or proteinaceous cyst. This could be further\nassessed with nonemergent renal ultrasound." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodensities are again noted in the liver measuring up to 2 cm in\nsegment 4 A (series 5, image 50) which remains stable in size and previously\ncharacterized as hepatic hemangiomas on MRI. No new concerning focal liver\nlesion identified. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. There is mild diffuse thickening of the gallbladder wall\nwithout significant distention. No radiopaque gallstones identified. There\nis no pericholecystic fat stranding or free fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cysts are unchanged. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Urinary bladder is decompressed. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES:\nThere has been significant interval improvement in retroperitoneal and pelvic\nlymphadenopathy:\nConglomerate retroperitoneal nodal mass now measures 2 x 2.8 cm, previously\n8.8 x 9.6 cm\nPreviously seen enlarged left external iliac node is barely perceptible\n\nNo new enlarged lymph nodes identified.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Significant interval improvement in retroperitoneal and pelvic\nlymphadenopathy as documented above.\n2. Mild diffuse thickening of the gallbladder wall without distension or\nsurrounding inflammatory change is nonspecific and can be see in the setting\nof hypoalbuminemia, CHF or secondary to chronic liver disease." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hepatic hypodensities of the right and left lobes and\nhemangiomas on prior MR are stable. No new liver lesions are identified. \nThere is no biliary dilatation. The gallbladder demonstrates mild wall\nthickening, similar to prior. No pericholecystic fat stranding.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: Haziness around the left adrenal gland appears stable. Otherwise,\nthe bilateral adrenal glands are unremarkable.\n\nURINARY: Multiple bilateral renal hypodensities measuring up to 3.8 cm (4:74)\nare stable from prior, compatible with cysts. Otherwise, the kidneys are\nunremarkable.\n\nGASTROINTESTINAL: There is no evidence of bowel obstruction. Haziness of the\nmesentery suggestive of mild panniculitis appears stable.\n\nPELVIS: Diffuse, mild bladder wall thickening, with mild adjacent fat\nstranding. There is no free fluid in the pelvis.The uterus and bilateral\nadnexa are unremarkable.\n\nLYMPH NODES: A left para-aortic nodal conglomerate measures approximately 1.9\ncm (4:71), previously 1.8 cm at the site of the treated lymphoma. There is no\nnew abdominal ric or pelvic adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: The bones are diffusely osteopenic. A sclerotic focus of the L4\nvertebral body (09:45) is likely a bone island, unchanged from prior. There\nis no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Small, fat containing umbilical hernia.", "output": "1. Stable, treated retroperitoneal adenopathy, now measuring 1.9 cm,\npreviously 1.8 cm. No new adenopathy within the abdomen or pelvis.\n2. Diffuse mild bladder wall thickening with surrounding fat stranding may be\ncompatible with cystitis.\n3. Please refer to the separate report of the chest CT performed on the same\nday for intrathoracic characterization." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensity in segment 3 (2:65) and 6 (2:70). The hypodensity\nin segment 6 likely represent a simple cyst. There is mild dilation of the\nintrahepatic bile ducts, minimally progressed since ___. The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation. The common bile duct is dilated measuring up to 1.0 cm\n(601b:30). There is gradual tapering of the distal common bile duct. No\nobstructing stones are seen. A periportal lymph node is not pathologic by CT\ncriteria.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.9 cm parapelvic cyst in the midpole of the left kidney is grossly\nunchanged in size compared to exam on ___. 81.1 cm hypodensity in\nthe upper pole of the left kidney is likely a simple cyst. There is no\nhydronephrosis bilaterally. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. There is interval\ndecrease in mesenteric fat since ___.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is a 5 mm anterolisthesis of L4 over L5. Mild compression\ndeformity of T11 is unchanged since ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Intrahepatic biliary dilatation and common bile duct dilatation measuring\nup to 1.0 cm without obstructing lesions, somewhat progressed since ___. MRCP is recommended for further evaluation.\n2. Cholelithiasis.\n3. Stable renal cysts.\n\nRECOMMENDATION(S): Intrahepatic biliary dilatation and common bile duct\ndilatation measuring up to 1.0 cm without obstructing lesions, somewhat\nprogressed since ___. MRCP is recommended for further evaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:42 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion. Please refer to separate report of CT chest\nperformed the same day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable 5 mm cyst in segment 6. No new concerning liver lesion. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis is resected.\n\nPANCREAS: Patient is status post Whipple's procedure with resection of the\npatient's known pancreatic head mass. The pancreaticojejunostomy and\nhepaticojejunostomy appear uncomplicated. Stranding and fluid is noted within\nthe porta hepatis but there is no loculation. No soft tissue to suggest\nresidual tumor. Multiple fiducial markers are noted in the region of the\npancreatic bed.\n\nCeliac axis, SMA and common hepatic arteries are patent. Main portal vein and\nSMV is patent. Perigastric collateral vessels are demonstrated. Small amount\nof stranding is noted posterior to the mesenteric vessels.\n\nSPLEEN: Loculated perisplenic fluid collection is demonstrated measuring 7.8 x\n1.0 cm, likely a postoperative seroma. Spleen is otherwise normal in\nappearance.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Some small focal areas\nof hypo enhancement involving the cortex of the right kidney (4:109) and left\nkidney (4:116) are new since the prior exam. These may represent small focal\nrenal infarcts. Multiple small hypodense lesions are noted in both kidneys,\nlargest in the interpolar region of the left kidney measuring 1.1 cm, too\nsmall to definitively characterize. No evidence of stones or hydronephrosis.\nThere are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Sigmoid diverticulosis. Appendix is normal. A\nfew prominent mesenteric lymph nodes are demonstrated, largest measuring 7 mm\n(4:136.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Patient is status post Whipple's procedure. Fluid and stranding noted in\nthe porta hepatis region is demonstrated with no loculation. No soft tissue\nwithin the pancreatic head to suggest residual tumor.\n2. No evidence of metastatic disease in the abdomen or pelvis.\n3. Small loculated fluid collection in the perisplenic region, most likely\nrepresents a postoperative seroma.\n4. Areas of cortical hypo enhancement are new compared to the prior exam and\nmay represent heterogeneous enhancement or small focal infarcts." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nHEPATOBILIARY: Hepatic enhancement is homogeneous with no suspicious masses. \nPortal vein and hepatic veins are patent. Gallstone is again present. There\nis no biliary ductal dilatation.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious masses.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY:There is re-demonstrated renal cortical hypodensities some of which\nare too small to characterize, probably representing cysts there is unchanged\npelviectasis of the upper pole of the left kidney.\n\nGASTROINTESTINAL: Stomach is unremarkable. Small bowel loops are not dilated.\nStatus post sigmoid colonic resection and anastomosis. The anastomosis\nappears intact. There are scattered colonic diverticulosis without\ndiverticulitis. There is no colonic wall thickening. Appendix is\nunremarkable.\n\nPERITONEUM: There is no free air or free fluid. There is no peritoneal\nstranding.\n\nLYMPH NODES: There is no abdominopelvic adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches.\n\nPELVIS: Urinary bladder is distended and appears unremarkable. Prostate gland\nis enlarged. There are calcifications of the vas deferens. There are no\ninguinal masses. There is no inguinal adenopathy.\n\nBONES:There are no acute osseous abnormalities or suspicious osseous lesions.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. No acute intra-abdominal process. No suspicious groin abnormality.\n2. Cholelithiasis. Other incidental findings as above." }, { "input": "LOWER CHEST: The included lung bases are clear. The heart is not enlarged and\nthere is no pericardial effusion.\n\nCT ABDOMEN WITH CONTRAST:\n\nHEPATOBILIARY: The liver enhances normally without focal lesions. There is no\nintra or extrahepatic biliary duct dilation. The gallbladder is normal without\nstones or wall thickening. The portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation without focal lesions, duct\ndilation or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation without focal lesions.\n\nADRENALS: Bilateral adrenal glands are normal in size and shape.\n\nURINARY: The kidneys excrete contrast promptly and symmetrically and are\nwithout hydronephrosis, mass or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is grossly normal. There is no free air. Small\nand large bowel are normal in caliber without wall thickening or obstruction. \nThe appendix is best visualized in the coronal plane on series 601 8 image\n___, normal. There is no free fluid.\n\nRETROPERITONEUM: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVASCULAR: The abdominal aorta and iliac arteries are normal in caliber.\n\nCT PELVIS WITH CONTRAST: The urinary bladder and rectum are normal. There is\nno pelvic wall or inguinal lymphadenopathy and no free fluid.\n\nBONES AND SOFT TISSUES: There are no worrisome blastic or lytic lesions. The\nabdominal and pelvic wall is within normal limits.", "output": "Normal appendix. No acute findings in the abdomen pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.6 x 2.0 cm hypodense lesion in the dome of the liver was characterized on\nrecent ultrasound as a cyst. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: There is stranding around the tail, body, head of the pancreas and a\nsmall amount of fluid extending into the left perirenal space. There is no\nevidence of pancreatic hypoenhancement to suggest necrosis. Portal vein and\nits major branches appear patent. The splenic vein appears patent. The SMA\nand celiac axis appear patent without evidence of aneurysm formation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis of the sigmoid, descending, and transverse colon. The appendix\nis normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus contains fibroids. A 2.6 cm rounded lesion\nanterior to the uterus in adjacent to the right ovary may represent subserosal\nthyroid versus a intermediate density ovarian cyst. Ovaries are otherwise\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute interstitial edematous pancreatitis.\n2. 2.6 cm hyperdense right adnexal cystic lesion which may represent a\nsubserosal fibroid. Recommend follow-up with pelvic ultrasound on a\nnonemergent basis.\n3. Diverticulosis." }, { "input": "LOWER CHEST: Incompletely images of the lower thorax demonstrate bibasilar\nconsolidations, which suggest a multifocal bilateral pneumonia. There is a\nsmall loculated left pleural effusion, measuring 3.5 cm (2:3). No pericardial\neffusion.\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is distended without evidence\nof cholelithiasis or inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A splenule is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple wedge-shaped areas of hypoattenuation and focal\nstriated nephrogram within the left interpolar region of the kidney (02:33)\nand the bilateral superior poles (601:36, 601:33). There is trace perinephric\nstranding on the left. Findings are concerning for bilateral pyelonephritis. \nThe kidneys are of normal and symmetric size. Multiple millimetric\nhypodensities within the interpolar region of the left kidney likely represent\nsimple cysts. There is no evidence of hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. There is\ncalcification of the left vas deferens.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES/SOFT TISSUES: There is no evidence of worrisome osseous lesions or acute\nfracture.Does not appear to be bony involvement with the abscess, which is\nlocated in close proximity to the inferior pubic rami. No evidence for bony\nerosion.\n\nThere does not appear to be intrapelvic or intra-abdominal involvement of the\nknown abscess, which is incompletely imaged. The abscess persists and appears\noverall improved from prior. A previously seen right hip joint effusion with\nsynovial thickening is improved. Multiple small rim enhancing fluid\ncollections within the right pectineus and adductor muscles are overall\ndecreased in size, with residual swelling of the soft tissue with some\nenhancement (2:92). The fluid collections are complex and discontinuous\nhowever the overall area measures approximately 5.7 x 1.9 cm within the\nadductor musculature, as well as a fluid density measuring 4.6 x 1.1 x 1.4 cm\nnear the right obturator foramen (2:86, 601:27). There is soft tissue\nstranding and involvement of the right obturator internus muscle (2:86). Of\nnote there are some small foci of gas within the proximal thigh musculature,\nconsistent with history of surgical intervention. There are surgical staples\nseen over the right proximal anterior thigh. Subcutaneous soft tissue\nstranding is increased along the right lateral thigh.", "output": "1. No evidence for intrapelvic or intra-abdominal extension of the known right\nthigh abscess, which is incompletely imaged but the imaged portion appears\nsmaller and improved from prior.\n2. Multiple wedge-shaped areas of hypoattenuation in the bilateral kidneys are\nconcerning for bilateral pyelonephritis.\n3. Multifocal bibasilar consolidation/ atelectasis at the lung bases.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:50 pm, 20 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Atelectasis at the right lung base is similar to prior. There\nare new mild ___ opacities in the partially visualized right middle\nlobe. There is no evidence of pleural or pericardial effusion. There are\nsevere coronary artery calcifications, partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. Bilateral perinephric stranding and fascial\nthickening is similar to prior.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. A 2.0 cm\nintermediate density left adrenal nodule is not significantly changed.\n\nURINARY: The kidneys are of normal and symmetric size. A 1.2 cm hypodense\nlesion in the interpolar region of the right kidney is similar to prior,\nlikely representing a cyst. There is new moderate bilateral\nhydroureteronephrosis extending to the level of the bladder. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is not visualized. There is no evidence of intra-abdominal fluid\ncollection.\n\nPELVIS: There is bladder wall thickening and a small left-sided bladder\ndiverticula. There is no bladder stone. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status post left above-knee amputation. There is fluid\nwithin the left acetabular cavity, as well as a small amount of subcutaneous\nair, slightly decreased from prior (2:87).\n\nSOFT TISSUES: There is stranding in the right groin, slightly decreased from\nprior. Left groin surgical staples remain in place. Stranding in the left\nsubcutaneous tissues is slightly decreased from prior. Small bilateral\ninguinal hernias containing fat are noted.", "output": "1. New moderate bilateral hydroureteronephrosis extending to the level of the\nbladder, which has a thickened wall. Correlate with urinalysis for infection.\n2. New mild ___ opacities in the partially visualized right middle\n___ be infectious or inflammatory in nature.\n3. Persistent fluid and air within the left acetabular cavity, slightly\ndecreased from prior, and may be postoperative in nature, however infection\ncannot be excluded.\n4. Diverticulosis, with no evidence of acute diverticulitis.\n5. No significant change in a 2.0 cm left adrenal nodule, statistically likely\nrepresenting an adenoma. ___ year follow-up dedicated adrenal protocol CT or\nMRI is again recommended.\n\nRECOMMENDATION(S):\n-Correlation with urinalysis.\n-___ year follow-up dedicated adrenal protocol CT or MRI." }, { "input": "LOWER CHEST: Right lower lobe atelectasis with mild airway wall thickening\nsuggestive of airways disease.. No pleural or pericardial effusion. Severe,\ncalcified coronary atherosclerosis. Ascending thoracic aorta is top normal in\nsize with a diameter of 4.0 cm.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophic. There is no pancreatic ductal dilatation. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Intermediate density 2.1 x 1.7 cm left adrenal nodule as seen\npreviously, potentially an adenoma. The right adrenal gland is normal in size\nand shape.\n\nURINARY: The kidneys are symmetric in size and shape. No hydronephrosis. No\nnephrolithiasis. 1.3 cm simple right renal cyst. Nonspecific, symmetric\nperinephric fat stranding. There is no evidence of concerning focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis is demonstrated\nwithin the sigmoid colon. A sigmoid colon diverticulum appears inflamed with\nfocal wall thickening and adjacent fat stranding. No adjacent fluid\ncollection or extraluminal air. The appendix is normal.\n\nPELVIS: A Foley catheter is in place with small locules of intravesicular gas.\nThe bladder wall appears slightly thickened. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: A periportal lymph node measures 1 cm. No retroperitoneal\nlymphadenopathy. No mesenteric lymphadenopathy. No pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Status-post left lower extremity amputation. No evidence of fracture\nor suspicious osseous lesion. Small right sacral ala bone island.\n\nSOFT TISSUES: There is fluid with locules of gas in the left acetabular\ncavity. Locule gas and fat stranding extend anteriorly toward the incision\nwithin the soft tissues and subcutaneous fat. Fat stranding/edema extends\ninto the adjacent left hemiscrotum. There is fat stranding underlying a\ncutaneous staple line in the right groin. There is asymmetric edema\nthroughout the visualized left thigh, including the gluteus musculature and\nsubcutaneous fat overlying the gluteus musculature. Small, fat containing,\nbilateral inguinal hernias.", "output": "1. Uncomplicated sigmoid diverticulitis.\n2. Apparent locules of gas with extensive fat stranding in the left acetabular\ncavity extending anteriorly toward the cutaneous staple line. While these\nchanges can be seen in the postoperative period, recommend correlation with\nsurgical date as this finding would be abnormal more than 1 week postoperative\nand raise the possibility of infection.\n3. Unchanged 2.1 cm left adrenal nodule, statistically likely an adenoma. \nRecommend correlation with biochemical markers and consider ___ year follow-up\ndedicated adrenal protocol CT or MRI for further evaluation.\n4. Severe calcified coronary atherosclerosis.\n5. The bladder is decompressed by Foley catheter, but the bladder wall appears\nsomewhat thickened. Correlation with urinalysis is recommended to exclude\ninfection.\n\nRECOMMENDATION(S):\n1. Unchanged 2.1 cm left adrenal nodule, statistically likely an adenoma.\nRecommend correlation with biochemical markers and consider ___ year follow-up\ndedicated adrenal protocol CT or MRI for further evaluation.\n2. The bladder is decompressed by Foley catheter, but the bladder wall appears\nsomewhat thickened. Correlation with urinalysis is recommended to exclude\ninfection." }, { "input": "LOWER CHEST: Please review same day dedicated chest CT report.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple scattered hypodense hepatic lesions corresponding to\nincreased FDG activity on recent PET, appear unchanged from the recent MRI but\nare either new or increased in size compared to the prior CT from ___, and are consistent with metastases. The largest lesion is peripherally\nin segment 6 measuring 17 x 15 mm, not clearly seen on the prior CT from\n___. Small amount of subcapsular fluid along the lateral aspect of\nsegment 6 measures up to 30 mm, present on the previous MRI, but increased in\nthe interval.\n\nSimple cyst in segment 4A is re- demonstrated. 19 mm hepatic hemangioma in\nthe dome of the liver appears unchanged (series 4, image 9). No ductal\ndilation. Unremarkable gallbladder.\n\nPatent hepatic vasculature. Replaced right hepatic artery from SMA is noted. \nTrace perihepatic and perisplenic ascites, as seen on the prior MRI.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: No splenomegaly and without focal lesion.\n\nADRENALS: Unremarkable.\n\nURINARY: Bilateral nephrolithiasis is present, the largest of which measures\n5 mm in the right interpolar region, but none are obstructive. No\nhydronephrosis or hydroureter.No suspicious lesion. Focal renal cortical\nirregularity on left may be the sequela of prior vascular insult or infection.\n\nGASTROINTESTINAL: Gastric band is in appropriate position. No intestinal\nobstruction. Focal bowel wall thickening of the ascending colon with luminal\nnarrowing and an apple-core lesion corresponds to increased FDG activity on\nrecent PET and consistent with colorectal carcinoma. No pneumoperitoneum.\n\nDiffuse omental nodularity consistent with metastases is worse compared to the\n___ CT.\n\nPELVIS: Unremarkable rectum and bladder. Status post hysterectomy with\nunremarkable appearance of the adnexal regions. No pelvic free fluid is\nnoted.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: Patent aorta and major branches.\n\nBONES AND SOFT TISSUES: A sclerotic focus in S3 without corresponding\nincreased FDG activity, likely a bone island. L1-L2 degenerative changes with\nloss of disc space. Left L4 spondylolysis with grade 1 anterolisthesis of L4\non L5. Grade 1 retrolisthesis L5 on S1 with narrowing of the central canal. \nNo soft tissue mass.", "output": "1. Ascending colon neoplasia with worsened hepatic and omental metastases\nsince the CT from ___, but unchanged from the previous MRI from\n___.\n2. Nonobstructing nephrolithiasis up to 5 mm.\n3. Lumbar spine degenerative changes." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple scattered hypodense lesions throughout the periphery\nof the liver were FDG avid on PET-CT ___ and are unchanged. The\nlargest of these lesions is a 1.7 x 1.5 cm hypodensity in the periphery of\nsegment VI (series 2, image 53), unchanged from ___. While these\nlesions may represent intrahepatic metastases they could also represent\nperitoneal implants. Loculated subcapsular fluid adjacent to segment VI is\nunchanged from ___. A 1.9 cm lesion in the dome of the liver has\nenhancement characteristics consistent with a hepatic hemangioma (series 2,\nimage 45). Sub cm hypodensities in segment ___ and the left lobe of the liver\n(series 2, image 44) likely represent simple hepatic cysts although are too\nsmall to definitively characterize. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Focal cortical thinning in the interpolar region of the left kidney\nis unchanged from ___. Multiple peripelvic cysts are noted\nbilaterally. There is no evidence of hydronephrosis. There is no perinephric\nabnormality. Multiple tiny nonobstructing stones are noted in the kidneys\nbilaterally.\n\nGASTROINTESTINAL: The patient is status post gastric banding without evidence\nof complication. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Circumferential, focal wall thickening\nin the ascending colon (series 2, image 67) corresponds with the patient's\nknown colon carcinoma. The remainder of the colon is unremarkable. Extensive\nomental nodularity consistent with known metastasis which is worse in the left\nmid abdomen is overall unchanged in appearance and extent. The appendix is\nnot visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. A replaced right hepatic artery from the SMA is noted.\n\nBONES: Left spondylolysis at L4 is associated with grade 1 anterolisthesis of\nL4 on L5. Severe disc space narrowing and endplate sclerosis is seen at\nL1-L2, unchanged. A sclerotic focus in the S3 vertebral body is unchanged and\nlikely represents a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Colon carcinoma of the ascending colon with unchanged metastatic disease,\nas detailed above.\n2. Unchanged degenerative changes of the lumbar spine." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Several hypodense lesions are again noted in the peripheral\nliver, similar to or possibly slightly decreased from prior exam and\nconsistent with previously described metastatic disease. The largest of these\nlesions is in the periphery of hepatic segment VI (2:35) and measures 1.7 x\n1.0 mm (previously 1.9 x 1.4 cm). A 1.9 cm hemangioma is again noted in the\ndome of the liver (2:46). Multiple hypodensities too small to characterize but\nlikely representing hepatic cysts are seen again in segment ___ (2:44 and\n2:47), similar to prior exam. Loculated subcapsular fluid adjacent segment VI\nis unchanged from prior exam (2:57). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple parapelvic cysts are noted bilaterally. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post gastric banding. The stomach is\notherwise unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The history of ascending colon cancer\nis noted, although it is difficult to specifically identified the site of\ncancer on this exam due to clumping of multiple bowel loops in the area of the\nknown cancer. Omental nodularity is seen, consistent with known metastatic\ndisease.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are noted in the spine, including anterolisthesis of L4\nover L5, similar to prior exam.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Ascending colon cancer with metastatic disease. Although it is difficult to\nspecifically identify the cancer on this exam due to clumping of multiple\nbowel loops the area of the known cancer, the overall appearance of the\ninvolved bowel and the metastatic disease is similar to prior exam." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous background attenuation\nthroughout. Again seen are multiple scattered hepatic hypodensities\nthroughout the liver. A segment VI hypodensity measures 1.1 x 0.8 cm,\ncompared with 1.7 x 1.0 cm previously (5:53). A 1.9 cm hepatic hemangioma in\nthe dome of the liver is unchanged (5:45). Multiple additional subcentimeter\nhypodensities in segments IV are too small to characterize, and are stable to\nminimally decreased in size compared with prior (5:44). No new focal hepatic\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. A small amount of subcapsular fluid adjacent to segment VI is\nunchanged (5:56). The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastric banding. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. No\ndefinite colonic mass is visualized. The rectum is within normal limits. The\nappendix is not visualized. Omental caking is decreased in density compared\nwith prior (5:74).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes throughout the spine are similar to\nprior, including anterolisthesis of L4 and L5, and endplate sclerosis of the\nL1 and L2 vertebral bodies. There is no evidence of worrisome new osseous\nlesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Omental caking is slightly improved compared with prior.\n2. Interval slight decrease in size of a segment VI hepatic hypodensity. \nMultiple additional subcentimeter hepatic hypodensities are small to\ncharacterize, however are stable to minimally decreased in size from prior. \nNo new focal hepatic lesions.\n3. No new sites of metastatic disease in the abdomen or pelvis.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nGiven the limitations of a noncontrast scan, previously noted hepatic\nhypodensities reflecting metastases are not as well seen. The largest\nhypodensity in segment 4a measuring 9 mm is again seen. The gallbladder is\nwithin normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen The spleen is mildly enlarged measuring 12.7 cm on axial\nslices with normal attenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Interval placement of left ureteral stent with improvement and near\nresolution of hydronephrosis seen on previous imaging. There are several\nnephrolithiasis remaining throughout the left kidney, with the largest\nmeasuring 6 mm in the left anterior interporlar segment (3; 37). There also\nseveral nephrolithiasis throughout the right kidney with the largest measuring\n6 mm in the right lower renal pole (3; 40). Bilateral renal pelvic cysts right\ngreater than left. The kidneys are of normal and symmetric size. There is no\nevidence of focal renal lesions within the limitations of an unenhanced scan. \nThere is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastric banding with a small hiatal\nhernia. The stomach is unremarkable. Patient has a history of ascending\ncolon cancer. Omental caking is again demonstrated. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. There appears to be a small 3 mm\nleft ureteral stone adjacent to the stent on series (3; 76). There are no\nbladder stones. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative disc disease most severe and L1- L2 with retrolisthesis of\nthe L5 vertebra\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval placement of left ureteral stent with resolution of left-sided\nhydronephrosis. Bilateral nephrolithiasis measuring 6 mm at the largest in\nthe left anterior interpolar segment and 6 mm at the right lower renal pole. \nThere remains to be a 3 mm left ureteral stone adjacent to the ureteral stent\n2. Redemonstration of hepatic hypodensities and omental caking, reflecting\nknown metastatic disease in setting of patient's history of colorectal cancer\n3. Retrolisthesis of the L5 vertebra" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a hypoattenuating lesion in hepatic segment 7, seen\non image 48 of series 6, measuring 1.8 x 1.5 cm, unchanged from the prior\nexamination, consistent with a hemangioma when compared to prior multi phasic\nCT examinations. Hypoattenuating lesion in the periphery of hepatic segment 6\nis faintly visualized, consistent with the patient's known metastatic lesion. \nThere is a hypoattenuating lesion in hepatic segment 2, seen on image 47 of\nseries 6, measuring 0.7 x 0.6 cm, unchanged. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Foci of cortical scarring are seen bilaterally. Stones are seen in\nthe kidneys bilaterally, as on the prior examination. These measure up to 6\nmm on the right, and 5 mm on the left. 4 mm stone noted in the proximal left\nureter. Peripelvic cysts again noted. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Gastric banding and hiatal hernia again noted. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe patient's known ascending colon malignancy is not well seen. Omental\ncaking again demonstrated.\n\nPELVIS: Previously seen left ureteral stent has removed. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: No suspicious osseous lesions, noting multilevel degenerative changes,\nwith anterolisthesis of L4 on L5, and retrolisthesis of L1 on L2.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged liver lesion and omental caking, consistent with the patient's\nknown metastatic colon cancer.\n2. Interval removal of a left-sided ureteral stent. Stones are again seen in\nboth kidneys, as well as in the proximal left ureter. No hydronephrosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.6 x 1.2 cm hypodensity near the dome the liver (series 2, image 47) is\nunchanged in size from prior examination and likely represents a hepatic\nhemangioma.. A 9 mm hypodensity in segment 4A (series 2, image 47) is\nunchanged from prior examination likely represents a simple hepatic cyst. \nHypodensities in the left lobe measuring up to 9 mm are consistent with simple\nhepatic cysts. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Renal scarring is unchanged, bilaterally. There is a 2 mm stone in\nthe left proximal ureter with mild associated left hydronephrosis. Parapelvic\ncysts are noted bilaterally. Urothelial enhancement on the left is likely\nsecondary to prior stent placement. Sub cm hypodensities in the left kidney\nare too small to characterize. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient status post gastric banding. Mild stranding\nalong the inferior aspect of the sigmoid colon (series 2, image 105) is\nunchanged and consistent with fat necrosis from prior hysterectomy. There is\ncircumferential wall thickening involving an approximately 2.6 cm segment of\ncolon at the hepatic flexure (series 601b, image 31). There is no\nobstruction. Omental nodularity and stranding most pronounced in the mid\nabdomen and left upper quadrant are mildly worsened from the prior\nexamination.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild retrolisthesis of L1 on L2 with extensive endplate sclerosis. \nThere is grade 1 anterolisthesis of L4 on L5. An 11 mm sclerotic focus in the\nmid sacrum (series 2, image 96) is unchanged from ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild increased omental carcinomatosis. No change in the primary ascending\ncolon lesion.\n2. 2 mm calculus in the proximal left ureter with mild associated\nhydronephrosis.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on ___\nat17:07into the Department of Radiology critical communications system for\ndirect communication to the referring provider. 5:07 pm, 30 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural effusion. There is trace pericardial fluid.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. Punctate renal stones are seen in the left kidney,\nmeasuring up to 5 mm in the interpolar region. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is noted, otherwise the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. Few diverticula are seen in the sigmoid colon without evidence of\ndiverticulitis. Otherwise, the colon and rectum are within normal limits. \nThe appendix is not visualized. Midline surgical clips are seen in the\nanterior abdomen adjacent to the stomach.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a mild superior endplate deformity of L2.\n\nSOFT TISSUES: There is diastasis recti.", "output": "1. No acute intra-abdominal abnormality.\n2. Nonobstructing left renal calculi measuring up to 5 mm." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. There is a small hiatal hernia.\n\nABDOMEN: Hypodense parenchymal attenuation of the liver suggests steatosis. \nMain portal vein is patent. No discrete concerning liver lesion is\nidentified. The gallbladder appears normal. The intrahepatic and\nextrahepatic biliary tree appears normal. Pancreas enhances normally. The\nspleen is normal in size. Adrenals are normal bilaterally. The kidneys\nenhance symmetrically. No hydronephrosis or worrisome renal lesion. The\nabdominal aorta is mildly calcified and normal in course and caliber. There\nis no retroperitoneal lymphadenopathy. The stomach and duodenum appear\nnormal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. No\nsigns of bowel ischemia. The appendix is normal. The colon contains a mild\nfecal load. No signs of colitis or pericolonic inflammation. Diverticulosis\nis noted. The urinary bladder is partially distended and appears\nunremarkable. No pelvic free fluid. Prostate and seminal vesicles appear\nnormal. No pelvic sidewall or inguinal adenopathy.\n\nBONES: No worrisome lytic or blastic osseous lesion is seen. Fixation\nhardware is noted at the right acetabulum.", "output": "1. Hepatic steatosis.\n2. Normal appendix.\n3. Small hiatal hernia." }, { "input": "LOWER CHEST: Segmental atelectasis at the right lung base. No focal\nconsolidations. No pleural or pericardial effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple subcentimeter hypodensities within the liver are too\nsmall to characterize, but stable, and likely represent cysts or biliary\nhamartomas. Otherwise, the liver demonstrates homogenous attenuation\nthroughout. There is no evidence of enhancing lesions. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There are multiple dilated fluid-filled loops of small bowel\nwith air-fluid levels. A transition point is seen with in the mid abdomen\n(series 2, image 51). There is slight swirling of the mesentery in this\nregion. There are decompressed loops distally, consistent with a small-bowel\nobstruction. The small bowel wall enhances normally throughout. There is no\nevidence of pneumoperitoneum or pneumatosis. There is a small hiatal hernia. \nOtherwise, the stomach is within normal limits. The colon is also within\nnormal limits. The appendix is not visualized. There is small amount of free\nfluid within the abdomen and pelvis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is lobular in appearance with multiple\nhypodense masses, likely representing fibroids. There are bilateral septated\ncystic adnexal structures measuring 3.1 x 3.1 cm on the right (series 2, image\n70), and 4.7 x 3.4 cm on the left (series 2, image 71).\n\nLYMPH NODES: There prominent but subcentimeter bilateral inguinal lymph nodes,\nnonspecific. No pathologically enlarged pelvic or inguinal lymph nodes. \nThere is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Bilateral symmetric sclerosis of the sacroiliac joints is noted,\ncompatible with sacroiliitis, unchanged. There is no worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. Otherwise,\nthe abdominal and pelvic wall is within normal limits.", "output": "1. Small bowel obstruction with a transition point within the mid abdomen. \nGiven the history of surgery, the most likely etiology is adhesions. Small\namount of free fluid within the abdomen and pelvis.\n2. Bilateral cystic adnexal structures measuring up to 4.7 cm on the left,\nlikely physiologic in a patient of reproductive age.\n3. Other incidental findings include sacroiliitis, a small hiatal hernia and a\nfibroid uterus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:35 ___, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is a simple left renal cyst measuring 1.3 cm. There is no evidence of\nconcerning focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is dilated at the distal tip up\nto 1.0 cm (series 601, image 32), fluid-filled, with moderate adjacent\nmesenteric stranding. A mildly attenuating punctate focus at the mid appendix\n(series 601, image 34) is consistent with an appendicolith. There is a focal\narea of mural hypoenhancement (2: 52, 601:31), concerning for gangrenous\ncholecystitis. No discrete fluid collection or extraluminal air are\ndemonstrated.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A tiny umbilical hernia containing fat is noted.", "output": "Gangrenous tip appendicitis with an appendicolith. No focal fluid collections\nor extraluminal foci of air." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The geographic hypodensities adjacent to the falciform ligament\nlikely represent focal fatty deposition. Otherwise, the liver demonstrates\nhomogenous attenuation throughout. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post left nephrectomy without evidence of local\nrecurrence. There is an extrarenal pelvis on the right. There is an 11 mm\nangiomyolipoma within the lower pole of the right kidney, stable since ___ (series 2, image 72). Multiple other hypodensities within the right\nkidney are too small to characterize, but likely represent small cysts. \nOtherwise, the right kidney is of normal and symmetric size with normal\nnephrogram. There is no evidence of hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Moderate\npredominantly right-sided diverticulosis is visualized, without evidence of\ndiverticulitis. The appendix is normal.\n\nPELVIS: The bladder is decompressed and cannot be fully evaluated. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: A left total hip arthroplasty is partially visualized, without evidence\nof hardware malfunction. The sclerotic focus within the L2 vertebral body\nlikely represents a bone island. There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: There are multiple soft tissue nodules within the anterior\nabdominal wall bilaterally, likely injection granulomas.", "output": "1. Status post left nephrectomy, without evidence of local recurrence or\nmetastatic disease.\n2. Stable 11 mm AML within the lower pole of the right kidney.\n3. Diverticulosis without diverticulitis.\n4. Soft tissue nodules within the anterior abdominal wall, likely injection\ngranulomas.\n5. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nGranulomas in segment II of the liver are unchanged. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post left nephrectomy. There is no evidence of\nlocal recurrence. Hypodensities in the upper pole of the right kidney are too\nsmall to characterize but likely represent simple renal cysts. A small\ncortical defect at the lower pole of the right kidney is unchanged from\n___. There is no hydronephrosis. The distal ureter is obscured by\nartifact.\n\nGASTROINTESTINAL: There is a small hiatal hernia otherwise the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is diverticulosis worse in the ascending\nand transverse colon. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Assessment of the pelvis is limited by artifact from the\npatient's left hip prosthesis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: The patient is status post left total hip arthroplasty. There is no\nevidence of osseous malignancy or infection within the abdomen and pelvis.\n\nSOFT TISSUES: Gas and granulomas in the anterior and posterior abdominal wall\nare consistent with prior injections.", "output": "1. No evidence of local recurrence or metastatic disease within the abdomen\nand pelvis.\n2. Small hiatal hernia.\n3. Diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: Previously seen nodule in the base the left lung is again noted. \nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Status post left nephrectomy. Postsurgical changes in the resection\nbed appear similar to prior exam. The right kidney is of normal and symmetric\nsize with normal nephrogram. There is no evidence of focal renal lesions or\nhydronephrosis. Subcentimeter hypodensity in the interpolar region of the\nright kidney is too small to characterize but likely reflects a simple cyst. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate sized hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThere is diverticulosis particularly of the transverse colon. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. There is no adnexal\nabnormality seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral hyperdensities and small foci of gas in the\nsubcutaneous fat in the right and left lower quadrant of the abdomen are\nlikely related to injections.", "output": "1. Status post left nephrectomy without evidence of local recurrence or\nmetastatic disease in the abdomen or pelvis.\n2. Nodules in the base of the left lung again noted. Please refer to separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings." }, { "input": "CT OF THE ABDOMEN AND PELVIS WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nAn ill-defined 1 cm apparent hypodensity within the right inferior hepatic tip\n(series 2, image 33) appears to be artifact from the adjacent rib and colon\n(series 601b, image 18). There is no intra or extrahepatic bile duct\ndilation. The gallbladder is normal.\n\nThe spleen, adrenal glands, pancreas, stomach, and intra-abdominal loops of\nsmall and large bowel are normal. There is no mesenteric or retroperitoneal\nlymphadenopathy, and no ascites.\n\nArising from the lower pole of the left kidney is a 6 mm stone, unchanged in\nlocation and size since the ___ examination. There is no\ncollecting system obstruction. No new renal, ureteral, or bladder stones are\ndetected. The bladder appears normal.\n\nThe prostate, rectum, and intrapelvic loops of small and large bowel are\nnormal. There is no intrapelvic lymphadenopathy or fluid.\n\nThere are no osseous lesions concerning for malignancy or infection.", "output": "1. 6 mm nonobstructing left lower pole renal stone is unchanged in size and\nlocation since ___. No new renal, ureteral, or bladder stone.\n2. No acute intra-abdominal or intrapelvic process, although examination is\nlimited by lack of IV or oral contrast." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is mildly enlarged measuring 13.3 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is atrophic. Both kidneys enhance and excrete\ncontrast symmetrically. There are subcentimeter hypodensities in the right\nkidney which are too small to characterize.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There are no pathologically enlarged mesenteric or\nretroperitoneal lymph nodes. Scattered retroperitoneal lymph nodes are\nunchanged including the largest lymph node adjacent to the left psoas muscle\n(series 2, image 296), measuring 7 mm. A left external iliac chain lymph node\nis also stable in size measuring approximately 9 x 14 mm (series 2, image\n118). Scattered inguinal lymph nodes are not pathologically enlarged.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES/SOFT TISSUES: There is no evidence of worrisome osseous lesions or acute\nfracture. There are multilevel degenerative changes most pronounced at L5/S1.\nA sclerotic focus within the L5 vertebral body and a sclerotic lesion in the\nL1 spinous process, are stable a a consistent with bone islands. There is a\nsmall fat containing inguinal hernia.", "output": "1. Stable examination including a unchanged non pathologically enlarged left\nretroperitoneal lymph node and left external iliac chain lymph.\n2. Unchanged mild splenomegaly." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Interval worsening in mild splenomegaly, with the spleen measuring\n16.0 cm in craniocaudal dimension in the current study compared to 14.0 cm\npreviously. There is a small accessory spleen anterior to it.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again noted is atrophic left kidney. The right kidney is again noted\nto be hypertrophied. There are subcentimeter hypodensities in the right kidney\nthat are too small to characterize. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There has been mild interval increase in size in the multiple\nretroperitoneal nodes however these remain subcentimeter in size. These were\nbarely seen on the prior study. For example, there is a 0.9 x 0.6 cm left\npara-aortic node (2:83), that previously measured 0.2 x 0.2 cm. Another\nexample includes a 0.6 x 0.6 cm periaortic lymph node (2:76), that previously\nmeasured 0.3 x 0.2 cm. A 1.4 x 1 0.6 cm portacaval lymph node (2:71) is\nunchanged from prior. Mildly prominent pelvic lymph nodes are also mildly\nincreased compared to prior. For example, a 0.9 x 0.8 cm right external iliac\nnode (2:104) is increased from 0.6 x 0.5 cm\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Diminutive left renal artery is redemonstrated.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are noted throughout the lumbar spine, notably at L5-S1. \nA bone island is again noted in the left side of L5 vertebral body.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Slight interval increase in size in retroperitoneal and pelvic lymph nodes\nwith mild interval increase in splenomegaly.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings" }, { "input": "LOWER CHEST: Mild dependent atelectasis. No focal consolidations. No pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Please note the superior-most liver is not included on this\nexamination. The visualized liver demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and lobulated in appearance with\nmultiple small fibroids, some of which are calcified. Physiologic ovarian\ncyst on the left. No other adnexal abnormalities.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small broad-based fat containing umbilical hernia. Otherwise,\nthe abdominal and pelvic wall is within normal limits.", "output": "1. No acute abdominopelvic process correlating to the reported history of\nsudden onset abdominal pain.\n2. Fibroid uterus." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted with focal bowel wall thickening, fatty stranding, and adjacent\nphlegmon (02:59 and 601:32) compatible with acute sigmoid diverticulitis. No\nassociated drainable fluid collections or macro perforations are identified. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes visualized throughout the imaged\nportion of the thoracolumbar spine without evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute uncomplicated sigmoid diverticulitis. No drainable fluid collections or\nmacro perforations identified." }, { "input": "LOWER CHEST: Small right pleural effusion with overlying compressed lung,\nwhich may represent atelectasis, however overlying pneumonia can't be\ncompletely excluded.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Previously\nadministered IV contrast is seen opacifying the renal calices in the ureters,\nlimiting assessment small calculi. No hydronephrosis. Mild bilateral\nperinephric stranding appears similar to the prior PET-CT.\n\nGASTROINTESTINAL: Prominent large necrotic inflamed distal esophageal lymph\nnode measures up to 3.1 cm, better characterized on contrast enhanced same day\nCTA performed several hours previous. A previously demonstrated conglomerate\nof lymph nodes in the right lower quadrant is significantly increased in size\nfrom the prior PET-CT, now measuring 11.4 x 3.3 cm. Inferiorly, the appendix\nis noted to be filled with fluid and measuring up to 9 mm (series 2, image\n49). There is associated mesenteric stranding and peritoneal thickening in\nthe right lower quadrant. Omental lymphadenopathy and caking is demonstrated\nwith increased soft tissue density component along the mid abdomen (series 2,\nimage 51), increased from the prior PET-CT. Colonic thickening is demonstrated\nalong the transverse colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is worsened periaortic, periportal and peripancreatic\nlymphadenopathy compared to prior study, as well as multiple prominent lymph\nnodes demonstrated throughout the mesentery near the left kidney and spleen.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLeft total hip prosthesis is intact.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Thickening of a long segment of transverse colon, which may be reactive to\ntreatment or infectious.\n2. Fluid-filled and dilated appendix measuring 9 mm, with mild are lower\nquadrant mesenteric stranding. Superiorly, there is a 11.4 x 3.3 cm\nmesenteric nodal conglomerate at the site of previously seen lymphadenopathy. \nFindings are equivocal for acute appendicitis/reactive inflammation in the\nsetting of worsening malignancy. Recommend clinical correlation.\n3. Extensive interval increase in widespread intra-abdominopelvic\nlymphadenopathy, previously characterized as FDG avid, compatible with\nworsening disease.\n4. Large, necrotic and inflamed distal esophageal lymph node again\ndemonstrated, better characterized on same day CTA.\n5. Small right pleural effusion with overlying compressed lung, which may\nrepresent atelectasis, however overlying pneumonia can't be completely\nexcluded.\n\nNOTIFICATION: The updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:16 am." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Wall thickening of the gallbladder fundus\nis again noted, stable and compatible with suspected adenomyomatosis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The patient is status-post total splenectomy. A small, unchanged soft\ntissue density lateral to the stomach and inferior to the left hemidiaphragm\nmay be a small accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status-post total left nephrectomy. There are\nmultiple unchanged, hypoattenuating lesions in the right kidney which are too\nsmall to completely characterize, but likely renal cysts. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged fibroid uterus. There is an\napproximately 3.5 x 3.6 cm simple appearing cyst is essentially unchanged\n(4:104).\n\nLYMPH NODES: Diffuse pelvic lymphadenopathy has mildly decreased in size, the\nlargest of which are bilateral external iliac nodes which measure\napproximately 1.3 cm in short axis (4:110) on the left and 0.8 cm in short\naxis (4:106) on the right. Mesenteric lymphadenopathy is essentially\nunchanged. The largest conglomerate mesenteric lymph nodes again measures\napproximately 1.4 cm in short axis (4:77). Scattered retroperitoneal lymph\nnodes are not pathologically enlarged by size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are very subtle, vaguely sclerotic lesions in the right inferior\npubic ramus, posterior right acetabulum, and L5 spinous process corresponding\nto areas of FDG avidity on recent PET-CT.\n\nSOFT TISSUES: A peripherally enhancing soft tissue lesion in the adductor\nbrevis is partially imaged, but again noted.", "output": "1. Mild interval improvement in pelvic lymphadenopathy as detailed above.\n2. Essentially unchanged mesenteric lymphadenopathy.\n3. A soft tissue lesion in the right a adductor brevis muscle is incompletely\nvisualized and remains concerning for metastasis.\n4. Subtle, vaguely sclerotic lesions in the right inferior pubic ramus,\nposterior right acetabulum, and L5 spinous process correlate with FDG avid\nlesions on recent PET and are consistent with metastasis.\n5. Wall thickening of the gallbladder fundus is stable and compatible with\nadenomyomatosis.\n6. Stable left ovarian cyst." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings, including a partially visualized\nleft pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Compared with CT abdomen pelvis on ___, the liver\nparenchyma is heterogeneous in appearance, with multiple new scattered\nhypodensities throughout the liver, the largest measuring 1.1 cm (2:44,48,59;\n601:20,21). There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder wall is again thickened at the fundus, consistent\nwith adenomyomatosis.\n\nPANCREAS: There is a new ill-defined hypodense lesion in the pancreatic head\nmeasuring approximately 8 mm, with mild dilation of the pancreatic duct distal\nto the lesion (2:63). There is no peripancreatic stranding.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is surgically absent. There is no evidence of focal\nsolid right renal lesion or hydronephrosis. Multiple subcentimeter\nhypodensities in the right renal cortex are too small to characterize, however\nare unchanged and likely represent cysts. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is formed\nstool in the small bowel, may reflect stasis from a motility disorder. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are multiple calcified fibroids in the uterus. A\n2.9 x 3.8 cm right adnexal cyst is slightly increased in size compared with ___, at which time it measured 3.3 x 3.2 cm, however is decreased in\nsize compared with ___, which time it measured 2.9 x 4.3 cm, and\nwas previously characterized as a simple cyst on MRI pelvis on ___\n(2:104).\n\nLYMPH NODES: A conglomerate of mesenteric lymph nodes with surrounding soft\ntissue stranding measures 1.7 x 1.5 cm, unchanged (2:72). There are multiple\nscattered pelvic lymph nodes, some increase in size from prior, the largest\nbeing a left external iliac node measuring 1.3 cm (2:90, 92, 94, 101, 104,\n106, 107). There are normal bilateral inguinal lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are multiple new sclerotic foci in the right acetabulum\n(601b:30, 2:107). There is no acute fracture.\n\nSOFT TISSUES: A 3.5 x 2.2 cm hyperdense lesion in the right adductor brevis\nmuscle is slightly increased in size compared with ___, with\nincreased surrounding muscular edema (2:124). A round hyperdense lesion in\nthe left posterior perirectal soft tissue is increased in size, measuring 1.7\nx 1.7 cm, compared with 1.4 x 1.1 cm previously (2:113). There is a new 1.0\ncm round hyperdense lesion in the soft tissue anterior to the right iliac bone\n(2:84).", "output": "1. Interval progression of disease, with multiple new hepatic metastases, a\npancreatic head lesion, increase in size and number of soft tissue lesions,\nnew right acetabular osseous metastases, and increase in size in several\nscattered pelvic lymph nodes compared with ___.\n2. A 3.8 cm right adnexal cyst is slightly increased compared with ___, however is decreased in size compared with ___ and was\npreviously characterized as simple cyst on MRI pelvis on ___.\n3. Formed stool in the small bowel may reflect stasis from a motility\ndisorder. No mechanical obstruction.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:00 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Emphysematous and linear atelectatic changes are seen at the lung bases\nbilaterally. There is no pleural effusion. Visualized portions of the heart\nshow significant coronary artery calcifications. There is no evidence of\npericardial effusion.\n\nThe liver is homogeneous in attenuation and without discrete masses or\nsuspicious lesions. There is no intra or extrahepatic biliary ductal\ndilatation. The gallbladder is normal with no evidence of gallbladder wall\nthickening or pericholecystic fluid. The adrenal glands, pancreas and spleen\nare within normal limits. The kidneys enhance symmetrically and excrete\ncontrast without evidence of hydronephrosis or renal masses.\nThe stomach, small bowel and large bowel grossly unremarkable. The appendix is\nnot clearly visualized but there is no evidnece for acute appendicitis. There\nis no free fluid. There is no free air.\nThe urinary bladder and terminal ureters are normal. Multiple brachytherapy\nseeds are seen within the prostate. There is no pelvic free fluid.\nOSSEOUS STRUCTURES: No suspicious lytic or blastic lesions are present.\n\nCTA: There is aneurysmal dilatation of the infrarenal abdominal aorta. There\nis extensive atherosclerotic calcifications seen throughout the abdominal\naorta, bilateral renal arteries, splenic artery and bilateral common iliac\narteries, extending into the common femoral arteries bilaterally. S \nignificant calcified and soft plaque surrounds the infrarenal aorta and\nextends to the common iliac arteries bilaterally. The celiac axis, SMA,\nbilateral renal arteries and ___ however are patent. There is a replaced left\nhepatic artery arising from the left gastric artery. The course of the right\nhepatic artery is aberrant, coursing posterior to the main portal vein, but\nthe artery arises from the celiac trunk. There is near complete occlusion of\nthe bilateral internal iliac arteries. There is aneurysmal dilation of the\nright and left common iliac arteries, measuring approximately in 2.0 and 2.3\ncm respectively (series 3, image 90). There is occlusive thrombus within the\nright common iliac artery, extending along the right external iliac artery\nand the proximal right common femoral artery, at which point ithere is\nreconstitution of the vessel. There are extensive collaterals seen along the\nanterior abdominal wall on the right and enlargement of the right inferior\nepigastric artery. The left common iliac artery is patent. There is\nsignificant atheroscerlotic disease in the left external iliac artery but the\nvessel is patent. There is significant occlusive disease in the left common\nfemoral artery with a narrrow caliber, however some flow is still identified\nwithin the vessel. Significant calcified plaque surrounds the common femoral\narteries bilaterally, right worse than left.\n3D Imaging Lab Measurements:\n\nAbdominal aorta at superior renal () artery takeoff: 26\nAbdominal aorta at inferior renal () artery takeoff: 19.7\nAbdominal aortic (5 mm below inferior renal artery): 20.6.\nAbdominal aortic (10 mm below inferior renal artery): 22.3\nAbdominal aortic (15mm below inferior renal artery): 31.4\nAbdominal aortic aneurysmal sac diameter (largest centerline axis): 45.8 X\n45.4.\nAbdominal aortic aneurysmal sac diameter (largest in axial view): 49.1\nInferior renal artery to aortic bifurcation: 111.2.\nInferior renal artery to right iliac bifurcation: 176.3\nInferior renal artery to left iliac bifurcation: 189.3\nAAA volume: 175.8 cm 3", "output": "1. Infrarenal abdominal aortic aneurysm as described above, measuring up to\n4.6 cm in widest dimension .\n2. Aneurysmal dilatation of the bilateral common iliac arteries.\n3. Occlusive thrombus of the right common iliac artery extending into the\nright common femoral artery with reconstitution at this level secondary to\nabdominal wall collaterals and an enlarged right inferior epigastric artery.\n4. Significant occlusive disease in the left common iliac, left external iliac\nand left common femoral arteries, however vessels are patent.\n5. Significant calcified plaque surrounding the bilateral common femoral\narteries, right worse than left." }, { "input": "LOWER CHEST: Bibasilar atelectasis. Otherwise, visualized lung fields are\nwithin normal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is focal fat deposition near the falciform ligament. The\nliver demonstrates homogenous attenuation throughout. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The bilateral kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. No evidence of retroperitoneal hematoma.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are atrophic.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is an acute compression deformity of L2 vertebral body with\napproximately 50% height loss (___). There are multilevel degenerative\nchanges of the imaged spine. Incidentally noted 2.6 x 1.0 cm sclerotic focus\nin the left ilium, likely representing a bone island (___).\n\nSOFT TISSUES: There is subcutaneous edema overlying the bilateral, left\ngreater than right, buttocks (___). The abdominal and pelvic wall is within\nnormal limits.", "output": "1. Acute compression deformity of the L2 vertebral body with approximately 50%\nheight loss. No other evidence of fracture.\n2. Subcutaneous edema overlying the bilateral, left greater than right,\nbuttocks.\n3. No evidence of retroperitoneal hematoma." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Again seen is\nsurgical material in the left lower quadrant along the wall of the sigmoid\ncolon. Focal areas of decreased bowel lumen likely represent peristalsis. No\nsuspicious bowel thickening or lesions are seen. The appendix is surgically\nabsent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Compression fracture with non fusion of the L2 vertebral body is\nre-demonstrated. No change in a sclerotic focus in the left iliac wing,\nlikely a likely bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Within limits of the study, no discrete thickening or suspicious colonic\nmasses are demonstrated. This study should not be considered a completion of\nscreening CT colonography.\n2. No significant change in appearance of a L2 vertebral body compression\nfracture with non fusion.\n3. Please note contrast extravasation occurred during this procedure. Please\nrefer to note available in the EMR for full description." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is\nminimal bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent with\nsurgical clips seen in the gallbladder fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is at the upper limits of normal measuring 13.1 cm,\ngrossly unchanged from comparison study.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is absent compatible with\nreported history of prior appendectomy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral ovaries are visualized and\nunremarkable. There is a corpus luteal cyst in the right ovary (2:67)\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abnormality to explain patient's reported right upper quadrant pain." }, { "input": "CT ABDOMEN:\n\nThere are mild-to-moderate bibasilar atelectatic changes at the lung bases. \nThere is a 2-mm lung nodule within the right middle lobe (2:4).\n\nThere is a 2.2-cm lesion within segment VIII of the liver (2:15) and a 2.6-cm\nlesion within the caudate lobe of the liver (2:23), which most likely\nrepresent cysts. In addition, there is a 3-mm lesion within segment ___\n(2:13) and a 11-mm lesion within segment II (2:19) and a 4-mm lesion in\nsegment III (2:29) which are too small to characterize.\n\nThe pancreas, gallbladder, adrenal glands, kidneys appear unremarkable. There\nis a nasogastric tube terminating in the body of the stomach. There is no\nintra-abdominal or retroperitoneal lymphadenopathy. The abdominal aorta and\nmajor branch vessels appear unremarkable without aneurysm or dissection.\n\nCT PELVIS:\n\nThere are large heterogeneous masses arising from the uterus, the largest\nmeasuring 6.6 x 6.1 cm, and these are most consistent with multiple uterine\nfibroids. There is a small amount of free fluid within the pelvis, which may\nbe physiologic. There is a Foley catheter noted within the bladder likely\nsecondary to Foley insertion. The colon and small bowel appear unremarkable.\nThere is no intra-abdominal collection or abscess appreciated.\n\nThere is slight fat stranding within the anterior abdominal wall likely\nsecondary to subcutaneous injections. In addition, there is mild anasarca.\n\nCT OSSEOUS STRUCTURES:\n\nThere are no suspicious lytic or sclerotic bone lesions.", "output": "1. No explanation for the patient's symptoms on this examination. No\nintra-abdominal abscess or collection.\n\n2. Multiple liver hypodensities, the largest of which most likely represent\ncysts.\n\n3. Fibroid uterus.\n\n4. Small right middle lobe lung nodule, in the absence of known malignancy, no\nfurther follow-up is necessary." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.7 cm hypodensity within the left lower renal pole and a\nsubcentimeter hypodensity within the left upper renal pole, likely simple\ncysts. There is no evidence of focal renal lesions or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. A small\namount of free fluid is noted in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\ncompression deformity is noted involving the superior endplate of the the L1\nvertebra, likely chronic.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute findings in the abdomen or pelvis to explain patient's symptoms. \nNo findings to suggest malignancy.\n2. Small amount of free pelvic fluid is incidentally noted." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. A calcified\ngranuloma seen in the right lower lobe. There is a moderate left pleural\neffusion. There is no pericardial effusion. The heart is mildly enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is distended without\nevidence of wall thickening or cholelithiasis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Subcortical\nhypodensities in bilateral kidneys are too small to characterize there is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a\nmoderate fecal loading throughout the colon and rectum. There is mild wall\nthickening of the rectum with surrounding fat stranding presacral edema which\nmay represent a mild proctitis. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. The right greater saphenous vein appears expanded and\ncontains thrombus.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic fractures are seen along the left inferior and superior pubic rami. A\n2.1 cm mixed lytic and sclerotic lesion is seen in the left femur, unchanged\ncompared to prior. There is mild anterolisthesis of L4 on L5. Degenerative\nchanges are seen throughout the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild wall thickening with surrounding fat stranding along the rectum may\nrepresent a mild proctitis.\n2. Moderate left pleural effusion.\n3. Distended gallbladder without wall thickening, recommend clinical\ncorrelation with fasting state or right upper quadrant symptomatology.\n4. The right greater saphenous vein appears expanded and contains thrombus,\nconsistent with superficial thrombophlebitis, if there is clinical concern for\nDVT, a lower extremity ultrasound can be performed." }, { "input": "LOWER CHEST: Moderate bilateral pleural effusions are noted and there is\natelectasis in the lower lobes bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver has a nodular contour concerning for cirrhosis. The\nliver demonstrates homogenous attenuation throughout. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. There is ascites throughout the abdomen and pelvis\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is an acute fracture of the right sixth rib laterally. Best seen\non series 2, ___ 5 there is mild anterior wedging of L1 with osteophyte\nformation likely chronic.\n\nSOFT TISSUES: There is a large hematoma in the left flank measuring 22.2 x\n11.5 x 10.0 cm. A contains a fluid fluid level on series 2 ___ 39, consistent\nwith history of anti coagulation. There is hematoma in the left lower\nquadrant such as on series 2, ___ 67..", "output": "1. Large left flank hematoma measuring 22.2 x 11.5 x 10.0 cm\n2. Acute fracture of the right sixth rib laterally\n3. Nodular contour of the liver concerning for cirrhosis\n4. Moderate bilateral pleural effusions with compressive atelectasis of the\nlower lobes\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:22 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "There has been no significant interval change in a large left flank hematoma\ncurrently measuring 21.8 x 9.8 x 11.6 cm. It previously measured 22.2 x 10.0\nx 11.5 cm. A fluid fluid level is again noted in the left flank component. \nThe hemorrhage extends into the left iliacus muscle which is unchanged to\nminimally increased from the prior study. Nonhemorrhagic ascites is noted\nthroughout the abdomen and pelvis, unchanged.\n\nMultiple other incidental findings are not changed from prior CT from\nyesterday.", "output": "1. Since yesterday, there has been no significant interval change in the main\nportion of the large left flank hematoma.\n2. There is extension of this hemorrhage into the left iliacus muscle which is\nunchanged to minimally increased from the prior study.\n3. Other incidental findings are not changed from the prior study. Please see\nreport of CT abdomen and pelvis dated ___." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No focal consolidations. No pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous small hypodensities are seen throughout the liver,\nincompletely characterized, but likely cysts or biliary hamartomas. \nOtherwise, the liver demonstrates homogeneous attenuation throughout. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A 3 mm stone is seen within the distal left ureter just proximal to\nthe UVJ (series 2, image 88). There is mild upstream left\nhydroureteronephrosis. There is also mild fat stranding surrounding the left\nkidney and extending along the course of the left ureter. Additional punctate\nnonobstructing stones within the interpolar region on the right and within the\nlower pole on the left (series 601, image 35 and series 2, image 45). \nOtherwise, the kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. \nCalcifications within the right hemipelvis likely right reflect phleboliths.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Sclerotic lesion within a left posterior rib likely represents a bone\nisland (series 2, image 3). Multiple bone islands are also seen throughout\nthe pelvis bilaterally. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 3 mm obstructing stone within the distal left ureter. Mild upstream left\nhydroureteronephrosis and surrounding fat stranding.\n2. Additional nonobstructing stones within the kidneys bilaterally." }, { "input": "LOWER CHEST: Mild atelectatic changes of the right lung base. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere has been interval removal of the transgastric drainage catheter. A\nlinear hypodense track is seen at the site of the previous catheter (series 2,\nimage 14). There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The appendix is not visualized. New increased density in the\nmesenteric fat is seen in the left lower quadrant of the abdomen (series 2,\nimage 43).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal wall is within normal limits.", "output": "1. Interval removal of the transgastric drainage catheter with a residual soft\ntissue density track. No residual abscess.\n2. Nonspecific mesenteric hyperdensity in the left lower quadrant mesenteric\nfat is new, and could represent infection or inflammation." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a punctate calcified granuloma in the right hepatic lobe. There is\nno evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is collapsed and\nunremarkable. The portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring up to 15 cm in longest axis, without\nfocal lesion. Small accessory spleen is identified. There is a nonspecific\nhypodense lesion within the superomedial aspect of the spleen measuring 20 x\n10 mm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRight interpolar renal cyst measures 58 mm. There is no evidence of solid\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable. There is a tiny hiatal\nhernia. The duodenum and distal small bowel loops are normal caliber without\nevidence of obstruction. The large bowel and rectum are thin-walled without\npericolonic fat stranding or fluid collection identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is prominently enlarged, with median lobe\nimpressing upon the base of the bladder.\n\nLYMPH NODES: Porta hepatis lymph node is enlarged, measuring 52 x 19 mm\n(04:29). Several central mesenteric/celiac axis lymph nodes are not enlarged,\nwith 1 anterior to the IVC measuring 19 x 16 mm, and another abutting the\npancreatic head measuring 23 x 10 mm. There are several shotty mediastinal\nlymph nodes which are mainly increased in number, though not size. A left\npara-aortic node measures 18 x 20 mm. Other scattered prominent and mildly\nenlarged retroperitoneal lymph nodes are seen. Left pelvic sidewall lymph\nnode measures 18 x 10 mm (4:70). Right pelvic sidewall lymph node is mildly\nprominent measuring 22 x 9 mm (4:69).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is transitional vertebral anatomy with partial lumbarization of S1.\n\nSOFT TISSUES: There are small fat containing bilateral inguinal hernias. \nSubcutaneous air is seen in the left ventral abdominal wall compatible with\ninjection site.", "output": "1. Mesenteric, retroperitoneal, and pelvic sidewall lymphadenopathy, as\ndescribed above, concerning for lymphoma.\n2. Splenomegaly. Nonspecific hypodense 20 x 10 mm splenic lesion.\n3. No other acute findings in the abdomen or pelvis.\n4. Enlarged prostate." }, { "input": "LOWER CHEST: Bibasilar consolidation likely reflects atelectasis, but\nsuperimposed aspiration pneumonitis cannot be excluded. There is no pleural\neffusion. There is a small, nonhemorrhagic pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild, periportal edema, most\nlikely related to fluid administration. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A nasogastric tube terminates in the stomach. Small bowel\nloops are relatively decompressed. There is diffuse colonic dilatation,\nmeasuring up to 6.7 cm in the transverse colon. There is a large amount of\nfecal loading within the distal colon and rectum and mild rectal wall\nthickening and perirectal fat stranding could reflect stercoral colitis. \nThere is a small amount of mesenteric edema in the right lower quadrant (2,\n66) and underlying bowel ischemia cannot be definitively excluded. There is\nno evidence of free air, pneumatosis, or portal venous gas.\n\nPELVIS: The urinary bladder is decompressed around a Foley catheter. The\nFoley catheter balloon appears to extend into the proximal right inguinal\ncanal. There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fluid-containing left inguinal hernia.", "output": "1. Diffuse colonic dilatation measuring up to 6.7 cm in the transverse colon\nwith a large amount of fecal loading. No evidence of perforation or\npneumatosis. Mesenteric edema and small amount of ascites may be associted,\nunderlying ischemia not excluded.\n2. Mild rectal wall thickening and perirectal fat stranding could reflect\nstercoral colitis.\n3. Bibasilar consolidation likely reflects atelectasis, but superimposed\naspiration pneumonitis cannot be excluded." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. No biliary ductal dilatation\n\nPANCREAS: There is a 2.0 x 1.8 cm hypoechoic lesion in the body of the\npancreas (series 8/image 24). Otherwise, the pancreas is otherwise\nunremarkable. No main pancreatic ductal dilatation.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable. There is no hydronephrosis.\n\nURINARY: There are bilateral tiny hypodensities, too small to characterize. \nOtherwise, unremarkable. No hydronephrosis.\n\nGASTROINTESTINAL: There is no intestinal obstruction or ascites.\n\nPELVIS: Foley catheter is noted.There is a 4.6 x 5.7 cm heterogeneous cervical\nmass with likely parametrial extension given abutment of the right uterine\nartery. The mass obstructs the urine corpus. Bladder and rectal extension is\nnot seen, but evaluation is limited on this exam. The ovaries are within\nnormal limits for age.\n\nBlood and packing material are noted within the vagina. There is a 1.5 cm\nleft Bartholin's cyst.\n\nLYMPH NODES: There are multiple enlarged retroperitoneal lymph nodes inferior\nto the renal veins. For example, there is an interaortocaval lymph node\nmeasuring 1.1 cm (series 2/image 36) and left periaortic measuring 1 and 1.1\ncm. There is a 1.0 cm left para-aortic lymph node (series 2/image 37). There\nis a 1.1 cm common iliac lymph node (series 5/image 54). There are multiple\nenlarged bilateral external iliac lymph nodes. For example, there is a 2.1 cm\nleft external iliac lymph node (series 5/image 71). There is a 1.4 cm right\nexternal iliac lymph node (series 5/image 71) and a 1.2 cm right obturator\nlymph node. There is no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Metallic hardware in the\nregion of the left uterine artery is consistent with coil embolization.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Heterogeneous 5.6 cm cervical mass obstructing of the uterine corpus with\nretroperitoneal adenopathy up to the level of the left renal vein, as\ndescribed above.\n2. 2.0 cm cystic lesion in the body of the pancreas, could represent a\nmucinous neoplasm or side-branch intraductal papillary mucinous neoplasm\n(IPMN)." }, { "input": "LOWER THORAX: Multiple pulmonary metastases. Please refer to the separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings.\n\nHEPATOBILIARY: Previously visualized 38 mm segment 6 hepatic lesion is no\nlonger identified, and has been previously treated with Y 90. There is a new\nsegment 6 segment 6 hypodense lesion measuring 22 mm (axial series 4, image\n60). 9 mm hypodense lesion within segment 8 (axial series 4, image 49) is\nalso new from previous. Multiple subcentimeter hypodense lesions are too\nsmall to characterize, likely representing small cysts or hamartomas, the\nmajority of which appear unchanged dating back to MRI from ___. 15 mm\nlow-attenuation lesion (axial series 4, image 59) along the posterior surface\nof the right hepatic lobe may represent a small cyst, less likely a capsular\ndeposit. No biliary ductal dilatation. Unremarkable gallbladder.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: The spleen measures 13.4 cm in maximal ___, previously 13.4 cm.\n\nADRENALS: The adrenal glands are normal in size and morphology.\n\nURINARY: The kidneys are unremarkable. Left-sided extrarenal pelvis. No\nhydronephrosis. Unremarkable bladder.\n\nGASTROINTESTINAL: Soft tissue thickening at the level of the gastroesophageal\njunction appears stable dating back to ___. Small bowel loops are\nnormal in caliber. There are several nonobstructed small bowel loops which\nare contained within a right-sided inguinal hernia. Patient is status post\nAPR, with diverting left lower quadrant colostomy.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: No retroperitoneal or mesenteric adenopathy. No pelvic or\ninguinal adenopathy.\n\nPERITONEUM, RETROPERITONEUM, MESENTERY: Persistent plaque-like thickening\nwithin the presacral space (axial series 4, image 108). No discrete soft\ntissue mass.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic calcification.\n\nBONES: Degenerative changes of the thoracolumbar spine, worst at T12-L1 and\nL4-L5. Rounded area of sclerosis in the L3 vertebral body, vaguely present on\nthe prior examination and unchanged in size.\n\nSOFT TISSUES: Left lower quadrant colostomy. Right-sided inguinal hernia\ncontaining a nonobstructed loop of small bowel. Right-sided hydrocele,\npartially imaged.", "output": "Please note that the most recent outside examination dated ___ is not\navailable for comparison at the time of this dictation. Comparison is made to\n___.\n\n1. Previously treated segment 6 hepatic lesion is no longer identified. 2 new\nlesions within segments 6 and 8 are suspicious for new hepatic metastases.\n2. Stable presacral soft tissue thickening is nonspecific and may represent\npost treatment change. Attention on follow-up is recommended.\n3. Persistent soft tissue thickening at the level of the gastroesophageal\njunction is stable from previous and may represent thickening of the\ndiaphragm, however attention on follow-up is recommended.\n4. Right-sided inguinal hernia containing a nonobstructed loop of small bowel." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized, however\nthere are no secondary signs of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is present in the uterus. No adnexal abnormality\nis seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There are mild degenerative changes in the lumbar spine. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No abnormality in the abdomen or pelvis to explain patient's symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild sigmoid\ndiverticulosis without evidence of diverticulitis. Appendix is not seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nhyperdense free fluid in the pelvis, possibly representing sequela of ruptured\nhemorrhagic ovarian cyst.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. There is a large 5.9 x 7.9 cm\nbilobed left adnexal cyst. Adjacent 2.9 x 5.1 cm right adnexal cyst appears\nslightly less well defined.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Hyperdense fluid in the pelvis with adjacent poorly defined right adnexal\ncystic lesion suggests recently ruptured hemorrhagic cyst.\n2. Left adnexal cystic lesion measuring up to 7.9 cm. Consider further\nevaluation with pelvic ultrasound if there is concern for ovarian torsion\ngiven the large size of this cyst.\n3. No evidence of diverticulitis. No other acute intra-abdominal process.\n\nRECOMMENDATION(S): Pelvic ultrasound, which was completed at the time that\nthis report was finalized." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits. Bilateral ovarian\ncysts measuring up to 4.8 cm on the left and 2.7 cm in the right in keeping\nwith simple right ovarian cyst in hemorrhagic left ovarian cyst is\ndemonstrated on same-day pelvic ultrasound.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Bilateral ovarian cysts better characterized on same day pelvic ultrasound.\nThe uterine morphology is also better evaluated on the pelvic ultrasound and\nmay represent a septate configuration for which further evaluation by\ndedicated pelvic MRI may be considered.\n2. Normal-appearing appendix.\n3. Cholelithiasis without evidence of cholecystitis.\n\nRECOMMENDATION(S): Please see impression 1." }, { "input": "LOWER CHEST: Imaged lung bases are clear.\n\nABDOMEN: The liver, spleen, gall bladder, pancreas an adrenal appear normal. \nSmall renal cortical hypodensities are noted, the largest of which arises from\nthe lower pole right kidney measuring 2.1 cm in maximal diameter most likely\nrepresenting a simple cyst. No pyelonephritis or hydronephrosis. The\nabdominal aorta is normal in course and caliber with minimal atherosclerotic\ncalcification. No retroperitoneal adenopathy. The stomach and duodenum\nappear normal.\n\nPELVIS: Small bowel demonstrates no signs of ileus or obstruction. The\nappendix is normal. The colon appears normal through the level of the\nproximal descending. There is circumferential thickening and mild pericolonic\nfat stranding affecting the mid and distal segments of the descending colon\nconsistent with acute colitis. Trace free pelvic fluid is also noted. The\nsigmoid colon and rectum appear normal. Prostate is not enlarged. Urinary\nbladder is mostly decompressed. Tiny fat containing inguinal hernias are\npresent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild skin thickening and subcutaneous fat stranding noted\ninvolving the lower abdomen to the left and right of the umbilicus for which\nclinical correlation is advised.", "output": "1. Acute colitis involving the descending colon. Trace free pelvic fluid.\n2. Mild skin thickening with focal subcutaneous fat stranding along the\nmidabdomen to the right and left of the umbilicus for which clinical\ncorrelation advised." }, { "input": "LOWER CHEST: Bibasilar atelectasis is noted. There is no frank pericardial or\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely coarsened and shrunken, compatible with\ncirrhosis. Innumerable hepatic nodules are noted, with a dominant mass in the\ninferior right hepatic lobe (2:32, 601b:28) compatible with the patient's\nknown hepatocellular carcinoma. Large volume ascites is unchanged. \nPerisplenic, esophageal, and perianal varices are again noted, with a\nrecannulized paraumbilical vein. Extensive portal venous thrombosis is again\nnoted. There is no frank intrahepatic or extrahepatic biliary ductal\ndilatation. Extensive gallbladder wall edema is likely secondary to third\nspacing.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring 15.1 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Numerous loops of proximal\nsmall bowel are collapsed but appear to demonstrate wall thickening (for\nexample, 02:35). There is no abnormally dilated small bowel to suggest bowel\nobstruction. Extensive fecal loading is seen throughout the colon. The\nappendix is normal. The rectum appears particularly thick walled with\nsurrounding inflammatory changes which have progressed from the prior\nexamination (2:87).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate free fluid in the pelvis.\n\nLYMPH NODES: Numerous prominent retroperitoneal and mesenteric lymph nodes are\nvisualized. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Focal wall thickening and adjacent inflammatory changes surrounding the\nrectum, is suggestive of proctitis given the patient's presentation.\n2. Proximal small bowel wall thickening may be secondary to underdistention\nand reactive changes from the surrounding ascites. However, superimposed\nenteritis is difficult to exclude.\n3. Hepatic cirrhosis with numerous ill-defined hepatic lesions, compatible\nwith known hepatocellular carcinoma.\n4. Splenomegaly, esophageal/perianal variceal formation, recannulized\numbilical vein, and large volume ascites, all of which are likely secondary to\nthird spacing in the setting of portal hypertension.\n5. Persistent portal venous thrombosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple subcentimeter hypodense lesions the largest the dome of the liver are\nstable from prior exam and likely represent cysts or biliary hamartomas. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right colon is normal in size and shape. Appearance of nodular\nthickening of the left adrenal gland appears stable compared to prior studies.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. There is unchanged\nappearance of peripherally enhancing tissue in the right adnexal region\nsecondary to history of sacrocolpopexy from prior exams.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. Prominent left external iliac lymph\nnode measuring up to 1.0 cm in short axis is similar to prior exam, unchanged\nsince ___ (4:4).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Indistinct area of sclerosis in the left iliac bone appears similar to\nprior exam and measures approximately 1.5 x 1.5 cm (4:93). There is sclerosis\nin the left side of the L4 vertebral body which also appears similar to prior\nexam measuring approximately 1.0 x 0.76 cm, not significantly changed since\nprior exam. Indistinct area of sclerosis in the left L4 pedicle also appears\nsimilar to prior. Sclerosis of the left L2 pedicle also appears similar to\nprior exam. A sclerotic lesion in the L1 vertebral body measures 0.8 x 0.6\ncm, previously 1.1 x 0.9 cm (4:57).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple osseous metastases, not significantly changed since prior exam.\n2. No evidence of new metastatic disease in the abdomen or pelvis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hyperdensities in segment ___ in the hepatic dome, are unchanged\nfrom prior. No additional focal liver lesion there is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. There is no bowel\nobstruction. There is thickening of the terminal ileum, new from prior. \nThere is no large bowel wall thickening.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Note is made of a lateral right rectocele,\nsuggesting pelvic floor dysfunction.\n\nREPRODUCTIVE ORGANS: The uterus is absent. There is unchanged appearance of\nperipherally enhancing tissue in the right adnexal region secondary to history\nof sacrocolpopexy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is mild\natherosclerotic calcification of the abdominal aorta.\n\nBONES: There is no significant change in the size of multiple sclerotic bony\nlesions. With the largest at L1 (5:56) measuring 1.3 x 1.0 cm (previously 1.2\nx 0.8 cm). Additional sclerotic lesions are seen at L4, the left iliac bone,\nand the L2 and L4 left pedicles. Ill-defined left anterior sclerotic focus\n(5:93) measures approximately 2.2 x 1.7 cm, previously 2.0 x 1.5 cm. \nIll-defined left posterior sclerotic focus (5:90) measures approximately 1.8\nx 1.6 cm, previously 1.9 x 1.4 cm. No new bony lesions are identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple sclerotic osseous lesions, ill-defined making comparison\ndifficult, but perhaps slightly larger compared to prior examination.\n2. No new disease in the abdomen or pelvis.\n3. New thickening of the terminal ileum, possibly focal terminal ileitis,\ncorrelate with symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen is an 8 mm hypodensity at the dome of liver, and an additional\npunctate hypodensity anteriorly, unchanged. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is a 1.0\nx 1.1 cm nodule in the left adrenal gland, unchanged since at least ___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. A\nsubcentimeter cortical hypodensity in the lower pole of the left kidney is too\nsmall to characterize by CT, unchanged. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is otherwise\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multiple sclerotic lesions are again noted, unchanged, including lesion\nin the L1 vertebral body measuring 9 mm (10:33), sclerosis of the left\npedicles at L2 and L4 (4:66, 78), and sclerosis of the posterior left iliac\nbone (4:93).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged sclerotic osseous lesions.\n2. No new metastatic disease in the abdomen pelvis.\n3. Please refer to separate report of CT chest performed same day for\ndescription of thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is mild focal fatty infiltration along the falciform\nligament. 9 mm hypodensity in segment 7 at the dome is unchanged. Another\nsub 5 mm peripheral hypodensity in segment 4 (series 2, image 58) is\nunchanged. There is an ill-defined hypodensity in segment ___ (series 2,\nimage 58) which appears less conspicuous compared to the prior study. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSub 5 mm cortical hypodensities bilaterally are too small to characterize. \nThere is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. There is no adnexal\nmass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is mild increased sclerosis within the left iliac bone compared\nto the prior study. Sclerotic lesions within the spine are unchanged. For\nexample, 10 mm sclerotic lesion in L1 vertebral body previously measured 10\nmm. There is no new bone lesion or extraosseous soft tissue component or\nevidence of a pathologic fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild increased sclerosis in the left iliac bone may be secondary to\ntreatment effect. No new bone lesion identified.\n2. No convincing evidence of metastatic disease in the abdomen and pelvis. \nIll-defined hypodensity in the right anterior section of the liver is less\nconspicuous compared to the prior study. Attention on follow-up is\nrecommended." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout, with\nfocal fat along the falciform ligament. A 1.0 cm circumscribed hypodensity in\nsegment VII and a 5 mm circumscribed hypodensity in segment IV (04:55) remain\nunchanged, and are favored to represent cysts or biliary hamartomas. An\nill-defined hypodensity in segment VIII/V (04:57) is indeterminate, similar\nappearance to prior CT from ___. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no focal renal lesion. Note is made of small bilateral extrarenal\npelves and fullness of the renal collecting systems. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is nonspecific wall thickening of the gastric antrum,\nwhich is unchanged compared to multiple prior studies. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Diffuse sclerosis of the left iliac bone is similar to prior. \nAdditional sclerotic lesions in the thoracolumbar spine, including the left\npedicle and transverse process at L2 and L4, are also unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Redemonstration of diffuse sclerosis of the left iliac bone and other\nsclerotic lesions involving the thoracolumbar spine. No new osseous lesions.\n2. Ill-defined hypodensity in hepatic segment VIII/V is unchanged compared to\nprior CT from ___. Further characterization with contrast\nenhanced MRI of the liver may be performed as clinically indicated.\n3. Please refer to separate report of CT chest performed same day for\ndescription of thoracic findings." }, { "input": "Lungs: Please see the report of the CT chest performed on the same day for\nmore details.\n\nLiver: The hypodense lesion at the dome measuring 1.3 cm is stable compared to\npreviously, statistically likely cyst.\n\nThe previously described hypodense lesions in segment 3, 4A and 7 are stable\nsince ___.\n\nThe ill-defined hypodensity in segment ___ is also stable since ___.\n\nThe liver is homogeneous with a smooth contour.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\nis unremarkable.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. No pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Tiny cortical hypodensities are seen in left kidney, likely cysts. \nNo hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. New moderate amount of free fluid.\n\nReproductive organs: Previous hysterectomy.\n\nGastrointestinal: Non-specific focal circumferential wall thickening involving\nthe splenic flexure, likely focal colitis, which could be related to\nchemotherapeutic reaction. Recommend attention on follow-up..\n\nNo evidence of obstruction.\n\nVascular: Mild atherosclerotic calcifications of the abdominal aorta.\n\nLymph nodes: No size significant lymph nodes.\n\nBone and soft tissues: Stable sclerotic lesions within the lumbar spine,\ninvolving L2 and L4, as well as bilateral iliac and left inferior pubic ramus.\nNo pathologic fracture.", "output": "1. No evidence of intra-abdominal metastasis.\n\n2. Stable sclerotic lesions within the lumbar spine, involving L2 and L4, as\nwell as bilateral iliac and left inferior pubic ramus. No pathologic\nfracture. No new bone lesions identified.\n\n3. New moderate amount of free fluid.\n\n4. Non-specific focal circumferential wall thickening involving the splenic\nflexure, likely focal colitis, which could be related to chemotherapeutic\nreaction. Recommend attention on follow-up." }, { "input": "CT OF THE ABDOMEN AND PELVIS WITH IV CONTRAST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nThe liver parenchyma appears normal in density. Again seen are subcentimeter\nhypodensities along the periphery of segments II (series 4, image 52), ___\n(series 4, image 53), V (series 4, image 59), and VII (series 4, image 45),\nare unchanged in comparison to the earlier is comparison CT examination from\n___, compatible with biliary hamartomas or hepatic cysts. Arising\nfrom the posterior aspect of segment VII is an ill-defined 8 mm lesion, which,\non prior multiphasic studies, appears most compatible with a small hemangioma.\nNo concerning hepatic mass is detected. There is no intrahepatic bile duct\ndilation. The gallbladder is normal.\n\nThe pancreas, spleen, adrenal glands, kidneys, and intra-abdominal loops of\nsmall and large bowel are normal. There is a small hiatal hernia (series 4,\nimage 50). The stomach is otherwise normal.\n\nThe abdominal aorta, celiac trunk, SMA, and renal arteries are patent and\nnormal in caliber.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy, and no ascites.\n\nThe bladder, uterus, rectum, and intrapelvic loops of small and large bowel\nare within normal limits. There is no intrapelvic lymphadenopathy or free\nfluid.\n\nThere are no osseous sclerotic or lytic lesions corresponding to areas of\nfocal tracer uptake within the L2 and L4 vertebral bodies. From the ___ bone scan. There is no acute or chronic fracture. Degenerative changes\nthroughout the thoracolumbar spine are minimal.", "output": "1. No CT findings correlating to areas of focal tracer uptake on the ___ bone scan within the L2 and L4 vertebral bodies. This could still\nrepresent early metastases, as degenerative changes appear minimal on CT. A\nrepeat bone scan within 6 months is recommended per the recommendation from\nthe ___ study, and could be performed in conjunction with an MRI at that\ntime.\n2. Multiple hepatic lesions, likely tiny cysts and a small segment VII\nhemangioma, remain stable.\n3. No intra-abdominal or intrapelvic lymphadenopathy.\n4. Small hiatal hernia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver enhances homogeneously. Tiny hypodensity in the right\nlobe of the liver is too small to characterize but likely a cyst or\nhemangioma. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Subcentimeter hypodensity at the lower pole of the\nleft kidney is too small to characterize, but likely represents a simple cyst.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Small duodenal\ndiverticulum is noted. There is diverticulosis of the ascending and\ntransverse colon. Contrast possibly from prior examination is seen in ileal\nsmall bowel loops as well as in the cecum. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy. Ovaries are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.", "output": "No acute intra-abdominal process, no findings to explain patient's symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation throughout\ncompatible with hepatic steatosis. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a subcentimeter cortical hypodensity in the lower pole of the left\nkidney which is too small to characterize and likely represents a renal cyst. \nThere is no evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe ascending and transverse colon is re-demonstrated colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes are visualized throughout the imaged\nportion of the thoracolumbar spine without evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No acute abnormalities identified within the abdomen or pelvis.\n2. Diverticulosis without diverticulitis." }, { "input": "NOTE: This study does not include the pelvis.\n\nLOWER CHEST:\nThe visualized lung bases are clear.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: The liver parenchyma enhances homogeneously. No focal liver\nlesions. No intrahepatic biliary ductal dilation.\nThe gallbladder is distended with no radiopaque calculi within it or\npericholecystic inflammation.\nPANCREAS: Homogeneous enhancement of the pancreatic parenchyma without main\nduct dilation.\nSPLEEN: No splenomegaly or focal splenic lesions.\nADRENALS: No adrenal nodules.\nURINARY: No hydronephrosis or solid enhancing renal masses.\nGASTROINTESTINAL: There is no bowel obstruction.\n\nLYMPH NODES: There are no enlarged lymph nodes in the upper abdomen\nVASCULAR: The visualized portion of the abdominal aorta demonstrates no\natherosclerotic calcification or aneurysmal dilation.\n\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.", "output": "No acute process in the upper abdomen. Specifically, no acute cholecystitis\non CT. Of note, the pelvis has not been included on this scan." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. There is a duodenum\ndiverticulum. There are focally mildly dilated in the left lower quadrant\nmeasuring up to 3.2 cm with decompressed loops distally. There is a possible\ntransition point in the left mid abdomen (series 601b, image 34). The\nremainder of the bowel appears normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Focal mildly dilated loops of small bowel in the mid and left lower abdomen\nwith decompressed loops distally and a possible transition in the mid abdomen\n(series 601b, image 33), findings are potentially concerning for early or\npartial small bowel obstruction." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. A nasoenteric tube ends in\nthe stomach. There has been interval improvement in the appearance of a small\nbowel, loops now are non dilated oral contrast has extended beyond the\nquestionable transition point. The large bowel is unremarkable. The appendix\nis not seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes of the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Essentially normal study with resolution of previously noted focal small bowel\ndistention in the left lower abdomen. NG tube positioned appropriately." }, { "input": "There are persistent pleural effusions with associated atelectasis, but right\nworse than left; the right one is small to moderate, the left one small. Note\nis made of coronary artery calcifications. There is a small amount of\npericardial effusion.\n\nCT of the abdomen: Evaluation of solid abdominal viscera is limited by lack of\nIV contrast. Within these limitations, the liver is homogeneous with no focal\nhepatic lesions identified. There is no intra or extrahepatic biliary ductal\ndilatation. The gallbladder contains gallstones but is otherwise normal. The\nadrenal glands, pancreas and spleen are normal. The non contrast-enhanced\nkidneys show no hydronephrosis or renal masses.\n\nThe stomach is collapsed. Small and large bowel are grossly unremarkable.\nThere is new small volume ascites. The intra-abdominal vasculature is\nextensively calcified. There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria. There is a generalized body wall edema which\nis not significantly different from prior examination.\n\nThere are two oval-shaped hyperdensities seen within subcutaneous tissues of\nthe anterior abdominal wall on the right (series 2, image 7, 8). The larger\nmeasures up to 20 mm, the small up to 13 mm.\n\nCT of the pelvis: There is increased amount of pelvic free fluid which\nmeasures low density, small in quantity. The urinary bladder contains a Foley\ncatheter and is otherwise normal. The rectum is grossly unremarkable. \nModerate soft tissue edema suggests fluid overload. Mildly prominent\nbilateral inguinal lymph nodes appear unchanged.\n\nOsseous structures: There is mild displacement of the lower aspect of the\nsacrum (series 6028, image 51), felt to be chronic in nature. No additional\nosseous abnormalities identified. No blastic or lytic lesion concerning for\nmalignancy.", "output": "1. Findings suggesting generalized fluid overload, including ascites, pleural\neffusions and anasarca.\n\n2. Mild displacement of the sacrum; imaging findings are more suggestive of\nan older than recent fracture, however, yet new since ___ imaging. An\nacute fracture is not excluded however.\n\n3. Severe calcified atherosclerotic disease of the aorta and its branches.\n\n4. Cholelithiasis with no acute cholecystitis.\n\n5. Two new oval-shaped hyperdensities seen within subcutaneous tissues of the\nanterior abdominal wall on the right, these could relate to prior injections,\nhowever these appear new, and if there is an doubtful about these may have\nbeen injection sites, further evaluation with ultrasound is suggested to\nexclude solid nodules along the medial lower margin of the left breast.\n\nNOTIFICATION: Findings number 3 and 7 were discussed by Dr. ___\nwith Dr. ___ on the telephone on ___ at 11:57 ___, minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There is mild bibasilar atelectatic change, otherwise the lung\nbases are unremarkable.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is a 1.2 x 1.7 cm arterially enhancing lesion in the\npancreatic body, the imaging appearance of which is compatible with a\npancreatic neuroendocrine tumor. It is not significantly changed in size or\nappearance when compared to priors. No other suspicious pancreatic\nparenchymal lesions are identified. There is no main pancreatic ductal\ndilation. There is no peripancreatic lymphadenopathy. Lack of a complete\ndistinct fat plane between the lesion and the SMV is seen, best appreciated on\nimage 34 of series 4, however there is less than 180 degrees contact at this\nlevel. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.4 cm renal cyst seen at the interpolar region of the left kidney.\nThere are scattered renal hypodensities too small to characterize but\nstatistically representing small cyst. There are no concerning or suspicious\nrenal lesions seen. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is fecalization in a few\nproximal jejunal bowel loops suggestive of slow transit at this level. There\nis no obstruction or other abnormality seen. There are bowel sutures noted at\nthe rectosigmoid junction, please correlate with clinical history. Remainder\nof the visualized colonic loops are unremarkable The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.2 x 4.5 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Benign-appearing lucent lesion in the left iliac wing with sclerotic\nborder seen measuring 1.7 x 0.7 cm. No suspicious bony lesions or fractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 1.2 x 1.7 cm arterially enhancing lesion in the pancreatic body, imaging\nappearance of which is compatible with a pancreatic neuroendocrine tumor. \nLesion is not appreciably changed in size and appearance when compared to\nprior.\n2. No evidence of extra pancreatic disease. Other incidental findings as\ndetailed above." }, { "input": "LOWER CHEST: Please see separate dictation for details on same-day chest CT.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is a 1.6 x 1.1 cm hyperenhancing partially calcified lesion in\nthe body of the pancreas (series 2, image 162). No additional pancreatic\nlesions are seen. The pancreatic duct is not dilated.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter renal hypodensities are too small to characterize, but\nunchanged. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. The\nstomach is decompressed. The small bowel is normal in caliber without focal\nwall thickening. Surgical sutures are present within the pelvis from prior\nsmall bowel resection. There is no evidence of local disease recurrence. The\nlarge bowel is normal in caliber without focal wall thickening. The appendix\nis well-visualized and normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 4.5 x 5.1 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The SMA and celiac axis are\npatent. The ___ is thrombosed.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. 1.6 cm hyperenhancing partially calcified lesion in the pancreatic body,\nmost consistent with a primary neuroendocrine tumor.\n2. No evidence of local disease recurrence or metastatic colon cancer in the\nabdomen and pelvis.\n3. Please see separate dictation for details on same-day chest CT.\n\nRECOMMENDATION(S): The impression was entered by Dr. ___ on\n___ at 16:57 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is mild\ncardiomegaly. A central venous catheter terminates in the right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cysts are unchanged. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS AND REPRODUCTIVE ORGANS: In comparison with ___, there has\nbeen removal of a right lower quadrant pigtail catheter. A left lower\nquadrant pigtail catheter is in place, without a significant surrounding\ncollection (02:58) there remains an enhancing mass in the pelvis measuring up\nto 15 x 7 cm, previously up to 15 x 10 cm (302: 70) consistent with the known\ntubo-ovarian abscess and pyosalpinx.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are noted.\n\nSOFT TISSUES: A large ventral hernia containing decompressed loops of bowel is\nunchanged.", "output": "Pelvic mass measuring 15 x 6.7 cm, previously up to 15 x 10 cm consistent with\nthe known tubo-ovarian abscess and pyosalpinx. There has been interval\nremoval of a right sided pigtail catheter. A left pigtail catheter remains in\nplace in a decompressed collection." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. PICC tip terminates in the\nproximal right atrium.\n\nABDOMEN:\nEvaluation of the abdomen particularly the anterior abdominal wall is limited\nby body habitus.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a simple cyst in the inferior pole of the left kidney measuring 2.6\ncm across maximally (series 2:30). There is no hydronephrosis or perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Bowel loops in a left ventral hernia are\nunremarkable. The appendix is normal.\n\nPELVIS AND REPRODUCTIVE ORGANS: Left pelvic drain has been removed. 6.2 x 4.2\ncm heterogeneous lesion in the right adnexa, which is difficult to precisely\nmeasure separately from the uterus, appears similar in size from the prior\nexam with increased adjacent fat stranding and perhaps mild increased\nhyperemia. 6.7 x 4.3 cm heterogeneous left adnexal lesion is also difficult\nto precisely discern from the uterus, but appears decreased in size with\nresolution of stranding previously seen on ___ compatible with\nresolving tubo-ovarian abscess. There is no pelvic free fluid.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A large infraumbilical ventral hernia contains fat and multiple\nloops of small bowel without obstruction. Additional supraumbilical fat\ncontaining hernia is demonstrated.", "output": "1. Normal appendix. No evidence of bowel obstruction.\n2. Right adnexal heterogeneous lesion measuring 6.2 x 4.8 cm is gross\nunchanged in size but demonstrates increased mild adjacent fatty stranding and\npossible increased hyperemia. There is no definite drainable fluid component,\nhowever, this could reflect recurrent tubo-ovarian abscess or worsening pelvic\ninflammatory disease. Pelvic ultrasound or MRI could be considered for\nfurther characterization.\n3. Left adnexal heterogeneous lesion measuring 6.7 x 4.3 cm is mildly\ndecreased with interval resolution of fatty stranding seen on ___\ncompatible with resolving tubo-ovarian abscess.\n4. No acute osseous abnormality seen to account for the patient's low back\npain.\n5. Re-demonstration of large ventral hernia containing fat and bowel loops\nwithout complications.\n\nRECOMMENDATION(S): Consider pelvic ultrasound or MRI for further assessment\nof the right adnexa." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal and symmetric in size. Bilateral cortical\ncysts are unchanged since the prior examination. There is no hydronephrosis\nin either kidney. No suspicious solid lesions are identified. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is no evidence of small or large bowel obstruction. \nInflammatory changes involving the sigmoid colon are most likely reactive. \nPortions of the bowel are excluded from the field of view anteriorly.\n\nPELVIS: The uterus is normal in size. Again noted is a complex,\nheterogeneous, multi-septated cystic lesion, in the left adnexa similar in\nlocation to the previously diagnosed tubo-ovarian abscess, measuring 6.9 x 7.3\nx 9.1 (2:66), most consistent with pyosalpinx and tubo-ovarian abscess, given\nthe patient's history. It had measured 5.3 x 5.5 x 7.0 cm on prior exam in\n___. Measured in addition, a complex primarily cystic lesion is seen\nin the right adnexa, also similar in location to the previously noted right\nsided tubo-ovarian abscess, measuring 4.5 x 7.1 x 3.9 cm (02:69) this had\nmeasured 3.6 x 6.6 x 4.7 cm on prior. Small locules of air (2:69) are present\nwithin the lesion, and are suspicious for infection.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes noted in the lumbar spine with intervertebral disc height\nloss and vacuum disc phenomenon at L3-4 and L4-5.\n\nSOFT TISSUES: The soft tissues of the abdominal and pelvic wall are not\ncompletely imaged given patient's body habitus. There is partially visualized\nleft lower abdominal bowel containing hernia without secondary obstruction. \nThis was present on prior exam.", "output": "1. A 9.1 cm left adnexal complex, multi-septated cystic lesion is compatible\nwith a tubo-ovarian abscess with surrounding associated inflammatory changes\nas seen on prior exam from ___.\n2. A 7.1 cm heterogeneous, primarily cystic lesion in the right adnexa may\nreflect recurrent tubo-ovarian abscess, similar in size compared to the ___.\n3. Nonobstructing left lower quadrant bowel containing hernia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is again a 1.5 cm simple cyst in the left lower renal pole. A 2.2 cm\nhypodensity is again seen in the interpolar region of the right kidney, likely\nsimple cyst. There is no evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is interval placement of a left percutaneous\ndrainage catheter which terminates along the periphery of a multiloculated\nleft tubo-ovarian abscess, currently measuring 6.6 x 6.0 cm (3:61), previously\n7.3 x 6.8 cm in ___. Additionally, there is similar appearance of a\npreviously described right tubo-ovarian abscess with multiple septations,\nmeasuring 7.0 x 2.8 cm, previously 7.1 x 4.5 cm (3:64). The uterus is normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is again a moderate-sized abdominal bowel containing\nventral hernia, unchanged.", "output": "1. Interval placement of a left percutaneous drainage catheter which\nterminates along the periphery of a left multiloculated ubo-ovarian abscess,\ncurrently measuring 6.6 x 6.0 cm, previously 7.3 x 6.8 cm ___.\n2. Similar appearance of a previously described right tubo-ovarian abscess\nsince ___, measuring 7.0 x 2.8 cm.\n\nRECOMMENDATION(S): Recommend readjustment of the left percutaneous drainage\ncatheter for optimal positioning." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN: Please note the study is limited by significant artifacts.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nStable renal cysts. There is no evidence of hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small and large bowel loops\nare normal in caliber. No evidence of bowel obstruction.\n\nPELVIS: The urinary bladder is partially distended. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: There is mild interval decrease in size of the left\nadnexal abnormality/abscess measuring 3.7 x 5.0 cm (previously 6.6 x 6.0 cm),\nthe right adnexal/tubo-ovarian abscess measures 5.1 x 3.6 cm (previously 7.0 x\n2.8 cm).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Technically limited study due to significant artifact. However there has been\nmild interval decrease in size of bilateral adnexal/tubo-ovarian abscesses." }, { "input": "LOWER CHEST: There is mild cardiomegaly. Mosaic attenuation pattern at the\nbilateral lung bases may be sequela of poor breath hold, however it appears\nnew from prior. Recommend correlation with pulmonary symptoms. There is a 3\nmm lateral left lower lobe as well as bibasilar atelectasis worse in the right\nlung base.\n\nABDOMEN:\nPlease note, due to patient's body habitus and scanner technique, the entirety\nof the anterior abdominal wall is not included in the study.\n\nHEPATOBILIARY: Of the visualized liver, there is a homogenous attenuation\npattern without evidence of focal lesion. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.6 cm simple renal cyst in the left kidney is unchanged. A subcentimeter\nhypodensity in the right renal cortex is too small to characterize by CT but\nstable from prior and likely benign. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Within the right adnexa, there is a 9.3 x 5.9 cm heterogeneous\ncollection consistent with known tubal ovarian abscess. The collection\nappears to have increased in size from prior, previously measuring 7.6 x 5.4\ncm, and abuts the abdominal wall. There is adjacent soft tissue stranding\nabout the transversalis muscle and overlying subcutaneous tissue, which\nappears mildly worsened from prior. No subcutaneous or intramuscular fluid\ncollection is identified.\nA heterogeneous structure in the left adnexa measures 4.9 x 3.4 cm, previously\n5.8 x 4.8 cm, consistent with known left tubo-ovarian abscess. There is\noverlying soft tissue stranding along the left anterolateral abdominal wall,\nwhich extends superiorly and appears increased prior but is incompletely\nimaged. The stranding demonstrates low-density, making infectious etiology\nless likely, and is consistent with edema.\n\nThe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis. The uterus is within normal limits.\n\nLYMPH NODES: No pathologically enlarged lymph nodes demonstrated.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Soft tissue stranding at the bilateral lower anterior abdominal\nwalls, incompletely imaged and described above. Similar appearance of a\nventral abdominal diastasis measuring approximately 15.4 cm, containing loops\nof small and large bowel. Within the diastasis, there is markedly laxity\nlikely complicated by a hernia into the pannus without obstruction.", "output": "1. Study is limited by body habitus and streak artifact.\n2. Increased size of right adnexal mass consistent with tubo-ovarian abscess\nwith increased adjacent fat stranding. No drainable collection.\n3. Interval decreased size of a left adnexal tubo-ovarian abscess.\n4. No significant change in a partially imaged 15.4 cm ventral abdominal wall\ncontaining loops of large and small bowel likely complicated by a focal hernia\ninto the pannus, without obstruction.\n5. Geographic ground-glass opacities at the lung bases could be related to air\ntrapping.\n6. Mild cardiomegaly.\n7. Soft tissue stranding along the left anterolateral abdominal wall is likely\nedema." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Evaluation of the liver is limited by the lack of intravenous\ncontrast. However, there are multiple hypodense hepatic lesions noted\nthroughout the liver parenchyma, with a dominant confluent area of hypodensity\ninvolving the central right lobe and caudate lobe (axial series 2, image 49;\ncoronal series 5, image 34) measuring approximately 9.7 x 9.2 x 9.6 cm. There\nis a nodular contour to the liver parenchyma, which may be related to multiple\nunderlying lesions or background hepatic cirrhosis. There is pneumobilia\ninvolving the left-sided intrahepatic biliary tree. The gallbladder has been\nremoved.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly prominent, measuring 13.7 cm in longest\n___. No focal lesion is identified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic bilaterally. 12 mm exophytic cyst arising\nfrom the upper pole of the right kidney. No hydronephrosis. No urinary\ncalculi are identified. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is evidence of a prior partial gastrectomy with\nsurgical suture line noted along the greater curvature of the stomach. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder is only partially distended which limits\nevaluation. There is trace free fluid within the right pericolic gutter.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is extensive periportal and retroperitoneal adenopathy. \nThe largest node measures 31 mm in the periportal region (axial series 2,\nimage 62). The largest retroperitoneal lymph node measures 17 mm, para-aortic\n(axial series 2, image 81). Several borderline enlarged mesenteric lymph\nnodes are also noted, largest measuring 10 mm (axial series 2, image 88).\nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Mild degenerative changes of the thoracolumbar spine without discrete\nlytic or sclerotic bony lesion.\n\nSOFT TISSUES: 2.8 cm soft tissue mass within the subcutaneous tissues of the\nright flank (axial series 2, image 87). Additional 1.1 cm soft tissue nodule\nis noted within the subcutaneous tissues of the right upper abdominal wall,\nsuperficial to the liver (axial series 2, image 49).", "output": "Limited evaluation due to the lack of intravenous contrast. Within these\nlimitations:\n\n1. Multiple hypodense liver lesions, with dominant mass involving the central\nright hepatic and caudate lobes.\n2. Extensive periportal and retroperitoneal adenopathy as well as subcutaneous\nmasses.\nOverall, findings are in keeping with metastatic disease to the liver, lymph\nnodes, and subcutaneous tissues. A multifocal hepatocellular or biliary\nmalignancy with metastatic spread could also be a differential consideration,\ngiven a dominant liver mass. Other differential considerations could include\nlymphoma or a primary cutaneous/subcutaneous malignancy such as melanoma. \nPercutaneous biopsy of the large subcutaneous right flank mass would likely be\nfeasible under ultrasound guidance for tissue diagnosis." }, { "input": "LOWER CHEST: The chest fndings will be reported separately.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is mild left perinephric\nstranding, which is nonspecific.\n\nGASTROINTESTINAL: There is a large hiatal hernia containing almost the entire\nstomach. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. There are several scattered diverticula of the descending and\nsigmoid colon. The colon and rectum are otherwise unremarkable.\n\nThere has been near resolution of the congestion and nodular thickening in the\nsmall bowel mesentery and omentum. There is mild residual stranding of the\nomentum in the right lower quadrant (series 3, images 76-82).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Aneurysmal dilatation of the\nleft common iliac artery measuring up to 2.3 cm, stable. Moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable severe compression fracture of the L1 vertebral body, with 9 mm of\nretropulsion along the thecal sac. There is moderate central canal stenosis\nat this level. There have been prior laminectomies at L4 and L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Near resolution of the congestion and nodular thickening in the small bowel\nmesentery and omentum. Mild residual stranding of the omentum in the right\nlower quadrant.\n2. The remainder of the study is stable, including a severe compression\nfracture of L1 with moderate central canal stenosis at this level.\n3. The chest findings will be reported separately." }, { "input": "Please note that the images are degraded by motion artifact.\n\nLiver: Liver demonstrates normal parenchymal morphology. No focal lesions\ngiven limitations of an unenhanced study.\n\nBiliary: The gallbladder is normally distended. No intra or extrahepatic\nbiliary dilatation.\n\nPancreas: Pancreas shows homogeneous signal intensity. No evidence of\npancreatic ductal dilatation.\n\nSpleen: Normal size without evidence of focal lesions.\n\nAdrenal Glands: Normal size bilaterally.\n\nKidneys: Stable atrophic right kidney. No evidence of nephrolithiasis. There\nis mild perinephric stranding surrounding the left kidney, which is new\ncompared to the prior CT from ___. There is no hydronephrosis.\n\nGastrointestinal Tract: Large hiatus hernia containing almost entire stomach\nfilled with oral contrast. The small and large bowel loops are normal in\ncaliber. Trace free fluid seen in the abdomen. There is minimal residual\nstranding in the omentum in the right (series 2, image 77), similar to the\nfindings on the prior CT from ___.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nPelvis: Urinary bladder is decompressed and shows Foley bulb in situ.\n\nVascular: Moderate aortic atherosclerotic changes. Stable aneurysmal\ndilatation of the left common iliac artery measuring 2.4 cm.\n\nOsseous and Soft Tissue Structures: Stable significant compression fracture\ninvolving L1 vertebral body with buckling of the posterior coursed cortex\ncausing spinal canal stenosis at this level. Multilevel degenerative disc\ndisease. No new abnormality identified.", "output": "1. Stable mild stranding involving the omentum on the right complete similar\nto the CT findings from ___. Mild increased perinephric stranding on the left, no evidence of\nhydronephrosis. Recommend clinical correlation to exclude underlying\ninfection.\n3. No other interval change." }, { "input": "LOWER CHEST: There is minimal bibasilar dependent atelectasis. There is a\nlarge hiatal hernia containing most of the stomach, which is unchanged from\nprior. The patient is status post median sternotomy. There is no evidence of\npleural or pericardial effusion. Coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 1\ncm hypodensity in the right hepatic lobe, which is unchanged from MRI in ___\nwhen it was described as a simple cyst. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. There are\nsubcentimeter hypodensities (04:21), which are not fully evaluated on this\nstudy, but apparently correspond to T2 hyperintensities on previous MRI.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic. The left kidney is normal size. A\nnormal nephrogram is again demonstrated bilaterally. There is no\nnephrolithiasis or ureterolithiasis. There is no hydronephrosis. There is no\nperinephric abnormality. There is no evidence of focal renal lesions. The\ndistal ureters and bladder are unremarkable.\n\nGASTROINTESTINAL: There is a large hiatal hernia containing the majority of\nthe stomach. The patient is status post small bowel surgery with suture line\nseen in midline. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is diverticulosis without\nevidence of diverticulitis. The appendix is not seen.\n\nPELVIS: The bladder is decompressed and contains a Foley catheter. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with stable post surgical\nchanges noting that the Foley catheter traverses the prostate to the left of\nmidline.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is a 2.5 cm partially thrombosed fusiform left common iliac\nartery aneurysm with ulcerated plaque, which is grossly unchanged compared to\nMRI from ___. There is no abdominal aortic aneurysm. Moderate\natherosclerotic disease is noted.\n\nBONES: There is a chronic appearing compression fracture of the L1 vertebral\nbody with retropulsion into the spinal canal causing moderate narrowing. \nThere is no evidence of worrisome osseous lesions or acute fracture. \nRetrolisthesis of L1 on L2 is new since prior. Grossly unchanged\nretrolisthesis of L2 on L3 and L3 on L4 is unchanged. Patient is status post\nL3 through L5 laminectomies.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No hydronephrosis or urothelial lesion is identified.\n2. The prostate is enlarged with stable postsurgical changes.\n3. There is an L1 compression fracture, which is most likely chronic with bony\nretropulsion causing moderate narrowing of the spinal canal.\n4. 2.3 cm partially thrombosed fusiform left common iliac artery aneurysm with\nulcerated plaque is grossly stable compared to MRI from ___.\n5. Diverticulosis without evidence of diverticulitis." }, { "input": "ABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of enhancing renal lesions or hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The previously visualized fat stranding surrounding the\ncecum and proximal ascending colon has completely resolved. There is no\nevidence of active ileitis or colitis. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnot visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and lobulated in appearance,\nlikely due to multiple small fibroids. No adnexal masses are visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Grade 1 anterolisthesis of L4 on L5 is unchanged. There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. The stranding within the right lower quadrant has completely resolved. \nThere is no evidence of active ileitis or colitis. No acute findings to\nexplain right lower quadrant pain.\n3. Fibroid uterus.\n4. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: Please refer to the separately dictated report of CT chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter subtle hypoattenuating lesion in segment 6 (series 5, image 36),\nthis has been stable since CT from ___. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits. No evidence of pericholecystic fluid or inflammatory changes.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is moderately distended. Small and large bowel\nloops are normal in caliber. There has been interval improvement in the\nappearance of stranding and wall thickening involving the ascending colon. \nThere are few scattered colonic diverticula, no evidence of acute\ndiverticulitis seen.\n\nPELVIS: The urinary bladder is within normal limits. There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nEvidence of uterine fibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative disc disease and grade 1 anterolisthesis of L4 vertebra. \nDegenerative changes involving the right hip joint.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of any acute finding in the abdomen or pelvis. Interval decrease\nin right colonic wall thickening and stranding in the right lower quadrant." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is collapsed, limiting\nevaluation. There is no pericholecystic stranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\nmultiple diverticula throughout the sigmoid colon without surrounding\ninflammation to suggest diverticulitis. There is adjacent fat stranding and\nminimal wall thickening of the terminal ileum, cecum, and ascending colon\nconsistent with ileocolitis, similar to slightly worse in extent to ___. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is mildly heterogeneous, likely representing\nuterine fibroids. There is no adnexal mass.\n\nLYMPH NODES: Tubular structure adjacent to the aorta is of unclear etiology,\nappears stable from prior exam, and may represent a vessel. Otherwise, there\nis no definite retroperitoneal or mesenteric lymphadenopathy. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No suggestion of metastatic disease of the abdomen or pelvis.\n2. Unchanged to slightly worse fat stranding and minimal wall thickening of\nthe terminal ileum, cecum, and ascending colon, consistent with ileocolitis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is mild diffuse decreased attenuation of the liver\nparenchyma in keeping with hepatic steatosis. No focal liver lesion\nidentified. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\nscattered colonic diverticula without evidence of acute diverticulitis. \nPreviously noted stranding adjacent to the terminal ileum cecum and ascending\ncolon have resolved in the interval.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic foci in the right iliac bone and right femoral head are unchanged\nand likely bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of metastatic disease in the abdomen and pelvis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is fat\nstranding and wall thickening in the area of the ascending colon, which is\nworse compared to prior, and consistent with an active mild uncomplicated\ncolitis. Multiple colonic diverticula noted without evidence of surrounding\nstranding to suggest diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Visualize uterus is unremarkable. There is no large\nadnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged sclerotic foci in the right iliac bone and right femoral head/neck,\nwhich likely represent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Fat stranding and wall thickening in the area of the ascending colon, which\nis worse compared to prior, and consistent with active mild colitis. No fluid\ncollections or free air.\n2. No abdominopelvic metastasis.\n3. Please see concurrent CT chest report for intrathoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a subcentimeter hypodense lesion in segment 6 of the liver that is\ntoo small to characterize. There is also a 1.4 cm hypodense lesion adjacent\nto the hepatic vein confluence that is too small to characterize, however this\nwas not FDG avid on prior PET-CT. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2 mm nonobstructing right renal stone. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Nodular contour of the uterus is redemonstrated, likely\nrelated to fibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are noted throughout the lumbar spine with\nanterolisthesis grade 1 of L4 on L5. Again noted is moderate osteoarthritis\nin the right hip with a large subchondral cyst noted in the acetabulum.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No definite evidence of metastatic disease in the abdomen or pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There are mitral annular\ncalcifications. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a stable 1.8 cm left adrenal adenoma. The right adrenal\ngland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The tip of an enteric tube terminates in the body of the\nstomach. There are numerous dilated loops of small bowel, some of which are\nsurrounded by a small amount of free fluid. There is a transition point in\nthe pelvis. The appendix is fluid-filled approximately and measures up to 1.0\ncm, however it is decompressed distally and there is no adjacent fluid or fat\nstranding to suggest acute appendicitis. There is no free air\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is complete occlusion of the infrarenal abdominal aorta by\ncalcified and noncalcified atherosclerotic plaque. The visualized portion of\na right axial fem cross fem graft is patent. The visualized portions of the\ncommon femoral, superficial femoral, and deep femoral arteries bilaterally\ndemonstrate at least moderate stenosis but are patent. The bilateral common\nand external iliac arteries opacify by collaterals and/or retrograde filling.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. High-grade small bowel obstruction with a transition point in the pelvis,\nlikely due to adhesions. There is no free air. There is a small amount of\nfree fluid in the pelvis.\n2. The appendix is fluid-filled approximately and measures up to 1.0 cm,\nhowever it is decompressed distally and there is no adjacent fluid or fat\nstranding to suggest acute appendicitis.\n3. There is complete occlusion of the infrarenal abdominal aorta by calcified\nand noncalcified atherosclerotic plaque. The visualized portion of a right\naxial fem cross fem graft is patent. The visualized portions of the common\nfemoral, superficial femoral, and deep femoral arteries bilaterally\ndemonstrate at least moderate stenosis but are patent. The bilateral common\nand external iliac arteries opacify by collaterals and/or retrograde filling.\n4. Cholelithiasis without CT evidence of acute cholecystitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:06 ___, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low attenuation compatible with\nhepatosteatosis. There is no evidence of focal lesions. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are subcentimeter hypoattenuated lesions in the bilateral kidneys\nmeasuring up to 7 mm in the lower pole of the left kidney (601b:30) which are\ntoo small to characterize in grossly unchanged from ___. . There\nis no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits without evidence of wall thickening. The\nappendix is not visualized.\n\nPELVIS: A left bladder diverticulum is noted. Mixing of contrast is noted in\nthe bladder. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nMultilevel degenerative changes are noted.\n\nSOFT TISSUES: There is a ventral hernia containing nondilated loops of small\nbowel.", "output": "1. No evidence of recurrence of lymphoma in the abdomen or pelvis.\n2. Please refer to dedicated CT chest report on same day for thoracic\nfindings.\n3. Hepatosteatosis. Bladder diverticulum. Stable hypo attenuating left renal\nlesions up to 7 mm, statistically likely to represent cysts." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: A hypoattenuating lesion hepatic segment VIII is too small to\ncompletely characterize, statistically likely a cyst or biliary hamartoma\n(series 4, image 15). The liver otherwise demonstrates homogenous attenuation\nthroughout. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is mildly atrophic with normal attenuation throughout\nand no evidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nFew, tiny, scattered hypoattenuating lesions are too small to completely\ncharacterize, statistically likely simple cysts. No suspicious renal lesion. \nNo hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. A small bowel\ncontaining ventral hernia is unchanged. The colon and rectum are within\nnormal limits, noting a suture line involving the sigmoid colon suggesting\nprior surgery. The appendix is not definitively identified.\n\nPELVIS: A 2.1 cm diverticulum arising from the posterior left aspect of the\nurinary bladder is unchanged. The distal ureters are unremarkable. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nbone island in the right femoral neck is unchanged.\n\nSOFT TISSUES: A small bowel containing ventral hernia is unchanged. Extending\ninferiorly from the hernia, there are midline fibrotic changes presumably\nrelated to prior surgery.", "output": "1. No evidence of recurrent lymphoma within the abdomen or pelvis.\n2. Unchanged, small bowel containing ventral hernia without evidence of\nobstruction.\n3. Unchanged bladder diverticulum.\n4. Please refer to separate report for same-day CT chest for complete\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Bases of the lung are clear bilaterally. There is no pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. There is mild extrahepatic dilation of the CBD up to 0.9\ncm tapering down smoothly until the ampulla. The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal appears nodular up to 0.9 cm (05:23). Of note,\nthis is similar in appearance to series 9, image 30 of previous MRI thoracic\nspine, allowing for difference in technique. The right adrenal gland is\nnormal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Patient is status post Roux-en-Y\ngastric bypass. There is contrast in the excluded stomach, and duodenum. No\ndefinite contrast is present within, the biliopancreatic limb distal to this. \nThe biliopancreatic jejunal limb is also mildly prominent measuring 2.9 cm in\ndiameter. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. Mild sigmoid diverticulosis. The colon and rectum\nare within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative change is seen in the lumbar spine particularly between L3-L4 and\nL5-S1. Mild retrolisthesis of L2 on L3, L3 on L4.\n\nSOFT TISSUES: Patient is status post ventral hernia repair without signs of\npost-surgical complication/herniation. The pelvic wall is within normal\nlimits.", "output": "1. Status post Roux-en-Y gastric bypass. Contrast is present in the excluded\nportion of the stomach, and duodenum without definite contrast in the\nbiliopancreatic limb distal to this. Considerations include reflux of\ncontrast retrogradely along the biliopancreatic limb into the excluded portion\nof the stomach. If clinical concern for staple line dehiscence/gastrogastric\nfistula, an upper GI contrast study can be performed to better evaluate.\n2. Status post ventral hernia repair without re-herniation or signs of\ncomplications.\n3. Left adrenal indeterminate nodule unchanged compared to prior MRI of\nT-spine from ___ allowing for difference in technique, likely benign.\n\nRECOMMENDATION(S): If clinical concern for staple line\ndehiscence/gastrogastric fistula, an upper GI contrast study can be performed\nto better evaluate." }, { "input": "LOWER CHEST: THE LUNG BASES ARE CLEAR EXCEPT FOR A 2 MM RIGHT LOWER PULMONARY\nNODULE.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The right adrenal gland is unremarkable. A 1.0 cm left adrenal\nnodule is unchanged (02:22).\n\nURINARY: The kidneys are unremarkable.\n\nGASTROINTESTINAL: Patient is post Roux-en-Y gastric bypass. There is no\ngastrointestinal obstruction. The appendix is normal. A surgical clip is\nnoted in the left abdomen (02:31). MILD HAZINESS IS AGAIN SEEN IN THE\nOMENTUM, UNCHANGED.\n\nPELVIS: There is no free fluid in the pelvis.The uterus and bilateral adnexae\nare within normal limits.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Prior ventral hernia repair changes are noted. There is no new\nabdominal or inguinal hernia.", "output": "1. No findings of acute appendicitis. No acute findings in the abdomen or\npelvis.\n2. Additional chronic stable findings, as above." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThe portal vein, splenic vein, and SMV are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. Uniform\nthickening of the left adrenal gland is not significantly changed from prior\nand was not FDG avid on PET-CT ___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter hypodensity in the interpolar region of the left kidney is too\nsmall to characterize, however is unchanged from prior and likely represents a\ncyst. There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Few subcentimeter aortic caval nodes are similar to prior. \nThere is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: A 3.3 cm infrarenal abdominal aortic aneurysm with mural thrombus\nis not significantly changed. There is complete occlusion of the left common\niliac artery, with reconstitution of the left external iliac artery,\nunchanged. Moderate atherosclerotic disease is noted.\n\nBONES: Focal sclerosis in the left iliac bone is unchanged from prior, and\nlikely degenerative. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: A 1 cm right breast nodule is unchanged. The abdominal and\npelvic wall is within normal limits.", "output": "1. Uniform thickening of the left adrenal gland is unchanged, and was not FDG\navid on PET-CT ___.\n2. Unchanged 1 cm right breast nodule.\n3. Unchanged 3.3 cm infrarenal abdominal aortic aneurysm with mural thrombus,\nand complete occlusion of left common iliac artery, with reconstitution of the\nleft external iliac artery.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please see separate dictation performed on the same day for\ndetailed evaluation of the chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Mildly thickened left adrenal gland is unchanged. The right adrenal\nis normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. There are multiple phleboliths.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Few subcentimeter aortocaval nodes are similar to prior. There\nis no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: The infrarenal abdomen aortic aneurysm measuring 3.2 cm with mural\nthrombus is unchanged. Again seen is the completely occluded left common\niliac artery with reconstitution of the left external iliac artery. Moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. 1 cm\nright breast nodule with central calcification is unchanged.", "output": "1. Unchanged mild thickening of the left adrenal.\n2. Unchanged 3.2 cm infrarenal abdominal aortic aneurysm with mural thrombus.\n3. Stable 1 cm right breast nodule.\n4. Please see separate dictation performed on the same day for detailed\nevaluation of the chest." }, { "input": "LOWER CHEST: Please see separate, same-day CT chest report for further\ndescription of intrathoracic findings.\n\nMinimal mesenteric fat limits evaluation. Within this limitation:\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Mild thickening of the left adrenal gland without discrete lesion\nor nodularity, similar to prior. The right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal\nnephrogram. Multiple sub 4 mm nonobstructing calculi within the left kidney.\nNo focal concerning renal lesions. No hydronephrosis or hydroureter. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 3.1 cm infrarenal abdominal aortic aneurysm with mural thrombus is\nunchanged. Complete occlusion of the left common iliac artery with\nreconstitution of the left external iliac artery is noted. Moderate\natherosclerotic disease.\n\nBONES: Moderate degenerative changes of the visualized thoracolumbar spine,\nmost notable at L2-L3. No lytic or sclerotic lesions concerning for\nmalignancy. No acute fracture identified.\n\nSOFT TISSUES: 11 mm right breast nodule with central punctate calcification\n(02:33) is similar to prior examination. The abdominal and pelvic wall is\nwithin normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Stable 3.2 cm infrarenal abdominal aortic aneurysm with mural thrombus.\n3. Unchanged 11 mm right breast nodule.\n4. Please refer to same-day, separate CT chest report for description of\nintrathoracic findings." }, { "input": "CT abdomen with contrast: Liver enhances homogeneously without focal lesion. \nMild biliary dilatation is unchanged from prior examination. Pneumobilia is\nexpected given with pole. Portal vein is patent. Gallbladder is absent.\n\nSpleen and adrenal glands are unremarkable.\n\nDilatation of the main pancreatic duct to 5 mm, increased compared to prior\nexamination. Some prominence of the jejunal wall at the level of the\npancreaticojejunostomy with trace surrounding free fluid and stranding. \nRemainder of the small bowel loops are normal caliber without evidence of\nobstruction. Large bowel is thin-walled and unremarkable.\n\nModerate atherosclerotic disease along a normal caliber abdominal aorta. \nScattered mesenteric lymph nodes measuring up to 6 mm are re- demonstrated,\nnot meeting size criteria for enlargement. Mildly prominent 9 mm left\nperiaortic lymph node is unchanged (2:70). Mesenteric and retroperitoneal\nlymph nodes are not enlarged by CT size criteria. No pneumoperitoneum or\nventral abdominal hernia.\n\nCT pelvis with contrast: Bladder, uterus, adnexa and rectum are grossly\nunremarkable. No free pelvic fluid or air. No inguinal or pelvic sidewall\nlymphadenopathy by CT size criteria.\n\nBones and soft tissues: Bones are diffusely demineralized. No suspicious\nfocal bone lesion.\n\nBones and soft tissues: 27 x 8 mm rim enhancing phlegmon in the superficial\nsoft tissues of the anterior abdomen along the site of the ventral midline\nincision (2:75) without definite abscess.", "output": "1. Thick-walled jejunum at the level of the pancreaticojejunostomy with\nsurrounding fat stranding and free fluid compatible with jejunitis. Correlate\nwith history of possible radiation therapy.\n2. 27 x 8 mm phlegmon in the superficial soft tissues of the anterior abdomen\nwithout frank abscess.\n3. Mild dilatation of the main pancreatic duct to 5 mm without pancreatic mass\nseen.\n4. No definite evidence of disease recurrence in the abdomen or pelvis.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 17:54 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are predominantly hypodense areas of hepatic parenchyma\nin segment IV, segment VI, segment VII that fill in on delayed imaging (series\n2, image 64, 61). There is ill-defined slight hyper enhancement at the\nanterior aspect of the hepatic dome (series 2, image 51). No discrete mass is\ndetected. There is persistent, stable pneumobilia and mild intrahepatic\nbiliary dilatation. There is new mild central peribiliary enhancement (series\n2, image 63), likely reflecting cholangitis. There is oral contrast refluxing\ninto the central biliary tree. The gallbladder is surgically absent. Soft\ntissue density again permeates throughout the porta hepatis (series 2, image\n67), appearing slightly increased in comparison to the ___ study.\n\nPANCREAS: The patient is status-post Whipple procedure. The remainder of the\npancreas enhances homogeneously. There is dilation of proximal the pancreatic\nduct up to 4 mm, stable in comparison to CT obtained approximately 3 months\nprior. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRight mild pelvicaliectasis appears new since ___, without\nhydroureter or obstructing stone or mass. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Contrast passes easily through the gastrojejunostomy. \nNotably, oral contrast refluxes through the entire biliary limb and through\nthe hepaticojejunostomy (series 5, image 24). Remaining loops of small and\nlarge bowel are normal caliber and without obstruction. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. An apparent dropped clip is lying dependently in\nthe pelvis adjacent to the posterior aspect of the uterus.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted and unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are numerous subcutaneous nodules of the bilateral\nanterior and lateral abdominal wall, presumably injection site granulomas -\nclinical correlation recommended.", "output": "1. Soft tissue density permeating throughout the porta hepatis appears\nslightly increased since ___, possibly representing posttreatment\nchange, though warranting continued attention given reported history of\nincreasing CA ___ levels.\n2. Severe reflux of oral contrast throughout the biliary limb and through the\nhepaticojejunostomy, with mild cholangitis.\n3. Ill-defined areas of hypodensity throughout the right hepatic lobe, more\nprominent in comparison to the ___ examination, may reflect\nsequela of underlying cholangitis or changes from chemotherapy. This is\natypical for metastases, but this warrants close follow-up, ideally with MRI,\nin ___ weeks. Alternatively, ultrasound assessment of the right hepatic lobe\ncould be performed as a feasibility study for percutaneous biopsy if tumor\nmarkers continue to rise.\n4. Mild right pelvicaliectasis appears new since ___, without\nobstructing mass or stone. Correlate with any urinary symptoms.\n\nRECOMMENDATION(S): MRI followup in ___ weeks, with possible US, as discussed\nabove.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 18:51 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nHEPATOBILIARY: Re- demonstrated is a left-sided percutaneous transhepatic\nbiliary drainage catheter in place with the tip terminating in the patient's\nhepaticojejunostomy. Mild biliary ductal dilatation and pneumobilia is\ndemonstrated and not significantly increased from the prior exam. There are\nno focal liver lesions. The gallbladder has been surgically removed.\n\nSPLEEN: Punctate calcification the spleen may be related to prior\ngranulomatous disease. The spleen is normal in size and enhancement.\n\nPANCREAS: Patient is status post Whipple procedure and pancreaticojejunostomy.\nThe residual pancreas demonstrates atrophy with unchanged diffuse ductal\ndilatation. This is stable from the prior exam. Minimal stranding adjacent\nto the celiac axis is stable from the prior study (02:19).\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys are normal in size and display symmetric nephrograms. \nAsymmetric prominence of the lower pole calices and renal pelvis on the right\nwith a nondistended ureter is unchanged.\n\nGASTROINTESTINAL: Patient is status post Whipple procedure. Compared to the\nmost recent prior examination, there is minimally increased wall thickening\nand stranding around the hepaticojejunostomy and pancreaticojejunostomy in the\nright upper quadrant. No dilated loops of large or small bowel are\nidentified. Oral contrast is seen in loops of large and small bowel which\nobscures assessment for intraluminal bleeding. No intra-abdominal free fluid\nor free air is identified.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nVASCULAR: The abdominal aorta shows moderate to severe calcified\natherosclerosis. The abdominal aorta is normal in caliber.\n\nPELVIS: The bladder is distended but otherwise appears unremarkable. There is\nno free fluid in the pelvis. The rectum and sigmoid colon are within normal\nlimits. Uterus and adnexa are unremarkable.\n\nBONES AND SOFT TISSUES: There are no suspicious lytic or blastic lesions seen\nin the visualized osseous structures. The soft tissues are within normal\nlimits", "output": "1. Minimally increased adjacent fat stranding and wall thickening involving\nthe hepaticojejunostomy and pancreaticojejunostomy in the right upper quadrant\ncompared to the most recent prior exam, but similar to that seen in ___, and may reflect enteritis in this region.\n2. Oral contrast within loops of large and small bowel obscures evaluation for\nintraluminal bleeding. Consider further evaluation with colonoscopy for\nassessment of lower GI bleeding when clinically appropriate.\n3. Left-sided percutaneous transhepatic biliary drain in unchanged position\nwith mild biliary ductal dilatation and pneumobilia, stable from the prior\nexamination." }, { "input": "LOWER CHEST: The lung bases are clear. The visualized heart and pericardium\nis within normal limits.\n\nHEPATOBILIARY: A left-sided PTBD has been pulled back since the prior\nexamination however likely still terminates within the bile ducts. Of note,\nthe ___ BD previously terminated in the patient's hepaticojejunostomy. The\npigtail portion of the catheter appears intact. Mild biliary ductal\ndilatation and pneumobilia is not significantly increased. No focal liver\nlesions. Gallbladder is surgically absent.\n\nSPLEEN: The spleen is within normal limits and unchanged from the recent\nprior.\n\nPANCREAS: The patient is status post Whipple 1 pancreaticojejunostomy. As\nbefore the residual pancreas is atrophic in shows diffuse ductal dilatation. \nStranding adjacent to the celiac axis re- demonstrated.\n\nADRENALS: Within normal limits\n\nURINARY: Prominence of the lower pole caliectasis on the right is unchanged. \nNo hydronephrosis in either kidney.\n\nGASTROINTESTINAL: Status post Whipple. Increased wall thickening and\nstranding adjacent to the hepaticojejunostomy and pancreaticojejunostomy in\nthe right upper quadrant is stable. No evidence of bowel obstruction.\n\nLYMPH NODES: No adenopathy.\n\nVASCULAR: The aorta is normal in caliber.\n\nBONES AND SOFT TISSUES: No suspicious osseous lesions or fractures.", "output": "1. Left-sided PTBD has been pulled back since the prior examination however\nlikely still terminates within the bile ducts. Consider fluoroscopic\ncholangiogram for further evaluation if clinically indicated.\n2. Mild biliary ductal dilatation and pneumobilia is not significantly\nincreased from the prior examination.\n3. Wall thickening involving the hepaticojejunostomy and\npancreaticojejunostomy in the right upper quadrant with adjacent fat stranding\nis not changed from the prior study." }, { "input": "Heart size is normal without significant pericardial fluid. There is trace\nbibasilar atelectasis.\n\nCT abdomen with contrast: Liver enhances homogeneously without focal lesion\nor biliary dilatation. Portal vein is patent. Gallbladder is unremarkable. \nSpleen, pancreas and adrenal glands are unremarkable.\n\nKidneys present symmetric nephrograms and excretion of contrast without focal\nlesion or hydronephrosis.\n\nStomach is distended with ingested material but is otherwise unremarkable. \nDuodenum and small bowel loops are normal caliber without evidence of\nobstruction. There is trace sigmoid and descending colon predominant\ndiverticulosis without evidence of diverticulitis. The large bowel is\notherwise thin-walled and unremarkable without pericolonic fat stranding or\nfluid collection. A normal appendix is visualized in the right lower\nquadrant.\n\nAbdominal aorta is normal in caliber. There is no mesenteric or\nretroperitoneal lymphadenopathy by CT size criteria. There is no ascites,\npneumoperitoneum or ventral abdominal hernia.\n\nCT pelvis with contrast: The bladder, prostate and rectum are grossly\nunremarkable. There is no free pelvic fluid or air. There is no inguinal or\npelvic sidewall lymphadenopathy by CT size criteria.\n\nBones and soft tissues: There is no suspicious focal bone lesion. A small\nintraarticular loose body is noted in the right hip joint.", "output": "1. No acute findings in the abdomen or pelvis.\n2. Diverticulosis without evidence of diverticulitis." }, { "input": "LOWER CHEST: Moderate right pleural effusion, similar compared with ___. There is 1.8 cm right costophrenic angle pleural metastasis\nseries 6, image 2, stable since prior. Trace left pleural effusion, more\nprominent. . Compared to ___, no significant change in multiple\npulmonary nodules throughout both lungs, likely metastases. There is a\npartially visualized central venous catheter with tip in the right atrium. \nThere is no evidence of pericardial effusion. There is 0.9 cm anterior chest\nwall nodule series 6, image 18, stable since ___, increased\ncompared with 0.7 cm on ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is a 0.7 cm hypodense lesion in the pancreatic tail (___),\npossibly representing an IPMN, not definitely seen on ___, possibly\nseen on ___. . Otherwise, the pancreas has normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 0.8 x 0.7 cm indeterminate lesion in the medial limb of\nthe left adrenal gland, stable since ___, favoring benign adrenal adenoma. The right adrenal gland is\nunremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: No acute fractures. Unchanged sclerosis of the left seventh rib. \nUnchanged fractures of the right and left seventh ribs.\n\nSOFT TISSUES: There are multiple soft tissue density lesions in the anterior\nsubcutaneous soft tissues , likely related to prior injections. Suggestion of\n0.7 cm enhancing nodule within left gluteus medius series 6, image 76,\npossibly metastasis, attention to this area on subsequent follow-up is\nrecommended.", "output": "1. No significant change in multiple pulmonary nodules throughout both lungs,\nconsistent with metastases. There is 0.9 cm anterior subcutaneous chest wall\nnodule, possibly metastasis. Suggestion of small nodule within left gluteus\nmedius, may represent reactive change or possibly metastasis. Bilateral\npleural effusions.\n2. 0.8 cm right adrenal nodule is stable since ___, favoring benign\nadrenal adenoma.\n3. There is a 0.7 cm hypodense lesion in the pancreatic tail, possibly\nrepresenting an IPMN." }, { "input": "The chest findings are reported separately.\n\nThe liver, gallbladder, pancreas, spleen, and adrenal glands appear within\nnormal limits. A simple cyst in the lower pole of the left kidney measures 10\nx 17 mm in axial ___.\n\nThere is a small but increased quantity of ascites. Mild soft tissue\nthickening is noted along of the dome of the bladder, and there is increased\nvascular engorgement of the omentum, although without clear nodularity. There\nis new very mild hydronephrosis of the left kidney but without significant\nhydroureter.\n\nThe uterus and adnexa are appear normal. There are number of subcentimeter\nperiaortic lymph nodes that are not enlarged by size criteria, but increased\nmeasuring up to 6 mm. Some accompanying retroperitoneal infiltration is\nsuspected noting vague increased attenuation in periaortic fat.\n\nNew sclerosis in the right sacrum and left ilium suggests evolving metastases\nalthough essentially occult before. A lytic lesion in the lateral right ilium\nwhich was visible before now shows increased sclerosis. Although\npredominantly lytic lesion in L4 appears unchanged, a new large area of lysis\nis present in L2.", "output": "1. Increased ascites and findings raising concern regarding developing\ncarcinomatosis.\n\n2. New large L2 lytic metastasis." }, { "input": "LOWER CHEST: There is interval increase in size of bilateral small pleural\neffusions, worse on the left. There is bibasilar consolidation, with the left\ngreater than right. The consolidation was seen on prior CT chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable. No biliary\ndilatation.\n\nPANCREAS: Pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The bilateral kidneys are unremarkable within normal nephrogram.\n\nGASTROINTESTINAL: There is no bowel obstruction, ascites or free air. The\nappendix is unremarkable.\n\nPELVIS: There is trace fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is mild poststenotic\ndilatation of the celiac trunk, nonspecific the.\n\nBONES: No aggressive osseous lesions are seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval increase of bilateral small pleural effusions, worse on the left. \nRedemonstration of bibasilar consolidation as seen previously.\n2. No acute process within the abdomen or pelvis." }, { "input": "LOWER CHEST: The visualized lung bases are clear. There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are innumerable ill-defined hypodensities scattered\nthroughout the liver concerning for metastatic disease, new from ___\n(series 2:image 16, 23, 31). There are stable scattered calcifications in the\nliver (series 2:image 24, 37). Dilated tubular structures within the liver\nlikely reflect focal segmental intrahepatic biliary ductal dilation likely due\nto centrally obstructing metastatic lesions. The gallbladder is surgically\nabsent. CBD is mildly prominent likely due to prior cholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable, and there is a small hiatal\nhernia. The small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits, and\nthere is a moderate fecal load. The appendix is not visualized, though there\nare no secondary findings to suggest appendicitis. There is no mesenteric\nfree air or free fluid.\n\nPELVIS: The urinary bladder minimally distended and unremarkable. The distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. The abdominal aorta and its major branches are grossly\npatent.\n\nBONES: There is no acute fracture. There are multiple new sclerotic lesions\nincluding involvement of the anterior T11 vertebral body, right L1 vertebral\nbody extending along the facet and the right L5 vertebral body concerning for\nmetastatic disease (series 2:image 28, 31, 58, series 602b:image 39, 41, 43). \nNo pathologic fracture is seen.\n\nSOFT TISSUES: Postsurgical changes are noted along the left anterior abdomen\npossibly from prior breast reconstructive surgery. There is a small fat\ncontaining left inguinal hernia.", "output": "1. Innumerable hypodense lesions scattered throughout the liver concerning for\nmetastatic disease.\n2. Segmental intrahepatic biliary ductal dilation likely due to malignant\nobstruction given extensive metastatic disease.\n3. Sclerotic bony metastasis in the lower thoracic and lumbar spine including\nthe L1 and L5 vertebral body." }, { "input": "LOWER CHEST: Visualized lung fields are notable for bibasilar atelectasis. \nThe heart is normal in size. No pericardial effusion. Minimal aortic valve\ncalcifications are noted. A catheter tip is seen terminating at the distal\nSVC.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen are innumerable ill-defined hypodensities scattered\nthroughout the liver concerning for metastatic disease, grossly unchanged from\n___, largest lesion measuring 2 x 2.3 cm (02:20) within segment 2\n(previously 2.3 x 2.1 cm with differences size likely related to slice\nselection and phase of contrast. Again seen is mild intrahepatic biliary\nductal in station in a patient who is status post percutaneous biliary drain\nplacement with intrahepatic biliary duct dilatation likely related to\ncentrally obstructing metastatic lesions. The percutaneous drain terminates\nin the second portion the duodenum. The gallbladder surgically absent with\nclips in the gallbladder fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is ill-defined hypodensity at the upper pole of the right kidney with\nill-defined margins which was present on recent prior exam from ___ but\nnot on remote prior from ___. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No hiatal hernia. The stomach is decompressed. The stomach\nis unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Subtle fat stranding with wall edema\nof the ascending colon and cecum noted. No extraluminal gas. The colon and\nrectum are otherwise within normal limits. The appendix is not visualized,\nhowever no secondary signs acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No large adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: No interval change in scattered metastatic disease involving the\nanterior T11 vertebral body, right L1 vertebral body extending along the facet\nand right L5 vertebral body worrisome for metastatic disease. No pathologic\nfracture. There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: Postsurgical changes are again seen along left anterior abdomen\nfrom prior breast reconstructive surgery. There is small fat containing left\ninguinal hernia. The abdominal and pelvic wall is otherwise within normal\nlimits.", "output": "1. Persistent intrahepatic biliary duct dilatation likely due to malignant\nobstruction given extensive hepatic metastatic disease in a patient who is\nstatus post percutaneous biliary drainage catheter.\n2. Innumerable hepatic lesions concerning for metastatic disease.\n3. Sclerotic bony metastases in lower thoracic and lumbar spine including L1\nand L5 vertebral body.\n4. Subtle fat stranding and wall edema of the ascending colon and cecum can be\nseen with early colitis. Given location typhlitis is on the differential.\n5. Hypoattenuating lesion at the upper pole the right kidney new since ___\nfrom ___ but present on last month's exam. Given persistence and lack of\nsignificant change, infection is unlikely. Malignant lesion is suspected. \nFollowup on future exam is suggested." }, { "input": "LOWER CHEST: There trace bilateral pleural effusions with adjacent irregular\nbibasilar collapse, likely bibasilar aspiration pneumonia. No pericardial\neffusion is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions within limitations of a noncontrast\nexam. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is filled with hyperdense sludge without evidence\nof distention or wall thickening. No surrounding pericholecystic fluid or\nstranding.\n\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable apart from a percutaneous\ngastrostomy tube in satisfactory position. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is diffuse colonic wall\nedematous thickening throughout its course, which may be due to\nunderdistention versus diffuse colitis. Rectal tube appears in situ.\n\nPELVIS: Urinary bladder is collapsed around a Foley catheter. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nHeterotopic bone is seen arising from the left posterior and superior\nacetabulum to the left greater trochanter.\n\nSOFT TISSUES: There is mild diffuse soft tissue stranding, which may be due to\npatient's overall fluid status.", "output": "1. No definite etiology identified for transaminitis. Gallbladder shows\nhyperdense sludge throughout without evidence of distention or wall\nthickening. No surrounding pericholecystic fluid or stranding.\n2. Diffuse colonic wall thickening throughout its course, which may be due to\nunderdistention versus diffuse colitis. Differential diagnosis would include\ninfectious, ischemic, or inflammatory.\n3. Please refer to the report from the concurrent CT chest for intrathoracic\nfindings." }, { "input": "Visualized portions of the lung bases demonstrate right lower lobe\natelectasis. Mild atelectatic changes are noted at the left lung base. No\npleural effusion or nodules are seen.\n\nThe liver is normal in size and contour. There is a 1.2 cm simple cyst within\nthe left hepatic lobe. No additional hepatic lesion is seen. There is intra or\nextrahepatic biliary ductal dilatation. The portal vein is patent. Layering\nhigh density material is noted within the gallbladder which may be compatible\nwith sludge. No radiopaque filling defect is noted within the gallbladder.\nThere is trace subhepatic ascites.\n\nThe spleen, adrenal glands and pancreas are normal in appearance.\n\nMultiple hypodense lesions are noted throughout both kidneys the largest of\nwhich measures up to 13.1 cm at the lower pole the left kidney, compatible\nwith a simple cyst. There is no evidence of hydronephrosis. No renal stones\nare seen.\n\nThe abdominal aorta is normal in course and caliber. There is no significant\nretroperitoneal, pelvic or inguinal lymphadenopathy.\n\nThere is moderate mesenteric stranding with bubbles of free air within the\nperitoneum just anterior to the left pararenal space (series 2, image 66) and\ntracking caudally to the region of the sigmoid colon. A small amount of free\nfluid noted within this region (series 2, image 9) in which the distal tip of\na percutaneous drainage catheter lies.\n\nThe distal tip of an enteric tube terminates within the stomach. The small\nbowel is normal in caliber without evidence of obstruction. There are\nscattered colonic diverticula with associated retained high density material,\nmost notably within the sigmoid colon, which terminates blindly within the\nleft lower quadrant of the abdomen consistent with a ___ pouch. There\nis a left lower quadrant colostomy.\n\nThere are small bilateral fat containing inguinal hernias. The urinary bladder\nis collapsed around a Foley catheter as limited evaluation. The prostate and\nseminal vesicles are unremarkable in appearance.\n\nThere is moderate subcutaneous soft tissue edema and nonspecific stranding at\nthe flanks bilaterally. The visualized osseous structures are unremarkable.", "output": "1. Moderate stranding with bubbles of extraluminal air noted within the mid\nleft abdomen extending caudally to the region of the left lower quadrant\n___ pouch with a small amount of free fluid noted within this region\nmost consistent with perforated diverticulitis. No discrete drainable fluid\ncollection is seen within the abdomen or pelvis.\n\n2. Right lower lobe atelectasis. Consider bronchoscopy in the appropriate\nclinical setting.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 7:04 ___, 15 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Bilateral atelectatic changes are noted. No pleural or\npericardial effusion. Leads from cardiac pacemaker device are noted.\n\nABDOMEN:\nHEPATOBILIARY: A 1.2-cm hypodensity, most likely a cyst, in Segment 4 is\noverall unchanged when accounting for differences in measurement technique\n(Series 4, Image 21). The liver otherwise demonstrates homogenous attenuation\nthroughout. No evidence of concerning focal lesions. No evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits. No gallstones or gallbladder wall thickening. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout. No focal lesions,\npancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout. No focal\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and symmetric. The large ruptured\nleft renal cyst in the mid pole is decreased in size from the prior exam, now\nmeasuring 5.7 x 5 x 7.7 cm, and previously measured 6.2 x 5.1 x 10.4 cm\n(Series 4, Image 56; Series 6, Image 32). The fat plane between this ruptured\nleft renal cyst appears preserved without evidence of adhesion or connection\nwith surrounding bowel. Multiple bilateral intermediate-density renal cysts,\nespecially on the right, are unchanged. Among these intermediate-density\nlesions on the right, a 2.1-cm lesion in the interpolar region (Series 4,\nImage 48) and a 1.9-cm lesion in the lower pole (Series 5, Image 55) are most\nconcerning. A 2.6 x 2.3-cm, low-attenuation probable simple cyst in the left\ninferior pole is unchanged (Series 4, Image 53). Other smaller probable cysts\nare noted bilaterally. No hydronephrosis or evidence of stones. Fat\nstranding around the left ureter is compatible with GI findings described\nbelow; the ureter is itself patent and unremarkable. The urinary bladder is\nunremarkable. The foley has since been removed.\n\nGASTROINTESTINAL: The gastrostomy tube and abdominal drains have since been\nremoved.\n\nThe patient is status-post end colectomy with a ___ pouch. Adjacent fat\nstranding persists around the ___ stump with stranding extending to the\nadjacent small bowel, likely now adherent to each other. Stranding posterior\nto the ___, along the anterior retroperitoneum, as well as\nanterosuperiorly to the distal descending colon just proximnal to the end\ncolostomy site is further suggestive that these structures are becoming more\nadherent to each other (e.g., Series 4, Images 56,54). The stoma appears\nintact. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.\n\nThe previously described right lower quadrant fluid collection has since\nresolved. No drainable fluid collection or abscess. No bowel obstruction.\n\nRETROPERITONEUM: No evidence of retroperitoneal or mesenteric lymphadenopathy\nby CT criteria.\n\nVASCULAR: No abdominal aortic aneurysm. Mild calcium burden in the abdominal\naorta and great abdominal arteries is unchanged. A hypodense filling defect\nin the right deep femoral vein, possibly extending to the right common femoral\nvein, is new since ___ and compatible with a deep venous thrombus\n(Series 4, Images 98-107).\n\nPELVIS: No evidence of pelvic or inguinal lymphadenopathy by CT criteria. No\nfree fluid in the pelvis.\n\nBONES AND SOFT TISSUES: No suspicious lytic or sclerotic bony lesions. Mild\ndegenerative changes in lumbosacral spine are unchanged with mild\nretrolisthesis of L4 on L5 (Series 7, Image 53). Post-surgical changes in the\nabdominal wall and soft tissue.", "output": "Right deep femoral vein thrombus, possibly extending to the right common\nfemoral vein, new since ___.\n\nInterval resolution of the right lower quadrant fluid collection just deep to\nthe anterior abdominal wall. No abscess or drainable fluid collection.\n\nEnd colostomy and ___ pouch, with apparent adherence of the pouch stump\nto adjacent small bowel and stranding further extending from this small bowel\nto the distal descending colon just proximal to the stoma suggesting\nadherence. No bowel obstruction.\n\nMultiple, bilateral intermediate-density renal lesions, more concerning on the\nright for which follow-up is recommended for further evaluation. Given the\npatient's comorbidities, comparison with prior imaging, or if not available, a\nnon-emergent targeted ultrasound in 3 months when the patient's clinical state\nimproves, is recommended.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___, covering for the referring provider, on the telephone on ___\nat 11:27 AM, after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Intermediate density rounded focus posterior to\nthe spleen measuring 1.1 cm (02:20) across maximal diameter is unchanged from\nCT ___ and likely represents an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is moderate to severe right-sided hydronephrosis secondary to a\ncalculus measuring 1.0 cm across maximal diameter (02:35) located in the right\nureteropelvic junction. There are also multiple nonobstructive stones in the\ninterpolar region and lower pole of the right kidney, the largest of which\nmeasures 1.0 x 0.9 cm (02:31) in the interpolar region. The nonobstructive\nstones in the right kidney appear larger in size as compared to CT abdomen\npelvis ___. Mild right perinephric stranding is seen. There are\nmultiple punctate nonobstructive stones in the left kidney. There is no\nhydronephrosis of the left kidney.. Re-demonstrated is a somewhat dense\nappearance of the bilateral left worse than right medullary pyramids,\nunchanged from ___.\n\nGASTROINTESTINAL: Stomach is relatively collapsed. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A tampon is noted in the lower uterine segment and\nvagina.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Moderate to severe right-sided hydronephrosis secondary to a 1 cm calculus\nat the right ureteropelvic junction.\n2. Mild right-sided perinephric stranding may relate to obstructing right UPJ\nstone, but component of acute pyelonephritis is not excluded. Clinical\ncorrelation is recommended.\n3. Hyperdense medullary pyramids of both kidneys are grossly unchanged as\ncompared to CT ___ and may reflect medullary nephrocalcinosis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 11:30 am, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Hypodense appearance of the\nintracardiac blood pool suggests possible anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A 1.1 cm round soft tissue density posterior to\nthe spleen is unchanged in size and likely represents an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is severe right\nhydronephrosis. There is an obstructing 6 mm mid ureteral stone with a\ncluster of smaller stones measuring up to 4 mm in the upstream mid ureter\n(2:92, 601:46), as well as a punctate nonobstructing stone in the region of\nthe ureteropelvic junction (2:64, 601:51). Multiple nonobstructing stones are\nagain seen throughout the interpolar region and lower pole of the right\nkidney, similar in size measuring up to 1.1 cm in the interpolar region. \nMultiple nonobstructing stones in the left kidney appear grossly similar. \nThere is no evidence of focal renal lesions within the limitations of an\nunenhanced scan. There is trace perinephric stranding about the right kidney\nwhich is nonspecific. Dense appearance of the bilateral left greater than\nright medullary pyramids appears similar to prior.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: Other than a tiny dependent passed stone within the bladder (2:137)\nthe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Severe right hydronephrosis with to right-sided ureteral stones, the larger\nin the mid to distal ureter measuring 6 mm.\n2. Multiple bilateral kidney stones. Hyperdense medullary pyramids within the\nbilateral kidneys appears similar and may reflect medullary nephrocalcinosis.\n3. Right perinephric stranding, please correlate for infection.\n4. Findings suggestive of anemia. Please correlate clinically." }, { "input": "LOWER CHEST: There are small right and trace left nonhemorrhagic pleural\neffusions and adjacent atelectasis at the lung bases. There is\nhypoattenuation of the blood pool relative to myocardium, suggestive of\nanemia. Aortic valve calcifications are partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous hypoattenuation throughout,\nsuggestive of steatosis. There is no evidence of focal lesions within the\nlimitations of an unenhanced scan. There is no evidence of intrahepatic\nbiliary dilatation. Extrahepatic common bile duct dilatation is similar to\nprior, and consistent with postcholecystectomy state. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A hypodense exophytic\nlesion arising from the left upper pole measuring 1.5 cm is not significantly\nchanged. There is no hydronephrosis. There is no nephrolithiasis. There is\nno perinephric abnormality. There are vascular calcifications in the\nbilateral renal vasculature, similar to prior.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal. There is no retroperitoneal hematoma.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of nonspecific nonhemorrhagic presacral edema.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is a chronic appearing deformity at the sacrococcygeal junction. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted. There is diffuse\nanasarca.", "output": "1. No evidence of retroperitoneal bleed or other acute process in the abdomen\nor pelvis.\n2. Small right and trace left nonhemorrhagic pleural effusions, diffuse\nanasarca, and nonspecific nonhemorrhagic presacral edema.\n3. Hypoattenuation of the blood pool relative the myocardium, suggestive of\nanemia.\n4. Diverticulosis, with no evidence of acute diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Trace\npericardial fluid is likely physiologic. No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. Moderate bilateral\nperinephric stranding are nonspecific..\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nNo evidence of retroperitoneal hematoma.\n\nPELVIS: Bladder is decompressed with a Foley catheter. Distal ureters appear\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes of the lumbar spine are most notable at L1-L2\nand L2-L3.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process. No evidence of retroperitoneal hematoma." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the interpolar left kidney is too small to\ncharacterize, however, this likely represents a simple renal cyst. There is\nno evidence of suspicious focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Similar to prior, there is a\nsmall bowel obstruction with transition point in the right lower quadrant\n(601:29) at the proximal ileum. Proximal to the site of transition, there is\nan approximately 25 cm long segment of fecalized, edematous small bowel with\nwall hyperemia, adjacent fat stranding and prominence of the Vasa recta. \nThese findings suggest acute inflammation, however, ischemia cannot be\nexcluded. Approximately 6 cm proximal to the transition point, there is an\narea of mild focal narrowing (601:30), however, on this single static image it\nis difficult to determine if this is a truly fixed point of narrowing. Distal\nto the transition point there is an additional 10 cm segment of small bowel\nthat is relatively decompressed, however, this also demonstrates wall\nhyperemia and edema as well as adjacent fat stranding. Distal ileum is\ndecompressed.\n\n The colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\ntrace amount of free fluid (02:54).\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a Schmorl's node in the inferior endplate of the T10 vertebral body\n(2:7).\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.", "output": "Small-bowel obstruction with transition point in the proximal ileum in the\nright lower quadrant, similar to the prior exam. There is an approximately 25\ncm long segment of small bowel wall proximal to the transition point as well\nan approximately 10 cm segment of small bowel distal to the transition point\nthat demonstrates bowel wall and mesenteric edema with mucosal hyperemia and\nadjacent stranding suggestive of inflammation. However, bowel ischemia cannot\nbe excluded. Surgical consultation is advised.\n\nRECOMMENDATION(S): Recommend surgical consult." }, { "input": "This study is limited by the patient's poor venous access and inability to\ntolerate a full dose of oral contrast.\n\nLOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The largest previously identified metastatic liver lesion has\npoorly defined borders within the limitations of this study, but appears\noverall unchanged in size. The additional previously identified lesions are\nnot well examined on this study. There is stable anti dependent pneumobilia,\nlikely related to the metallic CBD stent. The CBD stent position is grossly\nunchanged. The gallbladder is within normal limits without cholelithiasis or\nsurrounding fluid or fat stranding.\n\nPANCREAS: The known pancreatic neuroendocrine tumor is grossly unchanged in\nsize and appearance with multiple internal fiducial markers again identified. \nThe celiac trunk is obliterated and there is less than 180 degree soft tissue\ncontact of a pancreatic mass with the SMA. The proximal SMA appears patent,\nbut with minimal unchanged stenosis and post stenotic dilatation. Compared to\nthe CT abdomen/pelvis dated ___, there is increased peripancreatic\nand mesenteric fat stranding, most pronounced at the root of the mesentery. \nThere also appears to be mild wall thickening of the third and fourth portions\nof the duodenum. These findings are likely representative of edema related to\npersistent thrombosis of the portal vein.\n\nSPLEEN: The spleen is unchanged in size and appearance, without evidence of\nfocal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. As mentioned above, there\nappears to be mild wall thickening of the third and fourth portions of the\nduodenum in close proximity to the pancreatic mass with surrounding mesenteric\nfat stranding. The colon and rectum are within normal limits. The appendix\nis normal without wall thickening or surrounding fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: Scattered mesenteric and retroperitoneal lymph nodes do not meet\nCT size criteria for lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: In addition to the above-described vascular abnormalities, there is\nno abdominal aortic aneurysm or evidence of atherosclerotic disease.\n\nBONES AND SOFT TISSUES: There is a small hyperdense focus within the\nanterolateral T12 vertebral body, which is unchanged in size and appearance\nsince at least ___ and likely represents a bone island. The\nabdominal and pelvic wall is within normal limits.", "output": "1. Increased peripancreatic and mesenteric fat stranding and mild wall\nthickening of the third and fourth portions of the duodenum are most likely\nindicative of edema related to persistent portal vein thrombosis.\n2. Previously identified hepatic lesions are not well identified within the\nlimitations of the study. The largest and best identified lesion within the\nposterior right hepatic lobe appears grossly unchanged.\n3. The known pancreatic neuroendocrine tumor is overall grossly unchanged in\nsize and appearance." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nModerate volume ascites is present.\n\nHEPATOBILIARY: Multiple metastatic lesions in the liver, largest in the right\nhepatic lobe and segment 5 measuring 2.8 x 2.3 cm (05:99), and largest in the\nleft hepatic lobe measuring 1.1 x 1.0 cm in segment 2 (05:84). The liver\ndemonstrates decreased attenuation throughout, likely diffuse fatty\ninfiltration. There is no evidence of focal lesions. Biliary stent is noted\nwith pneumobilia present particularly left hepatic lobe. The gallbladder is\nwithin normal limits.\n\nPANCREAS: Enhancing pancreatic neuroendocrine tumor measures 5.1 x 3.6 cm\n(05:101), previously 5.2 x 3.6 cm on MRI. Fiducial markers are identified\nwithin the tumor.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon\ndemonstrates a decreased Astro pattern, particularly transverse colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Multiple small uterine fibroids are noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is severe stenosis of the celiac trunk and eventual\nobliteration by pancreatic tumor. The SMA is patent and demonstrates less\nthan 180 degrees of contact with the tumor. There is severe stenosis at the\norigin of the ___ but remains patent distally.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No significant change in size of pancreatic mass or hepatic metastases\ncompared to prior MRI given differences in technique.\n2. Moderate volume ascites.\n3. Diffuse severe fatty infiltration the liver.\n4. Persistent obliteration of the celiac axis. The SMA remains patent. There\nis stenosis of the proximal ___ although does not appear to contact tumor." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen enlarged, measuring 20 cm, and displays normal attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.8 x 1.7 cm nonenhancing lesion arising from the upper pole of the\nright kidney which demonstrates a thin rim of hyperdensity on noncontrast\nscan, may represent a hemorrhagic or proteinaceous cyst (4:24, 7:55). There\nis no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is a prominent number of non pathologically enlarged\nretroperitoneal lymph nodes, the largest being a 9 mm left periaortic node\n(7:68). There is no retroperitoneal or mesenteric lymphadenopathy. There are\nmultiple enlarged enhancing pelvic nodes, including a 1.6 cm left external\niliac node and a 1.3 cm right external iliac node (7:102, 106). There are\nprominent enhancing inguinal lymph nodes, measuring to 1.4 cm bilaterally\n(7:123; 127).\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Splenomegaly, measuring up to 20 cm, and enhancing pelvic and inguinal\nlymphadenopathy, concerning for lymphoma.\n2. 1.8 cm nonenhancing lesion arising from the upper pole of the right kidney\nwhich demonstrates a rim of hyperdensity on noncontrast images, may represent\na hemorrhagic or proteinaceous cyst, however further evaluation with renal\nultrasound is recommended to exclude a solid lesion.\n\nRECOMMENDATION(S): Recommend renal ultrasound.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 11:18 am, 15 minutes after discovery of the\nfindings." }, { "input": "LOWER CHEST: Scattered ground-glass opacities are seen bilaterally with\nincreased nodularity in the left lower lobe, similar to prior study. No\npleural or pericardial effusion\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. A 1.9 x 1.7 cm\nfat containing lesion is seen arising from the left adrenal gland consistent\nwith an adrenal myelolipoma.\n\nURINARY: The kidneys are of symmetric size. Bilateral kidneys demonstrate\ncortical thinning. A 1 cm lesion of intermediate density is seen arising from\nthe upper pole of the right kidney, previously characterized as a cyst. There\nis no hydronephrosis. Nonobstructing stones are seen in the right kidney\nmeasuring up to 4 mm in the interpolar region. A nonobstructing stone in the\nlower pole of the left kidney measures 3 mm. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the colon is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder is decompressed. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. A left common and external iliac artery stent is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Bilateral nonobstructing renal calculi measuring up to 4 mm.\n2. No acute intra-abdominal abnormality.\n3. 1.9 cm left adrenal myelolipoma." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple subcentimeter hypodensities within the liver are too\nsmall to characterize (series 2, image 8, 26), but likely represent cysts or\nbiliary hamartomas. Otherwise, liver demonstrates homogenous attenuation\nthroughout. There is no evidence of enhancing lesions. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is\ndecompressed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Large amount of ingested material within the stomach. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. No evidence of obstruction. Moderate fecal loading. The colon\nand rectum are within normal limits. The appendix is normal (series 2, image\n56).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a oval enhancing structure within the myometrium\nmeasuring 3.0 x 2.2 cm (series 602b, image 32), likely an intramural fibroid\ncausing distortion of the endometrial canal. There is fluid within the\nendometrial canal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormalities within the abdomen or pelvis. Normal appendix.\n2. Uterine fibroid." }, { "input": "The imaged portion of the lung bases appear within normal limits. Coronary\nartery calcifications are noted. Imaged portion of heart and pericardium\nappear otherwise unremarkable. Please refer to dedicated chest CT report of\nsame date for evaluation of thoracic structures. Since the previous\nexamination, there is slight increase in size in the hypo attenuating mass\nwithin the head of the pancreas, measuring 3.3 x 4.8 cm, previously 3.1 x 3.9\ncm in a similar plane (4:69). The degree of pancreatic ductal dilation with\nabrupt tapering at the margin of the mass is similar. A dependent\ncalcification is seen within the obstructed main pancreatic duct. The\ngastroduodenal artery is partially encased by tumor and remains patent (4:60).\nTumor encompasses approximately 30% circumference of the superior mesenteric\nartery, an unchanged finding (4:69). The portal vein, superior mesenteric\nvein, and splenic vein remain patent. A metallic common bile duct stent is in\nplace with resultant pneumobilia. There is been slight increase in size of a\nnode adjacent to the common hepatic artery which measures 1 cm (04:59),\npreviously 8 mm. A portacaval node that measures 6 mm in short axis dimension,\nis unchanged. Lesion in hepatic segment ___ junction that measures 7 mm and\nis hyperdense on the portal venous phase images (04:47), is unchanged in size\nand may represent a hemangioma ; a second smaller lesion in segment 7\npreviously seen is less well appreciated on the present study. No new focal\nliver lesions are identified. Spleen, bilateral adrenal glands, appear within\nnormal limits. There is no hydronephrosis. A left upper pole renal stone is\nnonobstructing and measures 8 mm. Parapelvic cysts are noted on the left.\nPunctate calcification in the right kidney consistent with a 3 mm\nnonobstructing stone, is unchanged. Abdominal aorta again shows fusiform\ninfrarenal dilatation to 2.9 cm, unchanged. Borderline dilation of the common\niliac arteries bilaterally is stable. Large and small bowel loops are normal\nin caliber and contour. There is no ascites. Mild peripancreatic stranding is\nnoted. CT of the pelvis with intravenous contrast: Bladder, distal ureters,\nprostate and seminal vesicles, rectum and sigmoid colon appear within normal\nlimits. There are no pathologically enlarged pelvic or inguinal lymph nodes.\nAneurysmal dilation of the common femoral arteries bilaterally is stable. Bone\nwindows: Sclerotic focus in a mid thoracic vertebra which may represent a bone\nisland, and lucency with geographic margins consistent with hemangioma in a\nlower thoracic vertebra, are unchanged, as is wedge configuration of L1 and\nT11 and T12 vertebrae. No new lesions suspicious for osseous metastases are\nidentified.", "output": "1. Slight interval increase in size in pancreatic head mass measuring 3.3 x\n4.8 cm, and slight increase in size of an adjacent common hepatic lymph node.\nThe degree of involvement of the adjacent superior mesenteric artery and\ngastroduodenal artery appear similar.\n2. Stable hyper attenuating hepatic lesion consistent with a hemangioma.\nAdditional previously seen probable hemangioma was not well appreciated on the\npresent study; no new liver lesions identified.\n3. Stable additional findings including bilateral nonobstructing renal stones,\ndiffuse fusiform dilation of the infrarenal abdominal aorta and bilateral\ncommon femoral arteries, compression deformities of thoracic and lumbar\nvertebrae and mildly enlarged prostate.\n4." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable. No pleural or pericardial effusions seen.\n\nABDOMEN: The liver enhances normally without concerning focal lesion. Main\nportal vein is patent. No biliary ductal dilation. The gallbladder is\nnormal. The pancreas enhances normally. The spleen is normal in size. Both\nadrenal glands are normal. The kidneys enhance symmetrically. No worrisome\nrenal lesion or hydronephrosis. The abdominal aorta is normal in course and\ncaliber. No retroperitoneal adenopathy. The stomach and duodenum appear\nnormal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. \nSeveral mildly prominent right lower quadrant mesenteric lymph nodes are\npresent, likely reactive, seen best on series 601, image 25. The appendix is\nat the upper limits of normal for size measuring approximately 9 mm in\ndiameter, though there is no surrounding inflammation or mucosal hyperemia to\nsuggest acute appendicitis. The colon contains a mild fecal load. No pelvic\nfree fluid. Urinary bladder is moderately distended appearing normal. The\nprostate is normal in size. There is no pelvic sidewall or inguinal\nadenopathy.\n\nBONES: No worrisome lytic or blastic osseous lesion is seen.", "output": "1. Prominence of mesenteric lymph nodes in the right lower quadrant, may be\nreactive.\n2. Top-normal appendix size without secondary signs of appendicitis.\n\nNOTIFICATION: ___ were d/w Dr. ___ at the time of initial\nreview." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. The\nliver is mildly hypodense, likely due to steatosis. There is no evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits. Multiple perihilar lymph nodes are seen, the largest\nmeasuring up to 8 mm.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. 1.4 cm accessory spleen is seen (2:65).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nMultiple prominent para-aortic and mesenteric lymph nodes are seen, though\nnonpathologic by CT size criteria. Intraperitoneal lymph node measures up to\n8 mm (02:50). There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intraperitoneal abnormality.\n2. Multiple mildly enlarged lymph nodes in the abdomen, consistent with\npatient's history of AML.\n3. Hepatic steatosis" }, { "input": "LOWER CHEST: Heart size is normal without significant pericardial effusion. \nCoronary artery calcifications are seen. There is hypoattenuation of the\nblood pool relative to the cardiac musculature suggestive of anemia. There is\nmild linear scarring or atelectasis in the left lung base. The imaged lung\nbases are otherwise grossly clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydroureteronephrosis or nephroureterolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a tiny hiatal hernia. The stomach is otherwise\ngrossly unremarkable. Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Very few scattered colonic diverticula are seen. The\ncolon and rectum are otherwise within normal limits. The appendix is normal. \nThere is no obstruction. Ingested oral contrast reaches the level of the\ncecum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are not seen. There is no gross\nadnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild lumbar degenerative changes. There is a Schmorl's node at the\nsuperior endplate of L4.\n\nSOFT TISSUES: There is paraumbilical rectus diastasis along with a tiny\nparaumbilical fat containing hernia to the left of midline (02:53).", "output": "1. No acute findings or infectious source in the abdomen or pelvis. No fluid\ncollection.\n2. Tiny fat containing paraumbilical hernia to the left of midline.\n3. Tiny hiatal hernia.\n4. Findings suggesting anemia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout. There is a 7 mm\nhypodensity in the posterior aspect of the pancreatic body (series 5, image\n27). There is no pancreatic duct dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small and large\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The appendix is normal.\n\nThere is no free fluid or fluid collection in the upper abdomen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES:\nPatient is status post abdominoplasty. There is a rim enhancing collection in\nthe anterior abdominal wall above the umbilicus and just superficial to the\nrectus abdominus measuring 3 x 8 x 11 cm (AP x TR x CC). There is mild\nsubcutaneous fat stranding along the inferior margin of this collection. \nThere is no ventral wall defect or hernia.", "output": "1. Fluid collection in the supraumbilical abdominal wall superficial to the\nrectus abdominus measuring 3 x 8 x 11 cm, likely a postsurgical seroma.\n2. No ventral wall defect or hernia.\n3. 7 mm hypodensity in the body of the pancreas most likely represents a side\nbranch IPMN. Further evaluation with MRCP is recommended." }, { "input": "LOWER CHEST: Mild dependent atelectasis. No focal consolidations. No pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Geographic hypodensity adjacent to the falciform ligament\nlikely represents focal fatty deposition. Otherwise, the liver demonstrates\nhomogenous attenuation throughout. There is no evidence of focal lesions. \nMild central intrahepatic biliary dilatation. No extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Contrast is seen along the dependent portion of the left renal pelvis\nwith the additional unenhanced fluid at the left renal pelvis likely\nrepresenting mild hydronephrosis with incomplete contrast mixture when\ncorrelated with prior ultrasound. This extends to the proximal left ureter. \nThere is also a small amount of perinephric fluid and fat stranding (series 4,\nimage 29). Although no stones are seen, this appearance may represent a\npassed stone or infection. Contrast is seen passing through the distal left\nureter into the bladder. Otherwise, the kidneys are of normal and symmetric\nsize with normal nephrogram. There is no evidence of focal renal lesions. \nThere is no evidence of urothelial lesions. The distal ureters and bladder\nare unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: There is a small amount of free fluid within the pelvis (series 4,\nimage 71), likely physiologic.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable in\nappearance for a premenopausal female.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild left hydroureteronephrosis to the level of the proximal ureter. \nIncomplete opacification on contrast-enhanced images of the apparent dilated\nleft renal pelvis and proximal left ureter is likely due to incomplete\ncontrast mixture rather than adjacent parapelvic cyst when correlated with\nprior ultrasound. There is a small amount of perinephric fluid and fat\nstranding. No stones are seen. This appearance may represent a passed stone\nor infection.\n2. No other acute abnormalities within the abdomen or pelvis.\n\nRECOMMENDATION(S): Correlation with urinalysis.\nFollow-up ultrasound after resolution of acute phase." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The gallbladder is surgically absent. \nMild intrahepatic and extrahepatic biliary ductal dilation is likely secondary\nto the patient's post cholecystectomy state, and appears unchanged from the\nprior examination.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Punctate\nnonobstructive nephrolithiasis is seen within the lower pole the right kidney.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Minimal residual thrombus within the IVC is noted (6:78),\nsignificantly improved from the prior examination.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. Moderate dextroscoliosis centered in the lower thoracic spine\nis again seen. The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the imaged abdomen or pelvis.\n2. Mild, unchanged intrahepatic and extrahepatic biliary ductal dilation\nstatus post cholecystectomy.\n3. Further description of the intrathoracic findings, please see the separate\nCT chest report." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic and\nextrahepatic biliary dilatation that appears unchanged when compared to prior\nstudies. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of intra-abdominal/pelvic metastatic disease.\n2. Mild intrahepatic and extrahepatic biliary dilatation status post\ncholecystectomy remains unchanged." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN: The liver, spleen, pancreas, adrenal glands and kidneys are\nunremarkable. There is stable mild biliary ductal dilatation. \nCholecystectomy changes are redemonstrated.\n\nGASTROINTESTINAL: No intestinal obstruction or ascites. A small periampullary\nduodenal diverticulum is again noted. The appendix unremarkable..\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. The uterus and adnexa are unremarkable on CT for\nage.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is again noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postoperative changes ___ flap reconstruction are noted.", "output": "Stable examination. No findings of metastatic disease in the abdomen or\npelvis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild dilatation of the central\nintrahepatic bile ducts is unchanged and likely secondary to patient's post\ncholecystectomy status.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n13 mm cortical hypodensity in the upper pole of the left kidney is unchanged. \nNo other focal renal lesion identified. There is no hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. There is calcified atherosclerotic disease at the origin of\nthe celiac trunk and SMA. There is moderate stenosis of the proximal SMA. \nDistal SMA and its branches are adequately opacified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are noted in the spine SI joints and symphysis pubis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of metastatic disease in the abdomen and pelvis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent. \nMild intra and extrahepatic biliary dilation, with the common bile duct\nmeasuring up to 11 mm, is unchanged and within expected limits post\ncholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There are multiple mildly\ndilated loops of proximal small bowel measuring up to 3.3 cm. There is an\nabrupt transition point in the mid pelvis with angulation (5:97). Findings\nare compatible with small bowel obstruction, likely secondary to adhesions. \nThe colon and rectum are unremarkable.\n\nPELVIS: There is a cystocele. The urinary bladder is otherwise unremarkable. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. No adnexal abnormalities are\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDextroconvex scoliosis of the thoracic spine is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Dilated proximal small bowel loops with transition point in the mid pelvis,\ncompatible with small bowel obstruction, likely secondary to adhesions.\n2. No evidence of metastatic disease in the abdomen or pelvis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: There are right greater than left basal atelectatic changes with\nminimal pleural effusion.\n\nHEPATOBILIARY: There is homogeneous hepatic enhancement with no suspicious\nmass lesions. Portal vein is patent. Gallbladder is unremarkable. There is\nno intrahepatic biliary ductal dilatation. Common bile duct is mildly\nprominent in caliber tapers to the level of the ampulla and is unchanged in\nappearance since ___.\n\nPANCREAS: Atrophic changes are noted within the pancreas with no pancreatic\nductal dilatation.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY:There is left greater than right renal cortical atrophy with multiple\nareas of renal cortical scarring. There is interval development of mild\nhydronephrosis, which can be secondary to distention of the urinary bladder..\n\nGASTROINTESTINAL: Stomach is under distended. Proximal small bowel loops are\nnormal in caliber. The right hemicolon appears unremarkable. Transverse\ncolon is under distended. Note is made interval worsening of the distension\nof descending colonic loops measuring up to 7.8 cm. There is notable\ntwisting/swirling of the sigmoid colon with the transition point along the\nleft pelvic inlet consistent with sigmoid volvulus. Given the appearance of\nthis patient's bowel loops since ___, this is probably acute on chronic or\nintermittent in nature. There is new mild mesenteric stranding and edema.\n\nPERITONEUM: There is no evidence of perforation.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber with moderate atherosclerotic\ncalcifications.\n\nPELVIS: Urinary bladder is markedly distended. Uterus is unremarkable. There\nare no adnexal mass lesions.\n\nBONES:Degenerative changes of the lumbar spine are noted. There are no acute\nosseous abnormalities.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Findings of large bowel obstruction secondary to sigmoid volvulus. \nFindings are likely acute on chronic or intermittent given the notable\ndistension of the bowel loops in ___. Evidence of mesenteric stranding and\nedema. No evidence of perforation.\n2. Mild bilateral hydronephrosis likely secondary to urinary bladder\ndistension.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:38 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There are trace bilateral pleural effusions. No focal\nconsolidation. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of hepatic mass within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is not visualized, likely collapsed.\n\nPANCREAS: There is moderate diffuse atrophy of the pancreas. There is no main\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is severe right hydronephrosis to the level of the\nureteropelvic junction, without obstructing stone or mass identified. There\nis no left hydronephrosis. There is no evidence of focal renal lesions within\nthe limitations of an unenhanced scan. There is no nephrolithiasis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is dilated and filled with oral contrast and\nair. Small bowel loops are normal in caliber. The patient has history of\nsigmoid volvulus, and is status post resection of the rectosigmoid with left\ncolorectal anastomosis on ___. The rectum is dilated up to 9.1 cm\nwith moderate amount of layering fluid. The distal colon is dilated with\nabrupt transition point and twist in the midline upper pelvis (series 2,\nimages 54-57), concerning for recurrent volvulus. Findings appear less severe\ncompared to prior episode from ___. No pneumatosis, free air, or\nascites. The appendix is not visualized.\n\nPELVIS: The urinary bladder is decompressed with a Foley in place. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative changes of the thoracolumbar spine are unchanged with\ngrade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: There is diffuse anasarca.", "output": "1. Dilated distal colon with abrupt transition and twist in the midline upper\npelvis, concerning for recurrent volvulus, although less severe compared to\nprior episode from ___. No pneumatosis or free air.\n2. Severe right hydronephrosis of unclear etiology to the level of the\nureteropelvic junction, of unclear etiology.\n3. Trace bilateral pleural effusions." }, { "input": "LOWER CHEST: Clear lung bases. Small hiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged hypodense liver lesions, too small to characterize,\nlikely cysts. Homogeneous liver other was without suspicious lesions. Patent\nhepatic vasculature. Unremarkable gallbladder.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: No splenomegaly. 9 mm dense lesion in the upper pole of the spleen,\npossibly hemangioma.\n\nADRENALS: Unremarkable.\n\nURINARY: No nephrolithiasis or hydronephrosis. Simple Interpolar right renal\ncyst.\n\nGASTROINTESTINAL: Sigmoid diverticulosis. Unremarkable bowel and appendix\notherwise.\n\nRETROPERITONEUM: No adenopathy.\n\nVASCULAR: Patent major vasculature. Mild arteriosclerosis.\n\nPELVIS: Indirect left inguinal hernia containing fat. No fluid or adjacent\nfat stranding. Unremarkable rectum and bladder. Process hypertrophy with\ncalcifications.\n\nBONES AND SOFT TISSUES: No suspicious osseus lesions.", "output": "Left inguinal mass noted on examination represents an indirect inguinal hernia\ncontaining fat." }, { "input": "LOWER CHEST: Linear atelectasis at the right lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple subcentimeter hypodense lesions throughout\nthe liver parenchyma. These are too small to characterize but statistically\nlikely represent small cysts or hemangiomas. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits. Suspected focal fundal adenomyomatosis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Duodenal diverticulum is noted\nalong the second stage of the duodenum. The small bowel is normal in caliber.\nUncomplicated sigmoid diverticulosis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Moderate prostatomegaly.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Unremarkable examination. No definite explanation for the patient's\nabdominal distention and pain is identified.\n2. Moderate prostatomegaly." }, { "input": "LOWER CHEST: There are new small pleural effusions, the right larger than the\nleft, and overlying atelectatic collapse.\n\nABDOMEN:\n\nHEPATOBILIARY: There is new trace perihepatic fluid, likely postoperative in\nnature. d The liver demonstrates homogenous attenuation throughout. Multiple\nsubcentimeter hypodensities within both hepatic lobes are again demonstrated,\nand appear unchanged from ___. There is no evidence of focal\nlesions. The common bile duct is more prominent than on prior, measuring up\nto 7 mm (601:28). The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is new trace perisplenic fluid, likely postoperative in nature. \nThe spleen shows normal size and attenuation throughout, without evidence of\nfocal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities within the cortex of the left kidney are too small\nto characterize but likely represent simple renal cysts and are unchanged from\nprior. There is no evidence of focal renal lesions or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates within the body of the stomach. \nThere is diffuse small bowel dilatation up to 4.6 cm with multiple air-fluid\nlevels. Fluid is seen within the colon. No intra-abdominal abscess or\nphlegmonous changes are noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Free fluid\nin the pelvis may be postoperative in nature.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Increased general anasarca is noted of the subcutaneous tissues.\nA midline laparotomy wound demonstrates soft tissue swelling without definite\nfluid collection.", "output": "1. Mild diffuse dilatation of small bowel with few air-fluid levels with air\nand fluid within the colon likely representing a mild postoperative ileus. No\nfrank areas of transition to suggest a recurrence small-bowel obstruction. No\nevidence for intra-abdominal phlegmonous collection or abscess.\n2. New small bilateral pleural effusions with overlying atelectatic collapse.\n3. Small volume free pelvic fluid is likely postoperative." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post prostatectomy. Multiple surgical\nclips are again noted in the region of the prostate and pelvic sidewalls. \nVasectomy clips are again noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: Extensive, diffuse sclerotic bone lesions are again visualized\nthroughout the bony skeleton, grossly similar in appearance to prior study and\ncompatible with metastatic disease.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Extensive sclerotic osseous metastases visualized throughout the bony\nskeleton, grossly similar in appearance to prior study.\n2. No evidence of intra-abdominal or intra-pelvic metastatic disease.\n3. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed on the same day." }, { "input": "CT ABDOMEN: Limited pre-procedure CT scan was performed. The visualized\nunenhanced liver is unremarkable. The gallbladder is mostly decompressed.\nHypodensity in the spleen likely corresponds to previously noted splenic\nabscess, incompletely imaged on this study.\n\nThe patient is status post pancreatic debridement and drainage. Within the\npancreatic bed, two rubber catheters entering via the right anterior abdominal\napproach are seen within the pancreatic bed/lesser sac fluid collection,\nfollowing the course of the prior chest tubes. The rubber catheters are in\nsatisfactory position, with the tip of one catheter terminating at the left\nlateral most aspect of the fluid collection. After discussion with the primary\nteam, decision was made not to manipulate the catheters as they are currently\nappropriately functioning and in appropriate position based on this\npreprocedure CT scan. The size of the collection as well as surrounding\nstranding and inflammation is unchanged from ___.\n\nThe adrenal glands are unremarkable. There is no hydronephrosis or renal stone\nbilaterally. A nasoenteric tube ends within the jejunum, unchanged. There is\nno bowel obstruction. An ostomy is seen in the left lower quadrant.\n\nBONE WINDOWS: No bone finding suspicious for infection or malignancy is seen.", "output": "Two rubber catheters that were placed within the tracts of the prior ___ chest\ntubes are in satisfactory position, terminating at the left lateral most\naspect of the pancreatic bed fluid collection. After discussion with the\nprimary surgical team, a decision was made to not replace the catheters with\nchest tubes as the currently placed catheters are in appropriate position and\nfunctioning appropriately.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ (surgery) on the telephone on ___ at approximately 3:50 ___,\n5 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains stones but\nwithout evidence of acute cholecystitis.\n\nPANCREAS: There is persistent atrophy of the pancreatic body and proximal\ntail with minimal residual stranding. A 2.9 x 4.1 x 2.0 cm simple fluid\ncollection within the pancreatic tail (02:33, 602b:54) has increased from the\nprior examination, previously measuring 0.7 x 0.8 x 2.4 cm in ___. The\npancreatic uncinate process, head, and tail are grossly normal in bulk and\nhomogeneous in attenuation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no nephrolithiasis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post distal transverse, descending,\nand sigmoid colectomy with a transverse colon colostomy noted in the mid left\nabdomen, in addition to a rectal pouch. The small bowel is fluid-filled and\nmeasures up to 8 top normal diameter of 3.0 cm. However, the residual large\nbowel is fluid-filled measures up to 7.0 cm in maximal diameter, most notable\nimmediately before the left mid abdominal colostomy site (02:51). Residual\nhyperdense material within the rectal stump may relate to a prior pouchogram\ndated ___.\n\nRETROPERITONEUM: Mesenteric stranding and multiple prominent mesenteric lymph\nnodes are likely reactive in nature. There is no evidence of pathologically\nenlarged retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: Degenerative changes are seen in the lumbar spine. No\nsuspicious osseous lesions are identified.", "output": "1. Status post partial distal colectomy and transverse colon colostomy, now\nwith fluid-filled and dilated large bowel extending to the level of the\ncolostomy. Findings are compatible with large bowel obstruction at the\ncolostomy site.\n2. Top-normal diameter and fluid-filled loops of distal small bowel likely\nrepresent early sequelae of the patient's large bowel obstruction.\n3. Persistent, atrophic pancreatic body and proximal tail with interval\nincrease in size of a pancreatic tail fluid collection at the site of prior\nnecrosis, now measuring 2.9 x 4.1 x 2.0 cm.\n4. Cholelithiasis.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to the ACS resident at\n00:40 on ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 6 mm hypodensity in the lower pole of the right kidney (05:40) and 4 mm\nhypodensity in the interpolar left kidney are too small to characterize. \nThere is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an involuting left corpus luteum cyst (5:62). \nRight adnexa is unremarkable. The uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormality in the abdomen or pelvis. Specifically, no hepatic\nabscess or cholangitis. The gallbladder is unremarkable and there is no\nevidence of biliary dilatation.\n2. Normal appendix. No evidence of bowel obstruction." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. No pleural or\npericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. No\nfocal lesions within the limitations of an unenhanced scan. No intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. No pancreatic\nductal dilatation. No peripancreatic stranding.No\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is mild-moderate left hydroureteronephrosis, increased from 8\n___, secondary to a 7 mm calculus in the left mid-distal ureter\n(series 2:65), which is now at the distal portion of the ureter crossing the\niliac vein, about 3 cm distal to where it was on ___ when it was just\nproximal to the crossing of the iliac artery. There are punctate 2 mm\nnon-obstructive calculi in the left (series 2:32) and right (series 2:31)\nkidneys.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. There are multiple punctate hyperdense foci\nposterolateral to the bladder which likely represent phleboliths, however\ndistal ureter stones cannot definitely be ruled out. The uterus and adnexae\nare unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLateral fusion hardware extends from T11-L3. There is associated multilevel\nmild to moderate degenerative disease. Of note the distal end of the fusion\nrod contacts and appears to slightly deviate laterally the left ureter.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Mild-moderate left hydroureteronephrosis which is increasde as compared to CT\nabdomen pelvis ___, secondary to a 7 mm calculus in the left\nmid-distal ureter which is slightly more distal than where it was on ___. The end of the left spinal fusion rod contacts and appears to slightly\ndeviate laterally the left ureter , but this is upstream from the stone.\n\nPunctate non-obstructing bilateral renal calculi." }, { "input": "There is mild atelectasis at the lung bases. There is no pericardial or\npleural effusion. The heart is mildly enlarged (series 2, image 7).\n\nThe liver contour is markedly nodular, in keeping with known history of\ncirrhosis. Lipiodol deposition is demonstrated throughout the right liver, in\nkeeping with recent history of TACE (series 2, image 20). Multiple arterially\nenhancing tumors within the right hepatic lobe which were demonstrated on the\n___ examination, in addition to an enhancing lesion within the\ncaudate lobe, are included within the TACE site.\n\nCholelithiasis is again demonstrated (series 2, image 26). The gallbladder\notherwise appears normal.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nModerate splenomegaly is again demonstrated, with massive splenic varices\n(series 2, image 27), unchanged in configuration from the MRI from ___.\n\nThe adrenal glands remain normal in size and shape.\n\nThere are bilateral renal nephrograms (series 601, image 38), with trace\nexcreted contrast within the collecting system bilaterally. There is no\nhydronephrosis.\n\nThe stomach and intra-abdominal loops of small and large bowel are normal in\ncaliber. Trace hyperdense material within the dependent region of the stomach\nand small bowel are likely ingested material, as they appear endoluminal\n(series 2, image 17).\n\nMild atherosclerotic calcifications demonstrated throughout the abdominal\naorta, without aneurysm.\n\nThere are no osseous lesions concerning for malignancy or infection.", "output": "1. Persistent bilateral renal nephrograms may reflect acute renal injury. \nCorrelate with creatinine levels and urine output.\n2. Post TACE with lipiodol distribution throughout the right liver and\ncaudate, where previously-seen liver lesions were demonstrated on the ___ MRI.\n3. No extrahepatic lipiodol deposition. No abdominal hemorrhage." }, { "input": "LOWER CHEST: Small left nonhemorrhagic pleural effusion, stable from prior\nexam with adjacent compressive atelectasis. Heart is enlarged and there is\ndecreased attenuation of the blood pool compatible with anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic in morphology. There are multifocal\ncalcifications throughout the right lobe of the liver, likely treatment effect\nfrom prior TACE. A TIPS extends from the left hepatic vein to the proximal\nright portal vein. Its patency cannot be assessed on this examination. Small\namount of perihepatic ascites. There is no evidence of focal lesions within\nthe limitations of an unenhanced scan. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is decompressed and\ncontains gallstones.\n\nPANCREAS: Mild pancreatic parenchymal atrophy. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 17 cm in AP dimension, unchanged from\nprior examination. There is no perisplenic fluid collection. Embolization\ncoils are noted in the splenic hilum. Metallic streak artifact from these\ncoils limits evaluation of this area.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys retain IV contrast from yesterday's splenorenal shunt\nembolization procedure. Both kidneys are symmetric in size and degree of\ncontrast enhancement. There is a striated nephrogram bilaterally. No\nhydronephrosis. No evidence of a focal renal lesion. There is no\nnephrolithiasis. Mild perinephric stranding, unchanged from multiple\nexaminations.\n\nGASTROINTESTINAL: The stomach is decompressed and not well assessed though\nappears grossly normal. No dilated small bowel loops in the left upper\nquadrant on yesterday's examination have resolved. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is distended with contrast and normal. There is a\nsmall amount of free fluid in the pelvis, mostly along the right side. This\nmeasures 25 Hounsfield units on average, an increase from 13 Hounsfield units\non the prior examination. The amount of free fluid is very similar.\n\nREPRODUCTIVE ORGANS: The prostate contains coarse calcifications but is not\nenlarged. The seminal vesicles are grossly normal\n\nLYMPH NODES: Haziness of the mesentery persists as do scattered, prominent,\nthough not pathologically enlarged mesenteric and retroperitoneal lymph nodes.\nPartially calcified left external iliac chain lymph nodes are similar. \nBilateral enlarged inguinal lymph nodes are stable across multiple prior exams\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There are two retroaortic left renal veins both of which are\ndilated secondary to splenorenal shunting. Perisplenic varices are again\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal findings.\n2. Small amount o" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 7 mm hypodensity in segment V/VI of the liver (06:57), too small to\ncharacterize. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is a small amount of pneumobilia, to be correlated with a\nhistory of sphincterotomy. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Note is made\nof a small right extrarenal pelvis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ninspissated oral contrast in the terminal ileum and ascending and transverse\ncolon. The colon and rectum are otherwise unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 7 mm hypodensity in segment V/VI of the liver, too small to characterize.\n2. Otherwise no evidence of primary malignancy or metastatic disease in the\nabdomen and pelvis.\n3. Small amount of pneumobilia, to be correlated with a history of previous\nsphincterotomy." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThere are a few hypoattenuated lesions diffusely in the liver. The largest\nhypoattenuated lesion measures 8 mm in segment VIII and is decreased in size\nas compared to outside hospital whole-body CT ___. Surrounding\nthis lesion there is heterogeneous hypoattenuation of unclear significance. \nMost of the hypoattenuated lesion seen on ___ have resolved or\ndecreased in size a on today's study. Coarse calcifications in the liver\ncompatible with prior granulomatous disease. There is a focal area of\nhypodensity adjacent to the falciform ligament (4:69) likely representing\nfocal fatty infiltration.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There are scattered coarse calcifications in the spleen compatible\nwith prior granulomatous disease. The spleen is normal in size.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nIntermediate density lesion measuring up to 0.9 cm in the upper pole of the\nleft kidney (07:25) is too small to characterize. There is an exophytic\nsimple cyst measuring up to 1.9 cm in the upper pole of the right kidney\n(4:64). There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is normal.\n\nLYMPH NODES: There is retroperitoneal lymphadenopathy which is significantly\ndecreased in size as compared to ___. The largest retroperitoneal\nlymph node is a left para-aortic lymph nodes measuring 2.0 x 1.0 cm (4:68). \nThe second largest retroperitoneal lymph node is a more inferior left\npara-aortic lymph node measuring 1.3 x 0.8 cm (4:79).\n\nPelvic lymphadenopathy seen on ___ has almost completely resolved\non today's study. There are non pathologically enlarged right iliac chain\nlymph nodes measuring up to 0.8 x 0.3 cm (4:110).\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Significant decrease in size to resolution of multiple hypoattenuated\nlesions previously seen on outside hospitals whole-body CT ___. \nThe largest hypoattenuated lesion is in segment 8 measuring 8 mm in greatest\ndiameter.\n2. Significant improvement in retroperitoneal lymphadenopathy as compared to \n___. The largest retroperitoneal lymph node is a left para-aortic\nlymph node measuring 2.0 x 1.0 cm.\n3. Almost complete resolution of pelvic lymphadenopathy is as compared to ___." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous background attenuation\nthroughout. Compared with ___, there has been interval decrease in\nsize and number of ill-defined hepatic hypodensities, with two hypodense\nlesions in the hepatic dome and left hepatic lobe measuring up to 5 mm\nremaining (2:45, 52). Again seen are multiple calcified granulomas in the\nliver. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size. There is a ill-defined 8 mm splenic\nhypodensity, not significantly changed, and not previously FDG avid (2:55). \nAgain seen are multiple calcified splenic granulomas.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 9 mm intermediate density lesion arising from the upper pole the left kidney\nis too small to characterize, however is not significantly changed from prior\n(2:60). A 1.7 cm exophytic cystic arising from the upper pole of the right\nkidney appears slightly decreased in size compared with prior (601b:39). \nThere is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Compared with ___, there is no significant change in\nprominent retroperitoneal lymph nodes. For reference, a 2.1 x 0.9 cm left\nperiaortic lymph node is not significantly changed (2:66). A more inferior\nleft periaortic lymph node measuring 1.2 x 0.9 cm is not significantly changed\n(2:76). There is no mesenteric lymphadenopathy. Subcentimeter bilateral\ninguinal lymph nodes are not significantly changed. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is are no suspicious bony lesions in the right iliac bone in the\nregion of focal FDG avidity seen on prior PET scan. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval decrease in size and number of multiple ill-defined hepatic\nhypodensities.\n2. No significant change in size of prominent retroperitoneal and inguinal\nlymph nodes.\nNo new lymphadenopathy in the abdomen or pelvis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: There is diffuse bilateral airspace consolidation involving\nprimarily the visualized left upper lobe and lingula, but also the lower\nlobes. There is bibasal atelectasis and a small left pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is diffusely hypoattenuating in keeping with steatosis. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is at least moderately distended but there are no\nevident pericholecystic inflammatory changes.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\npunctate calcified granuloma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Oral contrast has passed to the mid small bowel. Caliber of\nsmall bowel loops has decreased relative to the previous study, and a few\nremain mildly dilated at up to 3.5 cm. Overall, there is no convincing\nevidence of a high-grade obstruction.\n\nThere is small to moderate volume ascites, with prominent locule in the\nperisplenic region. There appears to be extension of the locule into the\nchest by the diaphragmatic hiatus. There is suboptimal evaluation for rim\nenhancing abscess on noncontrast CT.\n\nPELVIS: There is a Foley catheter in the bladder.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy. No adnexal masses are seen.\n\nLYMPH NODES: There a few mildly prominent mesenteric nodes, the largest\nmeasuring 11 mm. These are likely reactive. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are postsurgical changes in the lower abdominal wall. \nThere is diffuse subcutaneous edema. There is no drainable Fluid collection\nseen. There is been interval resolution of the ovoid collection in the Left\nanterior abdominal wall musculature.", "output": "1. Bilateral airspace consolidation has been further evaluated on radiographs\nfrom today and is concerning for multifocal infection.\n2. Moderate to small volume simple Fluid ascites, including prominent a\nloculation in the perisplenic region, possibly related to recent surgery. \nSuboptimal evaluation for rim enhancing abscess without IV contrast.\n3. Interval improvement of small bowel dilation." }, { "input": "At each lung base, multifocal consolidations are unchanged consistent with\nmultifocal pneumonia. A right posterior basilar pulmonary nodule measures up\nto 6 mm (03:22) without short-term change. An organized left-sided pleural\neffusion with loculation and partial rim measures up to 68 x 27 mm, previously\nup to 74 x 35 mm, mildly decreased. Calcified granulomas are again found in\nthe left hilum.\n\nNo focal liver lesions are identified. Hypoattenuating enlarged liver is\nconsistent with steatosis. There is no biliary dilatation. Gallbladder\nappears normal. Pancreas appears normal. Spleen is normal in size. Splenic\ncyst appears unchanged. Adrenals are unremarkable. Right kidney appears\nnormal. The left again shows a delayed attenuated nephrogram wall with mild\nwall thickening along the upper ureter but only minimal dilatation of the\nupper ureter. Small defect along the medial left upper pole appears\nunchanged.There is no hydro nephrosis. Distal left is not dilated and\ndifficult to follow.\n\nThe stomach is unremarkable. The proximal jejunum again shows mild wall\nthickening, which can probably be attributed to peritoneal inflammation. \nSmall bowel small bowel anastomosis can be seen in the epigastric region. \nLarge bowel appears normal.\n\nPatient is status post hysterectomy. Adnexa appear normal. Bladder is\nunremarkable. There is no lymphadenopathy. There is no free air or ascites.\n\nSystemic veins including pelvic veins are well opacified for review. There is\nno evidence for venous thrombosis. Separate origins for the splenic and\ncommon hepatic arteries is a normal variant. Arterial structures are\notherwise unremarkable.\n\nA pigtail catheter terminates in a rim enhancing left subphrenic collection\nthat has increased in size. It is irregular in shape but the main part\nmeasures up to 74 x 64 mm in axial dimension. Previously whole collection\nappeared is a thin crescent and measured only up to 16 mm in width. \nSubphrenic collection measures up to 44 mm in height, previously only 10 mm.\n\nIn the left lower quadrant, a second percutaneous pigtail catheter terminates\nin a nearly collapsed collection. Previously, before drainage, that\ncollection had measured over 10 cm in length. Residual rim enhancing\ncollection at the site now measures only up to 49 x 11 mm in axial ___,\nnearly collapsed.\n\nThere is air enhancement and stranding in the incision site in the midline\nwhich is nonspecific.\n\nThere are no suspicious bone lesions. Vertebral body heights and interspaces\nappear preserved in height.", "output": "1. Increase in size of left subphrenic rim enhancing collection, despite\npresence of in situ pigtail catheter. Correlation with catheter output is\nrecommended. Second more inferior pigtail catheter lies in a nearly collapsed\ncollection immediately deep to the abdominal wall in the left lower quadrant.\n\n2. No significant change in multifocal consolidations at each lung base most\nconsistent with pneumonia. Slight decrease in persistent loculated, semi\norganized left pleural collection. Empyema is not excluded.\n\n3. Persistent attenuated delayed nephrogram of the left kidney. Despite the\nlack of substantial hydroureteronephrosis, possibility of some degree of\nobstruction should be considered. It may be appropriate to consider urology\nconsultation, if needed clinically, in addition to correlation with laboratory\ndata.\n\n4. Hepatic steatosis.\n\n5. No short-term change in 6 mm nodule in the right lower lobe. If there are\nrisk factors such as smoking, strong family history of pulmonary malignancy,\nor occupational exposure, follow-up CT could be considered in one year.\n\n6. No evidence of deep vein thrombosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 1.1 cm indeterminate left adrenal nodule. The right\nadrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No intra-abdominal or pelvic abnormalities identified to correlate with\npatient's symptoms.\n2. Left adrenal nodule measuring 1.1 cm which may represent an adrenal nodule\nthough is indeterminate.\n3. Diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: Bandlike atelectasis is noted at the right lung base. Otherwise\nlungs are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple simple hepatic cysts and a right posterior lateral hepatic hemangioma\nare again noted, incompletely characterized on this noncontrast examination\nthe minimally changed the prior examination dated ___. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits, without stones or gallbladder wall thickening\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no nephrolithiasis. There is\nmild right perinephric stranding.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Colon and rectum are within normal limits. Appendix\ncontains air, has normal caliber without evidence of fat stranding. There is\nno evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: A small rounded sclerotic focus within S1 is unchanged\nfrom prior examination and likely represents a bone island. Umbilical hernia\ncontaining fat is noted.", "output": "No renal stone or hydronephrosis. Right perinephric stranding is concerning\nfor pyelonephritis in the appropriate clinical setting." }, { "input": "Within the left hepatic lobe, there is a 9-mm early enhancing focus\nwhich demonstrates no washout on the delayed images, may represent\nAV shunt or hepatoma, and should be followed on subsequent imaging. There is\nan 8-mm early enhancing focus within the right hepatic lobe in a segment VIII\nwhich demonstrates no definite washout on delayed imaging and is also\nsuspicious and should be followed. The liver is cirrhotic. There is no intra\nor extrahepatic biliary ductal dilatation. There is massive splenomegaly, the\nspleen measures 21.0 cm. There are multiple linear foci of high T1 signal\nintensity within the spleen, with which shift area of non- enhancements within\nthe mid-to-lower pole of the spleen consistent with focal hemorrhage versus\nblood products within infarcted spleen. Multiple SMA and celiac axis are\npatent. There are patent bilateral renal arteries. The pancreas, adrenal\nglands, and kidneys are unremarkable. There is gallbladder wall edema, which\nis likely secondary to liver failure. Multiple small gallstones are\ndemonstrated within the gallbladder. There is a trace perihepatic and\nperisplenic ascites. There is no lymphadenopathy or free intraperitoneal gas.\nThe bone marrow is normal in signal intensity.", "output": "1. Two arterial enhancing lesions, one within the left hepatic lobe and one\nwithin the right hepatic lobe which do not definitely demonstrate washout on\nthe delayed images. However, differential diagnosis includes hepatoma versus\nAV shunt. Close interval followup with repeat MRI in three months is\nrecommended for surveillance. These lesions were not previously seen on prior\nCTs.\n2. Massive splenomegaly with areas of infarction, which contain blood\nproducts.\n3. Cholelithiasis.\n4. Gallbladder edema which is nonspecific given ascites and may be secondary\nto liver failure.\n5. Cirrhosis with stigmata of portal hypertension. Multiplanar 2D and 3D\nreformations provided multiple perspectives for the dynamic series." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis noted. Otherwise, the visualized lung\nfields are within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A 1.8 cm hemangioma is again seen in the right liver lobe. \nOtherwise, the liver demonstrates homogenous attenuation throughout. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is not fully distended but appears thin-walled. \nVery trace pelvic free fluid is within physiologic range.\n\nREPRODUCTIVE ORGANS: There is a 2 cm right ovarian corpus luteum. Multiple\nuterine fibroids are seen, a dominant intramural fibroid measures on the order\nof 2.6 cm seen in the uterine fundus. There is also an additional 5 right\nthat appears to extend/involve the endometrial cavity, likely a submucosal\nfibroid. The left ovary appears grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Sclerosis along the bilateral sacroiliac joints is re- demonstrated,\nconsistent with bilateral sacroiliitis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No bowel obstruction or bowel wall thickening. No findings to suggest an\nacute Crohn's flare. Normal appendix.\n2. Fibroid uterus, similar in appearance to prior. One fibroid appears to\ninvolve the endometrial cavity (submucosal) versus less likely representing a\npolyp; stable in appearance since ___. Findings could be further\nassessed on outpatient pelvic ultrasound if clinical symptoms referable to\nthis.\n3. Right corpus luteum.\n4. Again seen bilateral sacroiliitis." }, { "input": "LOWER CHEST: Small bilateral pleural effusions. There are atelectatic changes\nat both lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a delayed\nnephrogram in the left kidney, as well as focal areas of retained contrast in\nthe lower pole of the right kidney concerning for ischemia/ATN. Left-sided\nrenal cysts are again noted.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: There is a Foley catheter in the bladder. There is no free fluid in\nthe pelvis. There is stranding in the inguinal regions bilaterally, related\nto the recent procedures.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. There is no retroperitoneal\nhematoma.\n\nVASCULAR: Stable infrarenal abdominal aortic aneurysm measuring up to 4 cm\ndiameter. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.", "output": "1. No evidence of retroperitoneal hematoma.\n2. Delayed nephrogram in the left kidney and lower pole of the right kidney,\nconcerning for ischemia/ATN.\n3. Postprocedure changes in the inguinal regions.\n4. Other findings as above.\n\nNOTIFICATION: The findings were conveyed to ___ at 14:20 on\n___" }, { "input": "LOWER CHEST: The visualized lung bases demonstrate mild dependent bibasilar\natelectasis. There is no a trace right pleural effusion. No pericardial\neffusion.\n\nABDOMEN: Evaluation of the intra-abdominal organs is limited without\nintravenous contrast.\n\nThere is lipiodol staining throughout the right hepatic lobe with multifocal\nareas of increased lipiodol uptake, compatible with uptake in known HCCs seen\non the prior MRI. Lipiodol is seen within the dominant 13.4 x 10.8 cm mass in\nthe right hepatic lobe, which previously measured 10.5 x 9.6 cm, larger on\ntoday's study. The inferomedial portion of the dominant mass does not have\nlipiodol staining, consistent with particle embolization without\nchemoembolization in the parasitized vessels in the SMA. No lipiodol is seen\nwithin the left hepatic lobe. No extrahepatic lipiodol is identified. Free\nfluid in the abdomen is new from MRI ___. The fluid is hyperdense\ninferior to the liver, compatible with small hemoperitoneum. No lipiodol is\nseen within the intraperitoneal blood products. Intermediate density\nperisplenic fluid is also noted. There is no free intraperitoneal air.\n\nThe gallbladder is hyperdense, likely due to vicarious excretion of contrast.\nThe spleen, pancreas and right adrenal gland are normal. A 1.9 cm left adrenal\nnodule has ___ ___ and demonstrates loss of signal on the out of phase images\nrelative to the in phase images on the prior MRI, compatible with an adrenal\nadenoma.\n\nThere is no hydronephrosis or stone in the kidneys bilaterally. Linear\nhyperdensity within the left renal upper pole (03:32) this is likely due to\ncontrast excretion, not extrahepatic lipiodol. There is no bowel obstruction.\nIntraluminal hyperdensity within the small bowel is likely related to ingested\nmaterial, unlikely to be extrahepatic lipiodol as it is not along the mucosal\nsurface, and is too dense for vicarious excretion of contrast.\n\nNo enlarged mesenteric or retroperitoneal lymph nodes in the abdomen by CT\nsize criteria. The imaged abdominal aorta is normal in caliber.\n\nBONES: No bone finding suspicious for infection or malignancy is seen.", "output": "1. Status post chemoembolization of the right hepatic lobe with lipiodol\nuptake in the right hepatic lobe and more concentrated uptake in multifocal\nHCCs. Interval increase in size of the dominant right hepatic lobe mass with\npartial lipiodol staining. No evidence of extrahepatic lipiodol.\n2. Small hemoperitoneum, predominantly perihepatic. This may represent rupture\nof the tumor. Correlation with postprocedure hematocrit is recommended.\n3. 1.9 cm left adrenal adenoma.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 11:41 AM, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST:\n\nA small right pleural effusion has decreased slightly in the interval.\nBibasilar atelectasis has decreased as well.\n\nABDOMEN:\n\nPERITONEAL CAVITY: A 5.7 x 1.2 x 3.7 cm (transverse by AP by craniocaudal)\nperipherally enhancing fluid collection inferior to the right lobe of the\nliver appears slightly more organized since the prior exam, now with a\nperipherally enhancing rim and central fluid attenuation (5:33, 7:25). This\nappears to communicate with the periphery of the treament zone at the lateral\nand inferior aspect of the right hepatic lobe, adjacent to the TACE site of a\ndominant mass, described below.\n\nLIVER: Changes of recent TACE are again demonstrated throughout the right\nlobe of the liver, with Lipiodol deposition in multiple lesions. The dominant\ntumor in segment VI has not significantly changed in size, 12.8 x 10.6 cm\n(05:22) and demonstrates enhancement along its inferomedial border (05:30). \nNumerous locules of gas with the lesion appear slightly increased since the ___ study. Previously described arterial enhancing foci and a\nsuspected small pseudoaneurysm are not currently detected, however it should\nbe noted that a pure arterial phase was not performed, so the sensitivity for\nre-detection is low on this study.\n\nGALLBLADDER AND BILIARY: The gallbladder again shows mild wall edema and\nhyperemia, likely reactive. There is no gallbladder distension. No radiopaque\ngallstones are seen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without pancreatic\nduct dilatation or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: A 1.5 cm nodule arising from the left adrenal gland is unchanged in\nsize from prior studies; this had signal characteristics of a adenoma on the\nMRI of ___. The right adrenal gland is normal.\n\nKIDNEYS: The kidneys display symmetric enhancement and excretion of contrast\nwithout hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber. Oral contrast\nprogresses without obstruction into colon. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: The portal veins, splenic vein, and superior mesenteric vein are\npatent. The abdominal aorta is non aneurysmal throughout.\n\nPELVIS:\n\nSmall volume of free fluid in the pelvis has decreased from prior. The urinary\nbladder is not well evaluated due to incomplete distention, but without gross\nabnormality. No enlarged pelvic sidewall or inguinal lymph nodes are seen.\n\nBONES AND SOFT TISSUES:\n\nThe concerning lytic or blastic osseous lesion is identified. Mild right groin\nsoft tissue stranding related to prior vascular access is further decreased.", "output": "1. Post right hepatic TACE with central necrosis and slight increase in gas\nwithin the dominant 12 cm hepatic mass. A neighboring 3.7 cm subhepatic fluid\ncollection abuts the lesion and appears to communicate with a rim of adjacent\nnecrotic hepatic parenchymal, slightly more organized, with extracapsular\nextension inferiorly, with persistent peripheral enhancement. The\ndifferential includes necrotic collection or abscess. Infection cannot be\nexcluded by imaging.\n2. Continued enhancement at the inferomedial aspect of the right hepatic lobe\nmay reflect residual viable tumor.\n3. Previously described hepatic pseudoaneurysm is not seen however this is\nexpected as this examination did not include a dedicated arterial phase. \nContinued attention to this region recommended.\n4. Mild decrease in pelvic free fluid and a small right pleural effusion.\n5. Stable 1.5 cm left adrenal nodule, which has features of a benign adenoma\non a reference OSH MRI." }, { "input": "LOWER CHEST: There is right basilar atelectasis. There is no pericardial or\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is new lipiodol involving segment VIII of the liver. \nLipiodol in segment V/VI has increased from prior, related to recent TACE. \nOther regions of lipiodol in the right lobe of the liver from prior TACE\nprocedures are unchanged. There is no extrahepatic lipiodol. Large necrotic\nmass involving segment VI better evaluated on contrast-enhanced studies but\nnot largely changed compared to ___. Hypodense lesions in segment II in\nregions of prior treatment appear smaller when compared to ___, but\nincompletely assessed without IV contrast. The liver demonstrates a nodular\ncontour consistent with cirrhosis. There is no intra-abdominal ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable. A 1.8 x 1.7 cm left renal\nnodule is unchanged, previously characterized as an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber and wall thickness. The visualized colon is\nunremarkable.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no upper abdominal aortic aneurysm. No atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Post chemoembolization with new lipiodol concentrated in segment VIII and\nV/VI. No extrahepatic lipiodol.\n2. Large necrotic segment VI mass not significantly changed in size, but\nbetter evaluated on contrast-enhanced study.\n3. Hypodense segment II lesions compatible with post treatment changes,\nminimally decreased in size compared to ___.\n4. Stable left adrenal adenoma." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: 4 mm hypodensity in segment VI is too small to accurately\ncharacterize but likely represents cyst versus biliary hamartoma. The liver\ndemonstrates otherwise homogenous attenuation throughout. There is no evidence\nof focal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere are bilateral simple and hemorrhagic renal cysts. There is no suspicious\nrenal cyst. There is no evidence of stones, focal renal lesions or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\nGASTROINTESTINAL: Wall thickening in the gastric fundus (06:55) is nonspecific\nand may represent GIST or collapsed gastric diverticulum. Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. There\nare diffuse diverticula throughout the descending and sigmoid colon without\nevidence of diverticulitis. Appendix contains air, has normal caliber without\nevidence of fat stranding.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is mild calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. There are degenerative changes of\nthe including severe disc space loss at L1-L2 with associated endplate\ndegenerative change. Appearance of 9 mm peripherally sclerotic lesion in the\nleft iliac adjacent to the sacroiliac joint favors a benign etiology. There is\ngrade 1 anterolisthesis of L4 on L5. Abdominal and pelvic wall are within\nnormal limits.", "output": "1. Nonspecific gastric fundal thickening with suggestion of exophytic\ncomponent. Differential includes GIST, gastric diverticulum, or nondistended\nfundus.\n2. Bilateral simple and hemorrhagic renal cysts. No evidence of suspicious\nrenal lesion.\n3. Extensive descending and sigmoid colonic diverticula without evidence of\ndiverticulitis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hepatic hypodensity in the right lobe is too small to\ncharacterize, however is unchanged from prior (5:50). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. Slight\nthickening of the medial limb of the left adrenal gland without a focal nodule\nis unchanged from priors (5:55).\n\nURINARY: The left kidney is atrophic, similar to prior, and displays normal\nnephrogram. The right kidney is of normal size and demonstrates normal\nnephrogram. Hyperdense material in the left kidney and left UPJ are not\nsignificantly changed from prior, likely representing stones. There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: An infrarenal abdominal aortic aneurysm measuring up to 3.5 cm is\nnot significantly changed (10:44; 5:70). Extensive atherosclerotic disease is\nnoted, including severe calcification at the ostium of the left renal artery\n(5:61).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. No significant change in a 3.5 cm infrarenal abdominal aortic aneurysm.\n3. Re- demonstration of severe left renal artery stenosis with resultant left\nkidney atrophy.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "CT abdomen with contrast: Liver enhances homogeneously without focal lesion\nor biliary dilatation. Portal vein is patent. Gallbladder is unremarkable. \nSpleen, pancreas and adrenal glands are unremarkable.\n\nLeft kidney is atrophied, unchanged. Kidneys otherwise present symmetric\nnephrograms without focal lesion or hydronephrosis.\n\nStomach, duodenum and small bowel loops are normal caliber without evidence of\nobstruction. Sigmoid predominant diverticulosis without evidence of\ndiverticulitis. Large bowel is otherwise thin-walled and unremarkable without\npericolonic fat stranding or fluid collection. Normal appendix in the right\nlower quadrant.\n\nSevere atherosclerotic disease of the abdominal aorta. Re- demonstration of a\ninfrarenal abdominal aortic aneurysm with maximum ___ of 3.5 x 3.4 cm,\nunchanged. Severe stenosis of the left renal artery origin and at least\nmoderate stenosis at the right renal artery origin. No mesenteric or\nretroperitoneal lymphadenopathy by CT size criteria. No ascites,\npneumoperitoneum or ventral abdominal hernia.\n\nCT pelvis with contrast: Bladder, uterus, adnexa and rectum are unremarkable.\nNo free pelvic fluid or air. No inguinal or pelvic sidewall lymphadenopathy by\nCT size criteria.\n\nBones and soft tissues: No suspicious focal bone lesion. Mild lumbar\nvertebral degenerative changes.", "output": "1. No evidence of recurrent disease in the abdomen or pelvis.\n2. Stable infrarenal abdominal aortic aneurysm measuring up to 3.5 cm in\ndiameter.\n3. Re- demonstration of severe left renal artery stenosis with consequently\natrophied left kidney." }, { "input": "LOWER CHEST: Please refer to the dedicated CT chest report from the same day\nfor description of thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: A tiny hypodensity in segment 7 is too small to accurately\ncharacterize, statistically most likely a cyst or hemangioma, unchanged\n(series 13, image 15). Otherwise, the liver is homogeneous in attenuation\nthroughout. No concerning focal hepatic lesion. No evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is decompressed and\nnormal.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Mild thickening of the medial limb of the left adrenal gland is\nunchanged without a discrete nodule, unchanged since at least ___\n(series 13, image 18). The left adrenal gland is normal in configuration. \nThe right adrenal gland is normal in size and shape.\n\nURINARY: The left kidney is atrophic, similar to the prior exam. The right\nkidney is normal in size. Both kidneys have normal nephrograms. Hyperdense\nmaterial in the calices of the left upper renal pole and ureteral pelvic\njunction persist since at least ___ where it is slightly more prominent\nbut unchanged from the most recent exam the in ___ (series 8, image\n29, 31, 33), likely stones. Prominence of the left proximal ureter is overall\nunchanged since at least ___ (series 8, image 29). No frank\nhydroureteronephrosis in either kidney. There is a partially duplicated left\ncollecting system. No suspicious focal renal lesion in either kidney. No\nperinephric abnormality.\n\nGASTROINTESTINAL: Ingested oral contrast reaches the ascending colon. The\nstomach is unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Sigmoid diverticulosis is mild,\nunchanged. The colon is otherwise unremarkable. Moderate stool remains in\nthe rectum. No bowel obstruction.\n\nPELVIS: The urinary bladder is partially distended and the distal ureters are\nunremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: No pathologically enlarged retroperitoneal, mesenteric, pelvic,\nor inguinal lymph nodes.\n\nVASCULAR: An infrarenal abdominal aortic aneurysm in the mid-distal abdominal\naorta measures up to 3.5 cm, unchanged (series 9, image 42). Diffuse,\nextensive calcified and noncalcified atherosclerotic plaque is noted\nthroughout the aorta and major branches. Extensive calcifications,\nparticularly at the ostium of the left renal artery is overall unchanged,\nresulting in stenosis (series 5, image 60). There appears to be slightly\ndecreased opacification of the bilateral internal iliac arteries (series 5,\nimage 96). The visualized portions of the femoral arteries are extensively\ncalcified.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Multilevel\ndegenerative changes of the visualized spine are overall similar, most\npronounced at L4-L5. Please refer to the bone scan from the same day for any\nadditional information.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n\n2. Persistent atrophic left kidney with prominence of the left proximal\nureter, unchanged since at least ___, likely related to narrowing of the left\nrenal artery ostium, also unchanged.\n\n3. Unchanged appearance of extensive atherosclerosis and a 3.5-cm infrarenal\nabdominal aortic aneurysm.\n\n4. Diverticulosis.\n\n5. Thickening of the medial left adrenal limb is unchanged since at least\n___.\n\n6. Left upper renal pole non-obstructing stones.\n\n7. Please refer to the dedicated CT chest report from the same day for\ndescription of thoracic findings." }, { "input": "LOWER CHEST: There is mild periosteophyte atelectasis in the medial right\nlower lobe. Visualized lung fields are otherwise within normal limits. There\nis no evidence of pleural or pericardial effusion. Dense mitral annular and\ncoronary artery calcifications are noted. Heart size is normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is atrophied, but has normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout with multiple\nstable hypoattenuating lesions previously characterized as hemangiomas on MRI.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple hypoattenuating renal lesions which are too small to\ncompletely characterize, but likely represent renal cysts. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Patient is status-post\nBillroth II with gastrojejunostomy. Remaining stomach appears normal. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is extensive diverticulosis throughout the transverse,\ndescending, and sigmoid colon without focal wall thickening or adjacent fat\nstranding. The appendix is not visualized. No free air free fluid is\ndemonstrated. There is no bowel obstruction.\n\nPELVIS: The urinary bladder is not well-distended and distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. Bilateral adnexae are\nwithin normal limits.Of\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Incidental note is made of a\ncircumaortic left renal vein. Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild vertebral body height loss of T11 is stable. Multiple small bone islands\nare unchanged.\n\nSOFT TISSUES: There are postsurgical changes within the midline anterior\nabdominal wall. There are numerous subcutaneous calcifications in the\nbilateral buttocks, probably injection site granulomas.", "output": "1. No acute abnormalities. Specifically, no evidence for bowel obstruction.\n2. Extensive diverticulosis without evidence of diverticulitis.\n3. Hypoattenuating splenic lesions are unchanged, previously characterized as\nhemangiomas on MRI." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Calcification of the aortic and\nmitral annuli are noted. There also atherosclerotic calcifications of the\ncoronary arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic without evidence of focal lesions or ductal\ndilatation. There is no pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: Multiple hypodensities throughout the spleen are better evaluated on\nprevious contrast-enhanced studies, but appear grossly unchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post Billroth II gastrectomy with\nexpected postsurgical changes. Small bowel loops demonstrate normal caliber\nand wall thickness throughout. The jejuno-jejunal anastomosis appears similar\nto ___. There is diverticulosis without wall thickening or\npericolonic fat stranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder is underdistended and distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy. The ovaries are\nunremarkable. .\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Circumaortic left renal veins are noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the thoracolumbar spine are unchanged compared to\nprior. Healed left posterior twelfth eleventh and tenth rib fractures are\nagain seen.\n\nSOFT TISSUES: Coarse calcifications overlying the anterior abdominal wall and\ngluteal muscles are similar to prior imaging and may relate to injection\ngranulomas/postsurgical changes.", "output": "1. No urinary calculi or hydronephrosis.\n2. Status post Billroth 2 gastrectomy with stable postsurgical changes given\ndifferences in imaging technique." }, { "input": "LOWER CHEST: Mild dependent atelectasis bilaterally. No focal consolidations.\nNo suspicious lung nodules. No pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. The gallbladder is surgically absent. \nMild central intrahepatic biliary dilatation, likely due to post\ncholecystectomy state, unchanged.\n\nPANCREAS: The pancreas appears atrophic. No ductal dilatation. No focal\nlesions. No peripancreatic stranding.\n\nSPLEEN: Numerous hypoenhancing lesions are seen within the spleen measuring up\nto 1.4 cm, unchanged compared to ___ likely hemangiomas or\nlymphangiomas. Otherwise, spleen shows normal size and attenuation\nthroughout.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Stable 9 mm exophytic hypodensity arising from the lower pole of the\nleft kidney (series 2, image 47) previously characterized as an AML. \nAdditional hypodensities within the kidneys are too small to characterize,\nlikely representing simple cysts. Otherwise, kidneys are of normal and\nsymmetric size with normal nephrogram. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y with stable appearing\nanastomoses. The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multiple healed left posterior rib fractures are re- demonstrated. \nMultiple small sclerotic lesions within the pelvis likely represent bone\nislands. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Injection granulomas overlying the gluteal muscles bilaterally. \nPartially calcified nodularity within the anterior abdominal wall, stable,\nlikely postsurgical. Otherwise, the abdominal and pelvic wall is within\nnormal limits.", "output": "1. No acute abnormalities within the abdomen or pelvis. Diverticulosis without\ndiverticulitis.\n2. Status post Roux-en-Y with stable appearing anastomoses.\n3. Numerous stable hypoenhancing lesions within the spleen, likely hemangiomas\nor lymphangiomas.\n4. Stable 9 mm left kidney AML." }, { "input": "LOWER CHEST: Mild dependent atelectasis is seen in the right lung. There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Multiple hypoenhancing lesions are re-demonstrated in the spleen the\nlargest measuring up to 1.4 cm, unchanged compared to prior imaging, and\nlikely represent hemangiomas or lymphangiomas.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is re-demonstration of a lower pole exophytic hypodensity, previously\ncharacterized as an AML that measures 1.0 cm, not significantly changed when\ncompared to prior imaging. There is no evidence of hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Billroth II gastric bypass with\nintact anastomoses. The stomach is unremarkable otherwise. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple injection granulomas are seen overlying the gluteal\nmuscles bilaterally. Coarse calcifications overlying the anterior abdominal\nwall are likely secondary to postsurgical changes and hernia repair.", "output": "1. No acute intra-abdominal or pelvic abnormalities.\n2. Diverticulosis without diverticulitis.\n3. Stable left renal AML." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate bilateral pleural effusions,\nsmall to moderate on the left, trace on the right, associated with bibasilar\natelectasis.\n\nABDOMEN: Moderate volume ascites is noted with extensive omental caking\nconsistent with peritoneal carcinomatosis. There is peritoneal nodularity\nmost notably in the deep pelvis.\n\nHEPATOBILIARY: There are multiple hepatic hypodense lesions which are poorly\ndefined and highly concerning for metastatic disease. The largest of these\nresides within segment 6 measuring approximately 5.3 x 5.9 x 5.0 cm. Main\nportal vein is patent. The gallbladder is unremarkable. Common bile duct is\nnondilated. Perihepatic ascites is moderate in volume.\n\nPANCREAS: A pancreatic tail lesion is highly concerning for primary\nmalignancy, measuring 3.0 x 2.4 cm (02:33). There is no pancreatic ductal\ndilatation.\n\nSPLEEN: The spleen is normal. A tiny hypodensity within the mid body of the\nspleen on series 2, image 29 is of doubtful clinical significance. The\nsplenic vein is occluded and there are numerous perisplenic and perigastric\ncollateral vessels.\n\nADRENALS: Adrenals are normal.\n\nURINARY: Bilateral simple cysts measuring up to 1.8 cm in the upper pole of\nthe right kidney are noted. Otherwise, the kidneys are of normal and\nsymmetric size with normal nephrogram. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A moderate sized hiatal hernia is noted. The stomach is\ndecompressed. The duodenum appears normal. Small bowel loops demonstrate no\nsigns of ileus or obstruction. Colonic diverticulosis is notable. The\nappendix is not clearly visualized though there are no secondary signs of\nappendicitis. The sigmoid colon appears slightly thickened likely due to\nchronic diverticulosis. An adjacent loculated fluid collection likely\nreflects peritoneal carcinomatosis though clinical correlation is advised as a\npossibility of complicated diverticulosis is impossible to exclude though no\nair is seen within this collection.\n\nPELVIS: Peritoneal thickening in the deep pelvis is consistent with peritoneal\ncarcinomatosis with large volume of ascites tracking into the pelvis. The\nuterus is not well visualized. No definite adnexal mass is seen. The urinary\nbladder is only partially distended appearing normal. There is no pelvic\nsidewall or inguinal adenopathy.\n\nLYMPH NODES: There is an abnormal lymph node at the porta hepatis best seen on\nseries 2, image 30 measuring 14 mm in short axis. Omental nodularity and\nperitoneal nodularity is consistent with peritoneal carcinomatosis. No\nretroperitoneal or pelvic sidewall adenopathy. No inguinal adenopathy. No\nperipancreatic adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Chronic splenic vein thrombosis likely due to malignant encasement\nby pancreatic tail lesion. No additional evidence for vascular encasement.\n\nBONES: Multilevel degenerative changes without evidence of worrisome osseous\nlesions or acute fracture. The patient is status post right total hip\narthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Peritoneal carcinomatosis with moderate to large volume ascites, multiple\nliver lesions concerning for metastatic disease, and a concerning lesion\nwithin the pancreatic tail, suspicious for a primary pancreatic malignancy.\n2. Extensive colonic diverticulosis. Given loculated fluid adjacent to the\nsigmoid colon, impossible to exclude complicated diverticulitis. In the\nabsence of recent focal pain in the left lower quadrant findings are more\nlikely indicative of peritoneal carcinomatosis. Please correlate clinically\npeer\n3. Bilateral pleural effusions, left greater than right.." }, { "input": "LOWER CHEST: Moderate bilateral simple pleural effusions are noted with\nadjacent atelectasis. Hyperdense material within the atelectatic left lower\nlobe (for example, 4:9) may represent a calcified nodule, bronchial with, or\naspiration. No suspicious lung mass identified. The heart is normal in size.\nThere is a small pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous low attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder demonstrates vicarious excretion of contrast, and\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney demonstrates moderate micro lobulations of the\ncortical margin. The left kidney is extremely atrophic, likely chronic in\nnature. Persistent bilateral nephrograms are noted from prior CT dated ___,\nsuggestive of renal disease. There is no evidence of focal renal lesions\nwithin the limitations of an unenhanced scan. There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal. A rectal tube is noted within the lower rectum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted, with narrowing of the ostia of both the celiac axis and\nsuperior mesenteric artery.\n\nBONES: No suspicious osseous lesion is detected. Extensive bilateral\nosteoarthritis versus AVN is noted involving the femoral heads. The patient\nis status post ORIF for a left proximal femur fracture.\n\nSOFT TISSUES: Diffuse soft tissue anasarca is noted bilaterally, with slight\nasymmetry likely secondary to the patient is rotated position.", "output": "1. No evidence of retroperitoneal hematoma.\n2. Diffuse anasarca, bilateral pleural effusions, and small pericardial\neffusion.\n3. Extensive atherosclerotic disease throughout the aorta and its major\nbranches.\n4. Chronic-appearing, severe left renal atrophy with persistent nephrograms\ndue to prior contrast enhanced CT dated ___. Please correlate with\nfeeding creatinine levels to rule out acute contrast induced nephropathy.\n5. Hepatic steatosis and diverticulosis." }, { "input": "LOWER CHEST: There are trace bilateral pleural effusion with associated mild\natelectasis. Otherwise, the visualized lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a hypodense lesion in the right hepatic lobe with performed nodule\nenhancement, likely an hemangioma. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAreas of cortical hypodensity with indistinct borders are seen in the\nbilateral kidneys, right greater than left, most compatible with\npyelonephritis. There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes at the SI joints are seen, which can be correlated with\nclinical signs of sacroiliitis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Findings compatible with bilateral pyelonephritis." }, { "input": "LOWER CHEST: Detailed evaluation lower lungs is limited by respiratory motion\nartifact. No obvious pulmonary mass is identified however. No pleural or\npericardial effusion. Atelectasis at the lung bases is mild.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits. No\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nBilateral renal cortical hypodensities are too small to accurately\ncharacterize but statistically most likely cysts, similar to the prior exam. \nThere is no evidence of focal renal lesions. No right collecting system\nhydronephrosis. There is a duplex left renal collecting system. The ureter\ndraining the left upper moiety is normal in caliber and contrast is seen\nthroughout its course draining into the bladder. The ureter draining the left\nlower moiety is mildly dilated as is the renal pelvis and it is not opacified\nwith contrast, suggesting delayed excretion. A 2.5 mm opacity in the left\nlower pelvis appears to reside in the distal left ureter there drains the\nlower moiety, rather than a phlebolith (series 2, image 75; series 601b, image\n37 ; series 602 B, image 46). This is consistent with an obstructing ureteral\nstone. No perinephric abnormality around the right kidney. There is\nincreased perinephric fat stranding surrounding the left kidney, suggesting\nsequelae of the left lower moiety obstruction.\n\nGASTROINTESTINAL: There is probably a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nmay be a tiny diverticulum arising from the omentum as it tear border of the\ndistal small bowel although difficult to completely assessed since this area\nbowels not completely distended (series 2, image 56). The colon and rectum\nare within normal limits. The appendix is normal. No intra-abdominal\ndrainable fluid collection. No free air.\n\nPELVIS: The urinary bladder is unremarkable. No free fluid in the pelvis. \nBilateral phleboliths are noted.\n\nREPRODUCTIVE ORGANS: Prostate is again enlarged with coarse central\ncalcifications. Left hydrocele is incompletely visualized, better assessed on\nscrotal ultrasound from the same day.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Mild\nmultilevel degenerative changes of the spine are noted.\n\nSOFT TISSUES: There appears to a prior repair of a left inguinal hernia,\nsimilar to the prior exam (series 2, image 74 ; series 601b, image 21). The\nabdominal and pelvic wall is otherwise within normal limits.", "output": "1. Duplex left renal collecting system, probably complete. There is mild to\nmoderate hydroureteronephrosis of the left collecting system draining the\nlower moiety, likely secondary to a 2.5 mm obstructing stone in the distal\nureter with associated delayed excretion of intravenous contrast and new\nsurrounding perinephric fat stranding. Correlate with urinalysis and clinical\nsymptoms.\n\n2. Prostatomegaly.\n\n3. Left hydrocele better appreciated on scrotal ultrasound from the same day.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. in person on ___ at 2:27 AM, 1 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Significant interval growth in right lower lobe pulmonary nodule\nnow measuring 1.0 x 1.1 cm, previously measuring 0.6 x 0.4 cm (9; 6). Please\nrefer to separate report of CT chest performed on the same day for description\nof the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post right nephrectomy. Small bowel and large\nbowel are noted in the nephrectomy bed. No suspicious soft tissue density is\nnoted within the nephrectomy bed. The left kidney is normal in size and\nnephrogram. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a area of apparent wall thickening in the posterior\nstomach wall, which may represent a gastric fold, attention on follow-up (2;\n59). Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Prominent left periaortic lymph node measuring 1.2 x 1.2 cm is\nunchanged compared to prior CT (2; 83). There is no mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nTrace retrolisthesis of L1 on L2 is again noted. Grade 1 anterolisthesis of\nL4 on L5 is again noted, likely degenerative.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of local recurrence or metastasis. Area of apparent wall\nthickening in the posterior stomach wall is unchanged compared to the prior\nexam and likely represents a prominent gastric fold - recommend attention on\nfollow-up.\n2. Prominent left periaortic lymph node is unchanged compared to prior CT. No\ndefinite new lymphadenopathy.\n3. Interval enlargement of right lower lobe pulmonary nodule since ___, please see separate CT chest report performed on the same day." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. There is no biliary dilation. \nGallbladder is unremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: Status post left nephrectomy with out evidence of recurrence in the\nnephrectomy bed. The right kidney is unremarkable.\n\nGASTROINTESTINAL: Apparent posterior stomach wall thickening seen on prior\nexam is less well appreciated on the current study and is likely a collapsed\ndiverticulum. No evidence of bowel obstruction. No ascites.\n\nPELVIS: There is no free fluid in the pelvis. The uterus and adnexa are\nunremarkable for age.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes demonstrated.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Rectus diastasis and a small fat containing umbilical hernia are\nagain noted.", "output": "1. No recurrent or metastatic disease in the abdomen or pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "Heart size is normal. The imaged lung bases are clear.\n\nCT abdomen with contrast: Punctate calcified granuloma in hepatic segment II.\nLiver enhances homogeneously without focal mass or biliary dilatation. \nGallbladder is unremarkable. Portal vein is patent.\n\nSpleen, pancreas and adrenal glands are unremarkable.\n\nKidneys present symmetric nephrograms and excretion of contrast without focal\nlesion or hydronephrosis.\n\nTrace hiatal hernia. Stomach is otherwise unremarkable. Duodenum and distal\nsmall bowel loops are normal caliber without evidence of obstruction. Large\nbowel is thin-walled and unremarkable.\n\nAbdominal aorta is normal caliber. Ascites is moderate in volume. Soft\ntissue thickening of the omentum best visualized in the left upper quadrant\nappears overall similar to the prior examination. Scattered mesenteric and\nretroperitoneal lymph nodes are not enlarged by CT size criteria. No\npneumoperitoneum. No ventral abdominal hernia.\n\nCT pelvis with contrast: Multilobulated mixed cystic and solid left adnexal\nmass is re- demonstrated. The inferior most portion at the level of the\ncervix measures 5.3 x 3.4 cm, not significantly changed given plane and\nimaging. The superior portion at the level of the uterine fundus measures 6.4\nx 4.0 cm, overall similar given difference in plane of imaging. There is a\nslight increase in the amount of free fluid in the pelvis best seen on series\n4, ___ 65. 22 mm dense lesion with focal calcification in the endometrial\ncanal at the level of the uterine fundus is unchanged. No inguinal or pelvic\nsidewall lymphadenopathy by CT size criteria.\n\nBones and soft tissues: Well-circumscribed sclerotic foci in the left iliac\nwing, right acetabulum and right sacrum are unchanged, compatible with bone\nislands. No suspicious focal bone lesion.", "output": "1. No significant interval change compared to ___ with re-\ndemonstration of a left adnexal mixed solid and cystic lesion compatible with\novarian cancer with omental metastasis.\n2. Stable 22 mm dense lesion within the endometrial cavity with the punctate\ncalcifications which may represent an intrauterine fibroid, polyp or possibly\nendometrial carcinoma.\n3. Moderate volume malignant ascites.\n4. No new focus of disease involvement." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. Again seen are\nbilateral small extrarenal pelves. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is not visualized. There has been a mild interval decrease in\nomental nodularity in the left upper quadrant. No new omental nodules are\nseen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is present. There is similar appearance of a\nhyperdense 2.6 cm lesion with central calcification within the fundus of the\nuterus compatible with fibroid. Again seen is a mixed solid and cystic left\nadnexal lesion which is overall increased in size with the superior portion\nmeasuring 7.8 x 6.8 cm, previously 6.4 x 4.0 cm. The inferior portion of the\nlesion is also markedly increased in size measuring 6.4 x 5.7 cm, previously\n5.3 x 3.4 cm. A third cystic portion on 5:88 is also larger measuring up to\n4.0 cm, previously up to 3.2 cm.\n\nLYMPH NODES: A left common iliac lymph node measuring 7 mm is not enlarged by\nCT size criteria but is increased in size since the prior study, previously 4\nmm (5:76). Additionally, there is a left periaortic lymph node measuring 8 mm\non 5:67 which previously measured 4 mm.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are stable subcentimeter sclerotic foci in the T8 vertebral body\nas well as the right sacral ala, left iliac wing, and the right acetabulum,\nfavored to represent bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Overall mixed pattern of response. Interval increase in the size of the mixed\nsolid and cystic left adnexal lesion.\nA left common iliac chain lymph node and a left periaortic lymph node do not\nmeasure enlarged by CT size criteria, however are increased in size since the\nprior study and are suspicious for metastatic involvement.\nInterval decrease in omental nodularity in the left upper quadrant. No new\nomental nodules are seen." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are three hypodense lesions along the periphery of the\nliver and within the falciform ligament, new from prior, consistent with\nimplants. The largest measuring 14 mm. Subdiaphragmatic implants are also\nindenting the right hepatic lobe.\n\nGallbladder is unremarkable. There is no biliary duct dilation.\n\nPANCREAS: The pancreas is atrophic.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is new moderate bilateral hydroureteronephrosis secondary to\nthe large heterogeneous pelvic mass. No focal renal lesions are seen.\n\nGASTROINTESTINAL:There is no small bowel obstruction. The sigmoid colon is\nencased by the pelvic mass with mild upstream colonic dilation, with concern\nfor impending obstruction. There is increased ascites and omental implants,\nseen in the left upper quadrant.\n\nPELVIS: Again seen, is a mixed cystic and solid left adnexal lesion which has\noverall increased in size from prior with the largest component now measuring\n10.0 cm in greatest dimension, previously 7 cm. Calcified fibroid is noted in\nthe uterine fundus. There is small volume pelvic fluid.\n\nLYMPH NODES: There has been interval enlargement of retroperitoneal\nadenopathy. Examples of enlarged lymph nodes include a 14 mm left iliac chain\nlymph node, previously 7 mm and a 11 mm aortocaval lymph node previously 5 mm.\nThere is also new inguinal adenopathy, measuring up to 15 mm on the left.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval progression of disease with worsening peritoneal carcinomatosis,\nnew serosal hepatic deposits, increased ascites, new inguinal and enlarging\nretroperitoneal lymph nodes, and enlarging primary adnexal mass.\n2. New moderate bilateral hydroureteronephrosis, adnexal mass serves as the\npoint of obstruction.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:28 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: There is mild atelectasis at the lung bases, bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: An 8 mm hypodensity in the posterior right hepatic lobe (series\n2, image 12) too small to characterize but likely represents a simple cyst. \nThe gallbladder is unremarkable. There is no intra or extrahepatic biliary\nductal dilatation. There is a moderate amount of ascites throughout the\nabdomen and pelvis.\n\nPANCREAS: A 2.9 x 1.6 cm hypoenhancing soft tissue lesion arising from the\npancreatic body is re-demonstrated with a moderate amount of local\nperipancreatic soft tissue stranding (series 2, image 23). There is\nre-demonstrated moderate narrowing of the superior mesenteric vein at the\nlevel of the pancreatic body. The splenic vein is obliterated with upper\nabdominal collaterals noted.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities are compatible with simple cysts. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Visualized loops of small\nand large bowel are unremarkable. There is extensive omental and mesenteric\nnodularity, suspicious for metastatic disease.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Soft tissue within the cul de sac adherent to the\nposterior wall of the uterus is concerning for metastatic disease.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 2.9 cm hypoenhancing pancreatic body mass with extensive peritoneal\ncarcinomatosis, moderate ascites, moderate attenuation of the superior\nmesenteric vein, and obliteration of the splenic vein.\n2. This study is minimally changed in comparison to the reference ___\nCT. No superimposed acute abdominopelvic process.\n3. Moderate ascites." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 9\nmm hypodense lesion is seen in the right hepatic lobe, too small to\ncharacterize, but likely a hepatic cyst or biliary hamartoma. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits. There is moderate ascites.\n\nPANCREAS: Again seen is a 2.6 x 1.5 cm hypoenhancing lesion in the body of the\npancreas, similar to prior. There is obliteration of the splenic vein. The\nSMV is attenuated. There is peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Subcentimeter\nhypodensities in bilateral kidneys are too small to characterize, but are\nlikely simple cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia, otherwise the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is no evidence of small or large bowel\nobstruction. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is unchanged soft tissue density in the posterior\ncul-de-sac tethered to the uterus, concerning for metastatic disease.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis extensive peritoneal nodularity concerning for metastatic disease, similar\nto prior. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 on L5 is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Grossly stable hypoenhancing pancreatic body mass with peritoneal\ncarcinomatosis, moderate ascites, and obliteration of the splenic vein and\nattenuation of the SMV.\n2. No evidence of small-bowel obstruction." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: Known hypoenhancing mass in the pancreatic body is not well seen in\nthe absence of IV contrast but unlikely to be significantly changed in size\ncompared to the prior exam. There is no pancreatic ductal dilatation. There\nis no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. Appendix is not seen. Enteric contrast extends the level of\nthe cecum. The rectum is largely fluid-filled.\nThere is large volume ascites increased in overall volume compared to prior\nexam. There is diffuse peritoneal carcinomatosis similar to prior. A nodule\nin the left upper quadrant appears to correspond to a splenule on the prior\nexam (02:44).\n\nPELVIS: Bladder is decompressed around a Foley catheter.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable. No adnexal abnormalities are\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 on L5 is noted, unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nSubcutaneous edema around the flanks and lateral thighs bilaterally is new\ncompared to prior exam.", "output": "1. Known pancreatic mass is not well visualized on this nonenhanced scan. No\nsignificant change in peritoneal carcinomatosis.\n2. Interval increase in large volume abdominopelvic ascites.\n3. No evidence of bowel obstruction. No free air or extraluminal contrast to\nsuggest perforation.\n4. New mild diffuse subcutaneous edema around the flanks and bilateral thighs.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: There is an minimal right greater than left dependent atelectasis\nin the bilateral lower lobes. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is an ill-defined area of hypoattenuation measuring 1.1\ncm in segment ___ which is adjacent to the falciform ligament, likely\nfocal steatosis. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits. The main portal\nvein and its major branches are patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is an ill-defined area of hypoattenuation measuring 1.9 x 1.6\ncm (2:37) in the anterolateral aspect of the spleen. No capsular defect is\ndetected. The spleen is normal in size. There is no perisplenic fluid or\ncollection.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 3.6 cm simple cyst in the upper pole of the left kidney (2:70). \nThere is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No traumatic solid-organ injury or hematoma.\n2. An ill-defined 2.0 cm hypodense splenic lesion is nonspecific but\nstatistically-likely a benign entity such as a cyst or hemangioma. There is no\ncapsular defect or perisplenic fluid or hematoma to suggest a laceration." }, { "input": "LOWER CHEST: Please see separate dictation for details on same-day chest CT.\n\nABDOMEN:\n\nHEPATOBILIARY: Calcification within the posterior aspect of the right lobe of\nthe liver, seen on prior ultrasound. There are no concerning focal liver\nlesions. The gallbladder is normal without radiopaque stones. There is no\nintra or extrahepatic biliary duct dilation. The portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is grossly\nunremarkable. The small bowel is normal in caliber without focal wall\nthickening. The appendix is well-visualized and normal. There is no\nintra-abdominal free fluid or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Brachytherapy seeds are seen within the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES AND SOFT TISSUES: There are multilevel degenerative changes of the\nlumbar spine most pronounced at L5/S1 where there is complete disc space loss\nand endplate sclerosis. Multiple sclerotic lesion including in the L3 and L1\nvertebral bodies and right iliac bone, are most consistent with bone islands. \nThere is a partially imaged benign appearing mixed lytic and sclerotic lesion\nin the right intertrochanteric region with a well-defined sclerotic border\n(series 601b, image 37).", "output": "1. No evidence of intra-abdominal or pelvic malignancy.\n2. Multiple sclerotic bony lesions, most consistent with bone islands, however\ngiven history of prostate cancer correlation with PSA is recommended.\n3. Benign appearing mixed lytic and sclerotic bony lesion in the right femur." }, { "input": "CT OF ABDOMEN:\n\nSince the prior study, there has been marked reduction in size of the\nbilateral pleural effusions with only a small right pleural effusion\nremaining. There also has been improvement in the basal atelectasis with some\npersistent atelectasis involving the medial basal segment of the right lower\nlobe. The left lobe is fully aerated. There are no concerning pulmonary\nnodules. No evidence of a basal pericardial effusion.\n\nNormal appearance of the liver parenchyma. The gallbladder, pancreas and\nspleen are within normal limits. Both kidneys are normal in size and enhance\nsymmetrically. Normal appearance of both adrenal glands. Normal appearance\nof the hepatic, portal, superior mesenteric and splenic veins. \n\nIn the right lower quadrant, inferior to the cecal pole, there is an 8.4 x\n10.5 cm air and fluid filled structure. This air and fluid structure has a\nsimilar morphology and is grossly unchanged in size in comparison to the prior\nCT. Note is made of a connection between the posteromedial aspect of this\nfluid collection and the adjacent sigmoid colon. \nPlease note this is well demonstrated on more a delayed CT acquisition\nperformed at 0930 hours on the same date. Please see report of clip ___.\n\nIt was initially unclear if this air-fluid collection represents the cecal\npole or a discrete intra-abdominal abscess communicating with the sigmoid\ncolon. On review of these images and the more delayed sequences performed at\n0900 hours, appearances are most consistent with an intra-abdominal abscess. \nThis would be amenable to percutaneous drainage.\n\nIn the left side of the abdomen, again note is made of air and fluid\ncollections, most notably in the left flank (2:65). This communicates with a\nT-shaped air-fluid collection measuring 4 x 7.7 cm (2:75). This T-shaped\nfluid collection possibly communicates with the larger fluid collection\n(2:74). The inferior part of the larger fluid collection is also seen\nextending medially anterior to the IVC but does not contain fluid at this time\n(2:52). \n\nThe small bowel is within normal limits. \n\nCT OF PELVIS:\nNormal appearance of the prostate and urinary bladder. Surgical clips in the\nright inguinal region are likely secondary to previous herniorrhaphy. There is\nabdominal aortic calcification, but no evidence of abdominal aortic aneurysm.\n\nOSSEOUS STRUCTURES: Degenerative changes are seen at L2-3 and L3-4 with disc\nspace narrowing and endplate sclerosis. Bridging osteophytes are seen at T9\nand T10.", "output": "1. Persistent air and fluid collections in the abdomen as described. The\nlarge air-fluid structure in the right lower quadrant present since ___ is\nmost in keeping with an abscess and is amenable to percutaneous drainage. \n2. Small fluid collections in the left side of abdomen may communicate with\none another and may be drainable via a left percutaneous approach. \n\nFindings were conveyed with Dr. ___ at 1030 hours. \nPlease see report under clip ___ for images from a nine-hour delayed CT\nof pelvis acquisition." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. The common bile duct demonstrates stable dilation to 10\nmm. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypoattenuating lesions in the right kidney are too small to completely\ncharacterize, but statistically represent simple cysts. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis without associated wall thickening, hyperemia, or inflammation.\nThere is a small amount of dependent ascites in the lower abdomen/pelvis, some\nof which tracks along the inferior and lateral cecum with haziness of the\nadjacent fat. Fatty infiltration of the cecum and ascending colon submucosa\nis noted. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild lumbar degenerative changes are worst at L4-L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Trace ascites in the lower abdomen and pelvis with haziness of fat adjacent\nto the cecum may reflect early or mild colitis. Fatty infiltration of the\ncecum and ascending colon submucosa may reflect chronic inflammatory changes. \nNo additional potential etiologies for free fluid are identified. Of note, no\ncolonoscopy is documented in the electronic medical record. Colonoscopy would\nbe recommended following the resolution of symptoms.\n2. Diverticulosis without diverticulitis.\n3. No CT findings of appendicitis, pancreatitis (correlate with serum lipase)" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. There is mild periportal edema. The\ngallbladder is surgically absent.\n\nPANCREAS: There are coarse calcifications of the pancreatic head which may\nrelate to chronic pancreatitis. There is no peripancreatic stranding. There\nare no focal pancreatic lesions.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically. Multiple\nsubcentimeter hypodensities are present in the bilateral kidneys and too small\nto characterize. Medullary nephrocalcinosis present bilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable. The distal esophagus is normal\nwithout a hiatal hernia. The stomach is grossly unremarkable. Small bowel\nloops are mildly dilated diffusely measuring up to 2.9 cm without transition\npoint. There is no focal colonic wall thickening. The appendix is\nwell-visualized and normal. There is a small amount of fluid adjacent to the\ncecum. There is no intra-abdominal free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There are scattered retroperitoneal lymph nodes but none that are\npathologically enlarged. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There are bilateral pars defects of L5. There are no suspicious bony\nlesions. There is an old fracture of the left inferior pubic ramus and the\nright posterior eleventh and tenth ribs.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of intra-abdominal or pelvic malignancy.\n2. Medullary nephrocalcinosis.\n3. Chronic right rib fractures and left inferior pubic ramus fracture.\n4. Periportal edema and a small amount of fluid adjacent to the cecum,\npossibly from mild fluid overload." }, { "input": "LOWER CHEST: There is nodular pleural thickening adjacent to the right\nanterior lower lobe. Adjacent to the right ninth rib laterally, there is a 34\nx 9 mm area of pleural thickening extending into the extrapleural space with\nan associated minimally displaced rib fracture (2:11). This finding is\nconcerning for a pathologic fracture and is unchanged compared to the prior\nexam. There is a 17 x 36 mm soft tissue extrapleural soft tissue mass in the\nright paravertebral soft tissues between the tenth and eleventh posterior ribs\n(2:8). There is a 9 x 10 mm soft tissue extrapleural mass in the right\nparavertebral soft tissues anterior to the right ___ posterior rib. Between\nthe right posterior ___ and 12th ribs is 22 x 17 mm extrapleural soft tissue\nmass. Visualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\n\nThere is residual atelectasis/consolidation in the medial basal segment of the\nright lower lobe with adjacent tree in ___ nodularity. There is new\natelectasis/consolidation in the lingula.\n\nA small right pleural effusion is again noted.\n\nA small pericardial effusion is unchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.Punctate calcifications in segment 6\nwithout an associated mass are non-specific but likely benign. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are bilateral extrarenal pelvises. The kidneys are of normal\nand symmetric size with normal nephrogram. There is no evidence of focal\nrenal lesions or left hydronephrosis. Mild hydronephrosis on the right is\nlikely related to a distended bladder. There is no perinephric abnormality. \nNo renal or year tract calculi are identified.\n\nGASTROINTESTINAL: There is circumferential thickening in the distal\nesophagus. The stomach is unremarkable. Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple small volume lymph nodes along the right\ncommon and external iliac chain. There is no retroperitoneal or mesenteric\nlymphadenopathy by size criteria. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Minimally displaced lateral right 9th rib fracture. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Right pleural thickening with adjacent soft tissue extra-pleural masses as\ndescribed above concerning for a malignancy of unknown primary. Adjacent to\nthe right ninth rib laterally, there is a 34 x 9 mm area of pleural thickening\nextending into the extrapleural space with an associated minimally displaced\nrib fracture (2:11) concerning for a pathologic fracture.\n2. No evidence on intra-abdominal malignancy.\n3. Small right pleural effusion.\n4. There is circumferential thickening in the distal esophagus. Correlation\nwith endoscopy is recommended." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Status post sleeve\ngastrectomy. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is not visualized, but there are no secondary signs of\nappendicitis..\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: IUD noted in the uterus. Adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. Numerous small\nright lower quadrant mesenteric lymph nodes are noted and not pathologically\nenlarged. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous soft tissue densities noted in the gluteal regions\nbilaterally, likely from prior prosthetic procedure. Changes along the\nanterior abdominal wall suggest prior herniorrhaphy and possible\nabdominoplasty.", "output": "No acute intra-abdominal process." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Status post sleeve gastrectomy. Remnant stomach is\nunremarkable. There is wall thickening and wall edema of nondilated distal\nileal loops and terminal ileum in the right lower quadrant (series 2:40). \nThere is no bowel obstruction. The colon and rectum are within normal limits.\nAppendix not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Intrauterine device is appropriately positioned. The\nuterus and bilateral adnexa are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous soft tissue densities in the bilateral gluteal\nregions are unchanged from ___ likely from prior silicone\ninjections. Hernia mesh is noted beneath the anterior upper abdominal wall.", "output": "1. Wall thickening and edema of distal ileal loops and terminal ileum in the\nright lower quadrant, compatible with infectious or inflammatory enteritis. \nNo bowel obstruction.\n2. Status post sleeve gastrectomy without evidence of complication." }, { "input": "CHEST: Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis. Multiple round hypodensities\nare seen within the bilateral kidneys, the largest measuring 4.2 x 2.8 cm\nwithin the left lower pole representing a cyst (3:65).\n\nBOWEL: The stomach opacifies with oral contrast. The stomach is distended with\nresidual fluid and tapers at the second duodenum in the area of mesenteric\nvessels. The small bowel opacifies with contrast without wall thickening or\nevidence of obstruction. Large bowel contains stool without evidence for wall\nthickening or obstruction. There is no abdominal free air free fluid.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: The abdominal aorta demonstrates severe atherosclerosis.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.", "output": "No evidence of malignancy within the abdomen or pelvis." }, { "input": "The visualized lung bases are clear. The heart is normal in size and there is\nno evidence of pericardial effusion.\n\nABDOMEN: The liver is fatty and without focal suspicious lesion. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary ductal dilatation. The patient is status post cholecystectomy. The\npancreas, spleen, and bilateral adrenal glands are normal. The kidneys\nenhance symmetrically and excrete contrast promptly. The ureters are normal\nin course and caliber.\n\nThe stomach is normal. The intra-abdominal loops of small and large bowel are\nnormal in caliber and demonstrate normal wall thickness. The appendix is\nnormal. There is no retroperitoneal or mesenteric lymphadenopathy. The\nabdominal aorta is normal in caliber. The celiac axis and SMA are grossly\npatent. There is no abdominal wall hernia, pneumoperitoneum, or free abdominal\nfluid.\n\nPELVIS: There is a 2.4 cm left ovarian simple cyst (2:70), previously\nmeasuring 3.4 cm. A left ovarian vein thrombus (2:64) is age-indeterminate,\nbut likely chronic. The bladder, sigmoid colon, and rectum are grossly\nunremarkable. No pelvic side-wall or inguinal lymphadenopathy. No free pelvic\nfluid or inguinal hernia.\n\nOSSEOUS STRUCTURES: Redemonstrated is spinal fusion hardware seen at the\nlevel L5-S1. No focal lytic or sclerotic lesion concerning for malignancy.", "output": "1. No evidence of acute intra-abdominal process.\n\n2. Left ovarian vein thrombosis, likely chronic.\n\n3. 2.4 cm simple left ovarian cyst.\n\n4. Fatty liver." }, { "input": "LOWER CHEST: Visualized lung fields are notable for right lower lobe\natelectasis and a 1.1 cm cyst in the left lower lobe. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post right partial hepatectomy and TACE. \nThe liver demonstrates homogenous attenuation throughout. There is mild\nintrahepatic biliary dilation and the extrahepatic biliary duct measures up to\n10 mm. The gallbladder is not visualized. Thrombus is noted in the portal\nvein extending at least to the bifurcation of the right and left portal veins,\nand possibly just beyond. Distally, the thrombus extends into the SMV and its\nbranches, more extensive than that seen on most recent MRI. Perihepatic fluid\nis again seen, including a focus of fluid posterior to the liver which is\nunchanged (02:16).\n\nPANCREAS: The pancreas has normal attenuation throughout. A 7 mm hypodensity\nis noted in the body of the pancreas, with an associated coarse calcification\n(02:25), too small to characterize on CT. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 15.5 cm. There is normal attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right adrenal gland is not well-visualized. The left adrenal\ngland is thickened, unchanged in appearance, previously characterized on MRI\nas adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple right renal hypodensities measuring up to 1.2 cm in the\nlower pole of the right kidney, with fluid density consistent with simple\ncyst. Additional bilateral subcentimeter hypodensities are too small to\ncharacterize on CT. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is wall\nthickening of the ascending colon with a small amount of free fluid tracking\nalong the colon. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Extensive venous collaterals are again noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is chronic nonunion of the left transverse process of L4.\n\nSOFT TISSUES: A wide neck ventral hernia containing bowel loops is again\nnoted, with no evidence of obstruction.", "output": "1. Status post transarterial chemoembolization.\n2. Increased extent of portal vein thrombus compared to most recent prior, now\nextending from at least the bifurcation of the right and left portal vein to\nthe first branches of the SMV.\n3. Wall thickening and pericolonic fluid of the ascending colon may represent\nportal colopathy. However, colitis cannot be excluded in the appropriate\nclinical setting.\n4. Splenomegaly." }, { "input": "LOWER CHEST: There is minimal atelectasis at the lung bases. Coronary artery\ncalcifications are present. The visualized heart and pericardium are\notherwise within normal limits.\n\nHEPATOBILIARY: A subcentimeter hypodensity in the left lobe of the liver is\ntoo small to the characterize on CT, possibly a cyst or biliary hamartoma. \nThe liver is normal in size and attenuation. The portal vein is patent. \nThere is no biliary ductal dilatation. The gallbladder is normal.\n\nSPLEEN: The spleen is normal in size and enhancement. Small amount of\nperisplenic ascites is new.\n\nPANCREAS: The pancreas demonstrates mild fatty atrophy. There is no\npancreatic duct dilatation or peripancreatic fat stranding.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nURINARY: The kidneys display symmetric nephrograms with no evidence of\nhydronephrosis. Scattered subcentimeter hypodensities in the left kidney are\ntoo small to fully characterize, likely cysts. Mild perinephric stranding\nbilaterally appears unchanged and is nonspecific. The ureters are symmetrical\nin their course to the bladder.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops are\nnormal in caliber and there is no evidence of small bowel obstruction. There\nis extensive diverticulosis throughout the colon without evidence of\ndiverticulitis. There is no free air or in the abdomen or pelvis. The\nappendix is normal. Focal ovoid calcification in the left hemipelvis is\nlikely the sequela of prior epiploic appendagitis (2:61).\n\nLYMPH NODES: There is no pathologic retroperitoneal or mesenteric\nlymphadenopathy. There is no inguinal or pelvic lymphadenopathy.\n\nVASCULAR: The abdominal aorta shows moderate to severe calcified\natherosclerosis. A focal area chronic aortic dissection just superior to the\niliac bifurcation is unchanged from the recent prior examination performed\nyesterday (series 2, image 46-48) with ectasia of the aorta measuring up to\n2.4 cm at this level.\n\nPELVIS: A Foley catheter terminates within the bladder. The bladder is mostly\ndecompressed. The rectum is normal. Prostate appears grossly unremarkable.\n\nBONES AND SOFT TISSUES: No suspicious osseous lesions are identified. There\nis grade 1 anterolisthesis of L4 on L5. S shaped scoliosis thoracolumbar\nspine is present.", "output": "1. No acute intra-abdominal process. Normal appendix. No free air.\n2. Extensive diverticulosis of the colon without evidence of diverticulitis.\n3. Tiny amount of perisplenic free fluid.\n4. Chronic focal dissection of the abdominal aorta just proximal to the iliac\nbifurcation, as seen on the previous study." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Several lucent lesions with thick sclerotic rim are noted within the\nmanubrium, left superior pubic ramus, the L1 vertebral body and the iliac\nbones, bilaterally. These lesions are unchanged from ___ and again\nconcerning for malignancy.\n\nSOFT TISSUES: Stranding and soft tissue nodules in the buttocks best seen on\nthe left on today's examination likely represent injection granulomas,\nunchanged. The patient is status post bilateral breast implantation.", "output": "1. Multiple mixed lucent and sclerotic osseous lesions throughout the axial\nskeleton are unchanged from ___ and remain concerning for malignant\ninvolvement. No evidence of lymphadenopathy within the abdomen and pelvis.\n2. Stable stranding and soft tissue nodules in the buttocks likely represent\ninjection granulomas, possibly related to prior cosmetic injections. \nCorrelation is recommended." }, { "input": "Lung bases without pleural effusions and normal heart size. Liver enhances\nnormally without focal abnormality or intrahepatic biliary ductal dilatation. \nHepatic and portal veins normally opacified. The gallbladder is unremarkable\nwithout radiopaque gallstones. The pancreas enhance normally without focal\nabnormality. The spleen is normal in size. A splenule is seen near the\npancreatic tail measuring 9 mm. Adrenal glands are normal bilaterally. \nKidneys enhance and excrete contrast symmetrically without focal abnormality. \nUreters are nondilated. The abdominal aorta is normal in caliber. Proximal\nbranch vessels and mesenteric arteries normally opacify. Subcentimeter\nretroperitoneal lymph nodes are seen in the aortocaval and periaortic region.\n\nThe stomach, small bowel loops are normal in caliber without focal\nabnormality. The ascending colon is nondilated and filled with fecal\nmaterial. The transverse colon is unremarkable. At the level of the junction\nof the transverse colon and the splenic flexure, there is a discrete\ntransition into significant wall thickening, pericolonic stranding, and mural\nedema, in a continuous manner to the rectum. No diverticula are seen. No\nsignificant free air or pneumatosis. Small amount of free fluid is seen in\nthe pelvis. Small lymph nodes are identified in the pericolonic region and\nin the left lower quadrant measuring up to 5 mm in short axis.\n\nUrinary bladder is underfilled and unremarkable. Uterus and adnexa are age\nappropriate. No significant inguinal adenopathy by size criteria.\n\nOverlying soft tissues are preserved. Periumbilical jewelry is noted. No\ndestructive osseous lesions are identified.", "output": "Contiguous colonic wall thickening, mural edema, and adjacent\npericolonic stranding involving the splenic flexure to the rectum; probable\nreactive lymph nodes in the left lower quadrant. Given distribution of\nfindings, consider inflammatory or infectious etiology. Less likely ischemia\ngiven distribution and age of patient. Mesenteric vessels are normally\nopacified. Small amount of free fluid in the pelvis is likely related to this\nacute colitis. No complications of abscess, perforation or pneumatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild central intrahepatic biliary\ndilatation. No extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Small accessory spleen inferiorly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal in caliber. Possible\npunctate appendicolith distally. The terminal ileum is not thickened.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Trace pelvic\nfree fluid is within physiologic range.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nThere may be a small corpus luteum in the left ovary.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No acute abnormalities within the abdomen or pelvis. Normal caliber appendix.\nPossible small corpus luteum in the left ovary. Very trace pelvic free fluid\nis within physiologic range." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nPunctate hypodensity in the left lobe is unchanged likely representing\nhammertoe are hemangioma. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Small accessory spleens are noted. 144\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis predominantly of the ascending colon. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing paraumbilical hernia.", "output": "1. Small fat containing paraumbilical hernia.\n2. Diverticulosis predominantly of the ascending colon." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. No focal consolidation or\npleural effusion. Heart is mildly enlarged. Trace pericardial fluid, likely\nphysiologic.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is post hepaticojejunostomy with persistent\npneumobilia. The liver demonstrates diffusely decreased attenuation,\nsuggestive of hepatic steatosis. There is no evidence of focal lesions. \nThere is persistent intrahepatic biliary ductal dilatation. The gallbladder\nis surgically absent. Serpiginous portal venous vessels at the right dome are\nstable since prior. Patent hepatic veins. There is percutaneous transhepatic\nbiliary drainage catheter a via left approach, tip terminating into the\njejunal loop. Bile duct dilatation has improved since ___. There is\nsmall volume fluid along the posterior margin of the liver, new since prior.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly measuring up to 16 cm in the axial plane. The spleen\nshows normal size and attenuation throughout. Again seen 1.6 cm splenic\nlesion with central enhancement, and within the superior aspect of the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube is present with its tip in the gastric body. \nPatient is post hepaticojejunostomy. There is again seen marked dilatation of\nthe biliary limb extending from the JJ anastomosis to the perihepatic\nsmall-bowel loops, overall unchanged since prior study dated ___. \nThe stomach is unremarkable. Proximal jejunal loops up to the level of\nanastomosis are mildly to moderately dilated, more prominent compared to\nprior. Mild wall thickening few small bowel loops are seen. Distal small\nbowel loops in the low abdomen and pelvis are decompressed.\nThere is diffuse mural thickening with mucosal enhancement of the visualized\ncolon, most likely represents infectious colitis, consider inflammatory\nprocess, unlikely schema given distribution. Major abdominal arteries, veins\nare patent. No pneumatosis intestinalis or intraperitoneal free air. The\nappendix is normal. Previously seen low abdominal fluid collection has\nresolved, with trace residual edema or thickening in the low anterior\nabdominal wall.\n\nPELVIS: Foley catheter is contained within a decompressed urinary bladder. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Post right salpingo-oophorectomy. Interval resolution of\npreviously seen bilateral adnexal fluid collections. No new fluid collections\nidentified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes of the visualized spine, greatest at\nL5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nPostsurgical changes in the right anterior abdominal wall related to PEG tube.\nInterval improvement of diffuse anasarca.", "output": "1. Post hepaticojejunostomy and with entero-enteric anastomosis. Persistent\nextensive dilatation of the biliary limb. More prominent dilatation native\njejunum. Distal to surgical anastomosis, small bowel loops are decompressed. \nBiliary dilatation has improved post drainage catheter placement.\n2. Pancolitis is likely related to infectious or inflammatory process. \nIschemia is less likely given distribution.\n3. Interval resolution of low abdominal fluid collections.\n4. Diffuse decreased attenuation of the liver suggestive of hepatic\nsteatosis. Correlation with LFTs is recommended." }, { "input": "LOWER CHEST: There is subsegmental atelectasis in the right lower lobe. There\nis no pleural effusion. Heart size is normal with a trace pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The right lobe of the liver appears atrophic. No concerning\nhepatic mass is present. Patient is status post hepaticojejunostomy with\npneumobilia demonstrated. There is also moderate intrahepatic biliary\ndilatation with the common bile duct not visualized. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is a well-defined hypoattenuating lesion in the spleen with\ncentral calcified septations measuring 1.9 x 1.1 cm (02:34). Spleen is\nenlarged measuring up to 13.6 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post hepaticojejunostomy. The biliary\nlimb appears circular in configuration with 2 anastomoses noted to a bowel\nloop in the left upper quadrant, and is diffusely dilated with fluid and air. \nDistal to the jejunojejunostomy (602:62), the small bowel (efferent limb) is\nrelatively decompressed and normal in appearance. The stomach, duodenum, and\nproximal jejunum proximal to the jejunojejunostomy appear relatively\ndecompressed and unremarkable. There is colonic diverticulosis without\nevidence of diverticulitis. Rectum is normal.\n\nPELVIS: The bladder is distended. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a right adnexal cystic lesion measuring 9.3 x\n7.8 cm (2:89) with several somewhat thickened and irregular septations within\nit, which displaces the uterus to the left. The uterus and left adnexa are\notherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post hepaticojejunostomy with marked dilatation of the biliary limb\nwith fluid and air. Of note, the biliary limb appears to be circular in\nconfiguration with 2 anastomoses noted to a bowel loop in the left upper\nquadrant. The stomach, duodenum, and proximal jejunum leading to the\njejunostomy as well as the small bowel loops distal to the jejunojejunostomy\n(efferent limb) appear relatively decompressed. Findings are concerning for\nafferent loop syndrome secondary to narrowing at the jejunojejunostomy leading\nto the efferent limb.\n2. Mild intrahepatic biliary dilatation may be due to dilatation and\nobstruction of the biliary limb. Pneumobilia is expected post\nhepaticojejunostomy.\n3. Complex right adnexal cystic lesion measuring 9.3 x 7.3 cm with apparent\nthickened irregular septations, suspicious for a cystic epithelial ovarian\nneoplasm. Pelvic ultrasound is recommended for further delineation.\n4. Right lobe of the liver is atrophic.\n5. Splenomegaly with cystic lesion containing calcified septations, possibly a\nposttraumatic cyst.\n\nRECOMMENDATION(S): Pelvic ultrasound for improved assessment of the right\nadnexal cystic lesion." }, { "input": "LOWER CHEST: There are new small bilateral pleural effusions with passive\natelectasis in both lower lobes.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nPneumobilia is no longer seen. Absence of IV contrast limits the evaluation\nfor intrahepatic biliary ductal dilatation, however there is probable\npersistent mild intrahepatic biliary ductal dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A coil is again noted within the superior aspect\nof the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post hepaticojejunostomy. The biliary\nlimb is again noted to be markedly dilated. Of note, there is oral contrast\nbeyond the jejuno-jejunal anastomosis, reaching the ileum. The stomach,\nduodenum, the proximal jejunum and the efferent limb are decompressed. \nColonic diverticulosis is again noted in the sigmoid and descending colon.\n\nThere is new small amount of ascites. There is trace pneumoperitoneum.\n\nPELVIS: The patient is status post right salpingo-oophorectomy, with\npostsurgical changes noted in the area. Small amount of gas within the\nbladder is likely related to prior instrumentation.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: Mild degenerative changes are again noted within the lower lumbar\nspine.\n\nSOFT TISSUES: Small subcutaneous emphysema along with stranding along the\nanterior abdominal wall in keeping with postsurgical changes. Skin staples\nare noted in the midline of the abdominal wall.", "output": "1. Status post hepaticojejunostomy with similar appearance of the markedly\ndilated biliary conduit. It is uncertain whether this represents chronically\ndilated biliary conduit since a revision has been recently performed or if\nthis is secondary to obstruction. Of note, oral contrast passes beyond the\njejuno-jejunal anastomosis and reaches the ileum.\n2. New small volume ascites is likely related to recent surgery.\n3. Pneumobilia is no longer seen with persistent mild intrahepatic biliary\nductal dilatation, raising concern for obstruction at level of the\nhepaticojejunostomy.\n4. Status post right salpingo-oophorectomy.\n5. Small bilateral pleural effusions with atelectasis in both lower lobes.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 18:04 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver is normal in attenuation with no focal hepatic\nlesions. The portal and hepatic veins are patent. The gallbladder is\nnondistended, with no visualized stones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically. Focal area of\ncortical thinning in the interpolar region of the right kidney (2:67) may\nrepresent sequela of prior infection. No hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. Soft tissue fullness of\nthe rectum may represent peristalsis and does not necessarily appear abnormal\non the coronal and sagittal views, however direct visualization may be more\nhelpful to evaluate for recurrent tumor. Appendix contains air, has normal\ncaliber without evidence of fat stranding.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES:\n1.7 x 1.6 cm intermediate density lesion at the level of L5 on the right\n(2:89) is compatible with a nerve sheath tumor, characterized MRI from ___. This is stable. No concerning osseous lesions are identified.", "output": "1. Soft tissue fullness in the rectum may be a function of underdistention,\nhowever direct visualization may be more helpful to evaluate for recurrent\ndisease at the site of the original tumor.\n2. Unchanged right L5 nerve sheath tumor.\n3. Please see a separate report discussing findings within the chest." }, { "input": "LOWER CHEST: There are multiple, bilateral pulmonary nodules. Please refer\nto separate report of CT chest performed on the same day for complete\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 7 mm hyperdense lesion within the lateral aspect of\nsegment VII on the portal venous phase which becomes isodense on the 3 minutes\ndelayed phase (5:64). This is unchanged in size and appearance since the CT\nabdomen/pelvis dated ___ and likely represents a flash filling\nhemangioma. There is also a tiny, stable hypodensity within segment VIII is\ntoo small to completely characterize (5:58). The liver otherwise demonstrates\nhomogenous attenuation throughout. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a small focus of cortical thinning at the midpole of the\nright kidney, which may reflect prior vascular or infectious insult. There\nalso one, tiny renal hypodensity in each kidney there are 2 small to\ncompletely characterize. The kidneys are otherwise of normal and symmetric\nsize with normal nephrogram. There is no evidence of hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\nwithin normal limits. There is a mass-like lesion within the posterior rectum\nconsistent with patient's known malignancy, decreased in size. There is some\nadjacent nodularity suggestive of extramural venous invasion, which appears\noverall improved compared to rectal MRI dated ___. The appendix\nis not visualized.\n\nPELVIS: The urinary bladder is well distended and distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is an intermediate density lesion within the\nright neural foramen at L5-S1 that is unchanged in appearance since ___ and likely represents a nerve sheath tumor, as characterized on the\n___ MRI. There is no evidence of worrisome osseous lesions or acute\nfracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Improved appearance of rectal malignancy without evidence of distant\nintra-abdominal or intrapelvic pelvic metastasis.\n2. Stable hemangioma within the lateral aspect of hepatic segment VII.\n3. Stable nerve sheath tumor of the right L5-S1 neural foramen.\n4. Please refer to separate report of CT chest performed on the same day for\ncomprehensive evaluation of the chest." }, { "input": "LOWER CHEST: Multiple pulmonary metastatic nodules in the lung bases are\nnoted bilaterally. Please refer to separate report of CT chest performed on\nthe same day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Previously visualized segment VII hemangioma is not well\nvisualized on today's exam. There are no new hepatic lesions. The liver\notherwise demonstrates homogenous attenuation throughout. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits. The portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A small right renal midpole cortical defect may be compatible with\nprior vascular infectious insult or may be a fetal lobulation, and is\nunchanged dating back to ___. The kidneys are otherwise of normal\nand symmetric size with normal nephrogram. There is no evidence of focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The appendix is\nnormal. Minimal concentric wall thickening of rectum is identified, unchanged\ncompared to prior exam. There is no perirectal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size and enhances\nheterogeneously. The seminal vesicles are\n\nLYMPH NODES: There is an enlarged 11 x 9 mm left para-aortic lymph node at\nthe level of the renal hilum (2:68) which was not previously seen on exam\ndated ___. A second preaortic lymph node measuring 11 x 7 mm (2:77)\nis also new compared to prior exam. Smaller preaortic lymph nodes are also\nseen on this study which were not seen on the last exam. There is no\nmesenteric or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Unchanged appearance of intermediate density mass within the right\nneural foramina at L5-S1 vertebral level, better characterized on prior MRI as\na nerve sheath tumor. Bilateral pars interarticularis lysis is noted without\n___ or ___ at the L5 vertebral level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval increase in size of retroperitoneal lymph nodes (detailed above)\ncompared to prior exam, measuring up to 11 x 9 mm in size. The known rectal\nmass best visualized on the MRI dated ___ is not as well\nvisualized on today's scan.\n2. Previously visualized segment VII hemangioma is not clearly seen on today's\nexam. There are no new hepatic lesions identified.\n3. Unchanged nerve sheath tumor along the right L5-S1 neural foramen.\n4. Please refer to same day CT chest for full description of intrathoracic\nfindings." }, { "input": "LOWER CHEST: Mild dependent atelectasis bilaterally. No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is mild periportal edema. The gallbladder is not\nvisualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is severe right-sided hydronephrosis worsened compared to the\nrecent MR enterography, with UPJ configuration. Though no obstructive stone\nis seen. There is no evidence of focal renal lesions within the limitations\nof an unenhanced scan. There is no nephrolithiasis. Mild right perinephric\nstranding is seen.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Ileocolic anastomosis is unremarkable. Oral contrast\nextends to the level of the descending colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not visualized. A 3.8 cm right adnexal cyst\nand a 2.2 cm left adnexal cyst do not appear significantly changed compared to\nprior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes noted along the anterior abdominal wall.", "output": "1. Severe right-sided hydronephrosis with UPJ configuration is significantly\nworsened compared to prior exams, with mild right perinephric stranding.\n2. No bowel obstruction.\n3. No significant change in size of bilateral adnexal cysts. Recommend\ncontinued yearly pelvic ultrasound surveillance.\n\nRECOMMENDATION(S): Continued annual surveillance of bilateral adnexal cysts\nwith pelvic ultrasound." }, { "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRedemonstrated is a region of focal hypodensity measuring 2.3 x 1.1 cm at the\njunctions of segments 8 and 4A of the liver (02:19), slightly smaller as\ncompared to the prior is examination an of on certain significance. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\nPANCREAS: The patient is status post distal pancreatectomy. The residual\npancreatic tissue is unremarkable in appearance.\nSPLEEN: The patient is status post splenectomy..\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis.\nMultiple bilateral renal hypodensities collecting cysts are noted, unchanged\nfrom the prior examination. There is no perinephric abnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. Appendix is not visualized.\nRETROPERITONEUM: Multiple prominent mesenteric and retroperitoneal lymph\nnodes are noted, none of which are pathologically enlarged by CT size\ncriteria.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. A 1.7 cm\ncorpus luteal cyst is noted on the left ovary (2:76). The right ovary\ndemonstrates a 2.0 cm simple ovarian cyst (2:78). There is no evidence of\npelvic or inguinal lymphadenopathy. Trace free fluid is noted within the\npelvis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions. Abdominal\nand pelvic wall is within normal limits.", "output": "1. No evidence of acute intra-abdominal process. Nonvisualized appendix.\n2. Stable postoperative appearance status post distal pancreatectomy,\ncholecystectomy, and splenectomy.\n3. 1.7 cm left hemorrhagic corpus luteal cyst, 2.0 cm right simple ovarian\ncyst, and trace free pelvic fluid.\n4. Slight interval decrease in size of a nonspecific hepatic hypodensity at\nthe junction of segments 8 and 4A. Recommend attention on followup." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. Pleural thickening at the left\nlung base is unchanged. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is mild central hepatic biliary duct dilation which is\nunchanged. Re- demonstrated area of focal hypodensity in VIA/VIII of\nuncertain significance, but not significantly changed. Extrahepatic biliary\nduct dilation with the common bile duct measuring up to 9 mm has also not\nchanged. The gallbladder surgically absent.\n\nPANCREAS: The patient is status post distal pancreatectomy and splenectomy. \nPostsurgical changes are stable. Remaining pancreatic parenchyma is\nenhancing. There is no peripancreatic stranding or fluid collection.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically. There is no\nhydronephrosis. Bilateral renal hypodensities are unchanged and most\nconsistent with simple cysts.\n\nGASTROINTESTINAL:The distal esophagus is normal without a hiatal hernia. Small\nbowel is normal in caliber without focal wall thickening. Large bowel is also\nnormal in caliber without focal wall thickening. The appendix is not\nvisualized but there are no secondary signs of appendicitis in the right lower\nquadrant. There is no intra-abdominal free fluid or free air.\n\nPELVIS: The bladder is distended. Appearance of the uterus and ovaries are\nunchanged. There is no pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There are scattered borderline enlarged retroperitoneal and\nmesenteric lymph nodes which are unchanged the largest gastrohepatic lymph\nnode measures 8 mm (series 2, image 27).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are no suspicious bony lesions.\n\nSOFT TISSUES: There is no soft tissue abnormality.", "output": "1. Stable postsurgical changes from distal pancreatectomy. No evidence of\nnecrotizing pancreatitis. No peripancreatic stranding or fluid collections.\n2. Stable mild central intrahepatic and extrahepatic biliary duct dilation." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.Contrast seen within the distal\nesophagus may represent reflux.\n\nABDOMEN:\n\nHEPATOBILIARY: A 2.1 x 1.5 cm subtle area of hypodensity (series 601b, image\n25) in segment VIa/VIII (series 601b, image 25) is of uncertain etiology,\nhowever is moderately decreased in size and is less conspicuous comparison to\nprior examinations. There is again mild prominence of the intrahepatic\nbiliary tree. The common bile duct measures up to 9 mm, unchanged from prior.\nThe gallbladder is surgically absent.\n\nPANCREAS: The patient is status post distal pancreatectomy without evidence of\nfocal lesion and is normal attenuation throughout.\n\nSPLEEN: The patient is status post splenectomy.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple rounded hypodensities measuring up to 1.6 in the kidneys bilaterally\nlikely represent simple renal cysts, better evaluated on MRCP from ___.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a large\namount of stool throughout the colon. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable intra and extrahepatic prominence of the biliary tree.\n2. Status post distal pancreatectomy and splenectomy without CT findings of\nacute pancreatitis or complications thereof.\n3. Contrast seen within the distal esophagus may represent reflux." }, { "input": "LOWER CHEST: A 5 mm nodule in the left lower lobe (2:4) is unchanged as\ndating back to CT abdomen pelvis ___. Minimal subpleural linear\nopacities in the right lower lobe (02:15) is unchanged and likely represents\nscarring. There is no pleural pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: An irregular subtle area of hypodensity measuring\napproximately 10 mm in maximal diameter (02:15) in segment VIII is unchanged\nin appearance in size from ___. There is no evidence of new liver\nlesion. Portal veins and hepatic veins are patent The liver demonstrates\nhomogenous attenuation throughout. There is mild prominence of the\nintrahepatic bile ducts and there is extrahepatic biliary dilatation with the\ncommon bile duct measuring up to 10 mm, minimally changed most recent\ncomparison study. The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post distal pancreatectomy with surgical clips\nnoted at the margin of the remnant pancreas. The pancreas has normal\nattenuation throughout, without evidence of focal lesions or pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple hypoattenuated round lesions measuring up to 1.3 mm in the\nlower pole of the left kidney (02:25) are unchanged from most recent\ncomparison study and likely represent simple cysts, better evaluated on MRCP\nfrom ___. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis, likely physiologic given patient's\nage.\n\nREPRODUCTIVE ORGANS: The uterus is normal. There is a corpus luteal cyst in\nthe left ovary (2:71) which is likely physiologic.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. There are multiple mesenteric lymph\nnodes measuring up to 6 mm across shortest diameter (02:40) which are\nminimally changed from ___ in an not pathologically enlarged by CT\nsize criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are noted at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild intrahepatic biliary dilatation and extrahepatic biliary dilatation is\nunchanged as compared to CT abdomen pelvis ___.\n2. Status post distal pancreatectomy and splenectomy without evidence of acute\npancreatitis.\n3. 5 mm pulmonary nodule in the left lower lobe is unchanged in size from CT\nabdomen and pelvis ___. If patient is at high risk for lung\ncancer, repeat chest CT is recommended in 12 months. If patient is at low\nrisk, no additional follow-up imaging imaging is recommended. These\nrecommendations are per the ___ Society guidelines on pulmonary\nnodules." }, { "input": "LOWER CHEST: Small focal peripheral relatively linear ground-glass opacity in\nthe right middle lobe is nonspecific, but seen on the prior study, and could\nbe focal atelectasis or sequelae of chronic inflammation or infection (series\n2, image 4). No evidence of a pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. The 2.9 cm possible hemangioma on prior exams is\nnot well visualized on this exam, likely related to the phase of imaging. \nEctasia of the common bile duct to 8 mm is similar to the prior ultrasound and\nCT and within normal limits for cholecystectomy status. Mild prominence of\nthe central intrahepatic biliary ducts is similar to the prior exam.\n\nPANCREAS: The patient has had prior distal pancreatectomy with surgical clips\nat the margin of the remaining proximal pancreas. The remaining pancreas is\nslightly atrophic but has normal attenuation without evidence of a focal mass.\nNo evidence of main pancreatic ductal dilation. No peripancreatic fat\nstranding or fluid collections.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cortical hypodensities are again demonstrated, statistically\nmost likely cysts. No hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: A hiatal hernia is small. The distal esophagus may be\nthickened. The stomach is distended with ingested fluid and oral tablets. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon has a moderate to abundant diffuse stool burden. The\nappendix is not definitely visualized, although there are no secondary signs\nof acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Bilateral\nureteral jets of intravenous contrast are demonstrated. There is a small\namount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. No concerning adnexal\nmasses. A 2-cm follicle/corpus luteum is seen in the left ovary. Trace\npelvic free fluid is within physiologic range.\n\nLYMPH NODES: A lymph node at the hiatus measuring 7 mm in short axis is\nunchanged (series 2, image 23). No retroperitoneal or mesenteric\nlymphadenopathy. No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted. The main portal vein and SMV appear patent.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\nMultilevel degenerative changes in the spine are most pronounced at L5-S1 with\na small broad-based disc bulge indenting the anterior thecal sac and mild\nretrolisthesis of L5 on S1, unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post distal pancreatectomy, splenectomy, and cholecystectomy. No CT\nfindings of acute pancreatitis.\n2. Prominent CBD with mild central intrahepatic biliary ductal dilation,\nsimilar to prior.\n3. Small hiatal hernia. Partially imaged distal esophagus appears thickened. \nIf this has not been recently evaluated, suggest further assessment with\nendoscopy or upper GI series.\n4. Moderately distended stomach.\n5. Moderate to abundant colonic stool burden.\n6. Left ovarian corpus luteum. Physiologic amount of free fluid in the\npelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. Prominence of the common bile duct up to 8 mm is\nunchanged and likely reflects sequela of prior cholecystectomy.\n\nPANCREAS: Patient is post distal pancreatectomy. There is normal enhancement\nof the remaining pancreas, without focal lesions identified.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral simple renal cysts are noted. No focal mass lesions or\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small and large bowel loops\nare normal in caliber. There is large stool burden in the proximal colon.\n\nA left abdominal percutaneous jejunostomy tube is in situ. There is marked\nsubcutaneous edema and gas around the jejunostomy site, which extends to the\nabdominal wall musculature (04:47). No organized fluid collections.\n\nPELVIS: Air is noted within the bladder. No abnormal bladder wall thickening.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Numerous prominent aortocaval, para-aortic and bilateral pelvic\nsidewall lymph nodes are bigger from ___, but not enlarged by CT\nsize criteria, likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status post right hip excision arthroplasty with spacer\nplacement in the right acetabulum. There is extensive soft tissue edema\naround the right femoroacetabular joint, with extension to the surrounding\nsubcutaneous tissues. There is subcutaneous gas around the right\nfemoroacetabular joint and in the surrounding musculature, including the right\niliacus and gluteal muscles.\n\nNo erosive or lytic changes are seen in the right acetabulum or right proximal\nfemur. A right lateral approach drainage catheter terminates near the right\nlesser trochanter.\n\nSOFT TISSUES: No abdominopelvic wall hernia.", "output": "1. Subcutaneous edema and gas surrounding the left abdominal jejunostomy site\nand abdominal wall musculature is suspicious for infection. No organized\nfluid collections.\n2. Status post right hip excision arthroplasty with spacer placement. \nExtensive soft tissue edema and subcutaneous gas around the right hip may be\nsecondary to recent surgical intervention and/or infection.\n3. Air within the bladder lumen may be related to recent catheterization or\ninfection.\n4. Numerous prominent retroperitoneal and pelvic lymph nodes are bigger from\n___, likely reactive." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild pneumobilia in the left\nlobe of the liver, likely due to CBD stent placement. The gallbladder is\nsurgically absent. A biliary stent is appropriately positioned within the CBD\nand terminates in the second portion of the duodenum.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic soft tissues are unremarkable.", "output": "1. No acute intra-abdominal or intrapelvic abnormalities.\n2. Status post biliary stent placement with expected pneumobilia." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney normal. There is a complex a renal mass in the\nposterior interpolar column (images 6; 69, 9b; 32 and 10b; 29) which measures\n3.1 x 3.2 x 3.6 cm. Extending to abut the likely not invading the renal\nfascia, and without invasion of the left renal vein.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\nunremarkable. Sigmoid and rectum distended by stool. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Small calcified uterine fibroid\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nSKELETAL: There is a large bone obstructing inhomogeneously enhancing soft\ntissue mass with scattered calcifications around the left hip (images 6; 112,\n9b; 24) which measures 8.3 x 11.7 x 14.8 cm. This has increased a\nconsiderably compared to the ___ exam", "output": "1. Stable 3 cm left renal mass with rapidly expanding large bone destructive\nmass around the left hip." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic biliary\ndilatation. The common bile duct measures up to 1.4 cm, slightly increased\nsince ___ when it measured 1.1 cm (601; 27), and can be greater than expected\ngiven cholecystectomy. There is portal edema, which is nonspecific. The\ngallbladder surgically absent\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Patient is status post\nRoux-en-Y gastric bypass without evidence of small-bowel obstruction. The\nexcluded stomach is not distended. The visualized small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\njejunojejunostomy anastomosis is noted in the left mid abdomen. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nCalcifications are noted in the subcutaneous tissues of the right lateral\nabdominal wall, likely from prior trauma.", "output": "1. No evidence of small-bowel obstruction.\n2. Periportal edema is nonspecific but may be seen in toxic hepatitis.\n3. The common bile duct measures up to 1.4 cm, minimally increased compared to\n___ when it measured 1.1 cm. There is mild intrahepatic biliary dilatation\nsimilar to ___." }, { "input": "CHEST:\n\nThe lung bases are clear. The included heart and pericardium are unremarkable.\n\nABDOMEN:\n\nThe liver is normal in appearance without focal lesions identified. The portal\nvein is patent. The gallbladder is unremarkable with no radiopaque gallstones.\nThere is no intra or extrahepatic biliary duct dilation.\n\nThe adrenal glands and spleen are unremarkable. The pancreas enhances\nhomogeneously and is without focal lesions. The pancreatic duct is not\ndilated. There are no peripancreatic abnormalities.\n\nThe kidneys display symmetric nephrograms. There are no focal renal lesions.\nThere is a left extra renal pelvis. There is no hydronephrosis.\n\nThe distal esophagus is normal with no hiatal hernia. The stomach, small and\nlarge bowel are unremarkable. The appendix is not visualized.\n\nThere is no retroperitoneal or mesenteric lymph node enlargement by CT size\ncriteria.\n\nThere is no abdominal free fluid or free air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nThere is a 4.7 x 4.3 x 5.6 cm right ovarian cyst.\n\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.\n\n\nCTA ABDOMEN AND PELVIS: The abdominal aorta and its major branches are patent.\nthe common hepatic artery arises directly from the abdominal aorta. There is\nno abdominal aortic aneurysm.\n\nThe inferior epigastric arteries are patent bilaterally from the external\niliac artery to the perforator branches. There are 2 perforators on the right\nand 1 perforators on the left.\n\nThe perforators on the right measure: intermediate 1 mm, medial 2 mm.\nThe perforators on the left measure: 1.5 mm.", "output": "1. Patent inferior epigastric arteries bilaterally. The largest perforator on\nthe right measures 2 mm. The largest perforator on the left measures 1.5 mm\n2. 5.6 cm right ovarian cyst, recommend pelvic ultrasound for further\ncharacterization." }, { "input": "In the interim since the prior study, the patient has undergone abdominal wall\nsurgery for use of the deep internal epigastric artery and and metallic\nsurgical clips are seen along the lower rectus muscles and the left-sided\nrectus muscles have become somewhat attenuated but are not absent. No\nabdominal wall defect or hernia is seen, however the patient's large fibroid\nuterus may be more easily palpable through the slightly thinner abdominal wall\nmusculature and, in the interim since ___, has increased slightly in\n___ measuring 11.8 by 6.5 x 7.5 cm compared to 10.8 by 5.8 by the 7.0\ncm in ___. Note that ___ pelvic ultrasound showed a smaller\nuterine measurements compared to in ___ ultrasound. Large simple\nappearing right ovarian cyst which is anterior on the right has decreased\nslightly in greatest dimension now measuring 2.3 cm, previously greater than 5\ncm. No mesenteric mass or other organomegaly is seen and no free fluid is\nseen in the abdomen.\n\nAlthough the liver is not included in its entirety in the view this scan, no\nabnormality is seen in the visualized liver, gallbladder, spleen, pancreas,\nadrenal glands or right kidney. The configuration of the left upper renal\ncollecting system suggests a ureteropelvic junction obstruction, appearance\nnot significantly different compared to ___. The appendix is not seen but no\ninflammation is seen in the right lower quadrant and terminal ileum is normal\nin appearance. The urinary bladder is impressed upon from the large uterus but\nappears normal.\n\nNo significant bony abnormality is seen.", "output": "Postsurgical changes in the lower rectus abdominal muscles bilaterally with\nsome thinning of musculature on the left compared to preoperative study. The\npatient has a large fibroid uterus may be more easily palpable. Previously\nseen 5 cm right ovarian cyst now measures 2.3 cm in greatest dimension.\n\nProbable left ureteropelvic junction obstruction, unchanged." }, { "input": "LOWER CHEST: There is moderate dependent atelectasis in bilateral lower lobes.\nThere is mild cardiomegaly. There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates low attenuation throughout compatible\nwith hepatic steatosis. There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple intermediate density rounded foci in the bilateral kidneys\nmeasuring up to 2.1 cm in the lower pole left kidney (series 2:42) and 2.3 cm\nin lower pole the right kidney (series 2:46). There is a simple cyst in the\nupper pole of the right kidney measuring 3.3 cm (series 2:39). There is no\nhydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged. There is a penile\nreservoir (series 2:79) and a penile prosthesis which is partially imaged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild degenerative changes at L4-L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abnormality in the abdomen or pelvis to explain patient's reported\nabdominal pain. Specifically, no evidence of cholecystitis or pancreatitis. \nNo obstruction.\n2. Multiple intermediate density rounded foci in the bilateral kidneys\nmeasuring up to 2.1 cm in the lower pole of the left kidney and 2.3 cm in the\nlower pole of the right kidney are indeterminate. Nonurgent renal MRI or\nultrasound suggested for further characterization.\n\nRECOMMENDATION(S): Nonurgent renal MRI or ultrasound suggested for further\ncharacterization." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion. The heart is mildly enlarged. Dense\ncoronary and aorta annular calcifications are seen. Patient is status post\nmedian sternotomy with intact wires. There is the mildly displaced healing\nfracture of multiple right posterior ribs. Mild deformity of the left\nposterior lower ribs are likely due to prior trauma.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen are multiple hypodensities throughout the liver, the largest\nmeasuring up to 2.5 cm, likely simple cysts, grossly unchanged from prior\nexam. There is mild prominence of the intrahepatic bile ducts without frank\ndilatation. There is no evidence of extrahepatic biliary dilatation. The\ngallbladder is within normal limits. There is a small amount of\npericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral cortical thinning and irregularity may be due to prior infectious or\nvascular insult. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost partial colectomy with an end colostomy in the left lower quadrant. \nThere is a new parastomal hernia measuring 11.7 x 3.5 cm which contains\nmesenteric fat and loops of non-dilated small bowel as well as a small amount\nof fluid. The opening of the parastomal hernia measures up to 4.0 cm. No\nevidence for bowel obstruction or bowel wall thickening. In addition, there\nis small amount of free fluid in the lower pelvis. The appendix is normal. \nSoft tissue density in the presacral space measuring approximately 3.1 x 2.0\ncm (2:83) is likely related to resolving hematoma from prior surgery.\n\nPELVIS: The urinary bladder appears to contain several dependent calculi. The\ndistal ureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is heterogeneously enhancing and markedly\nenlarged. The seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Moderate to severe degenerative changes are seen in the lumbar spine\nand bilateral hip joints. There is mild grade 1 L4 on L5 anterolisthesis and\nretrolisthesis of L5 over S1, unchanged from ___.\n\nSOFT TISSUES: There is a small soft tissue nodule in the anterior abdominal\nwall measuring 1.2 cm (02:42).", "output": "1. New large mouth parastomal hernia containing small amount of fluid,\nnon-dilated loops of small bowel, and mesenteric fat. The hernia sac measures\nup to 11.7 x 3.5 cm with 4.0 cm opening. No evidence of bowel obstruction.\n2. Prostatomegaly with small bladder calculi." }, { "input": "LOWER CHEST: Bibasilar dependent atelectatic changes. Visualized lung fields\nare within normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout, foci\nof focal fatty sparing are demonstrated. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is nonspecific thickening of the adrenal glands bilaterally. \nNo evidence of focal lesions identified.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is decompressed. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic\ndiverticula are noted without evidence of wall thickening or associated fat\nstranding. The rectum is unremarkable. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The vaginal walls appear thickened. There is a small\namount of free fluid within the posterior cul-de-sac which may be reactive in\netiology. The uterus is unremarkable. The ovaries are unremarkable. There is\nno evidence of tubo-ovarian abscess or hydrosalpinx.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Sclerotic foci within the lumbar spine likely represent bone islands. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. Otherwise,\nthe abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of colitis.\n2. Colonic diverticula without evidence of wall thickening or associated fat\nstranding. The rectum is unremarkable.\n3. Normal appendix.\n4. Thickening of the vaginal walls with associated trace free pelvic fluid. \nNo sign of hydrosalpinx or tubo-ovarian abscess. Clinical correlation is\nrecommended.\n\nNOTIFICATION: D/w Dr. ___." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable.\n\nABDOMEN: The unenhanced appearance of the liver, gallbladder, spleen, adrenal\nglands, and pancreas is normal. No renal stone, hydronephrosis or signs of\nureteral stone. No perinephric stranding. The abdominal aorta is normal in\ncourse and caliber without appreciable atherosclerotic calcifications. No\nretroperitoneal lymphadenopathy. The stomach is decompressed and the duodenum\nappears normal.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is normal. The colon is unremarkable without significant fecal\nloading or signs of wall thickening. There is small volume free pelvic fluid\nwhich appears simple, could be physiologic or indicative of ovarian cyst\nrupture. The uterus and bilateral ovaries are unremarkable. Mild thickening\nof the urinary bladder wall requires clinical correlation for cystitis.\n\nBONES: There is no worrisome lytic or blastic osseous lesion.", "output": "1. No hydronephrosis, renal or ureteral stone.\n2. Small volume free pelvic fluid could be physiologic or indicative of\novarian cyst rupture.\n3. Normal appendix.\n4. Mild thickening of the urinary bladder wall requires clinical correlation\nfor cystitis." }, { "input": "Lung bases: Heart size is normal without significant pericardial fluid. \nThere is trace bibasilar atelectasis.\n\nCT abdomen: Multiple hepatic cystic lesions measuring up to 2.0 cm in the\nleft hepatic lobe are unchanged. The larger lesions are compatible with\nbiliary hematoma. The sub cm lesions are too small to fully characterize but\nlikely also represent hematoma. Background liver parenchyma enhances\nhomogeneously without new lesion or intrahepatic biliary dilatation. Portal\nvein is patent. Multiple gallstones are noted in a mildly dilated\ngallbladder. There is mild surrounding inflammatory change.\n\nSpleen, pancreas and adrenal glands are unremarkable. Kidneys present\nsymmetric nephrograms and excretion of contrast without focal lesion or\nhydronephrosis.\n\nStomach is unremarkable. Duodenum and small bowel loops are normal caliber\nwithout evidence of obstruction. Postsurgical changes are present from right\npartial colectomy. There is prominent thickening of the residual large bowel\nwall starting from the right mid abdominal anastomotic junction, extending to\nthe proximal transverse colon and there is prominent surrounding mesenteric\nfat stranding. The distal large bowel is unremarkable. There is no\nextravasation of ingested oral contrast which reaches the level of the sigmoid\ncolon.\n\nAbdominal aorta is normal caliber. Scattered mesenteric and retroperitoneal\nlymph nodes are not enlarged by CT size criteria. There is no\npneumoperitoneum. There is no ventral abdominal wall hernia.\n\nCT pelvis: Bladder, uterus, adnexa and rectum are unremarkable. There is no\nfree pelvic fluid or air. There is no inguinal or pelvic sidewall\nlymphadenopathy by CT size criteria.\n\nBones and soft tissues: There is no suspicious focal bone lesion. There is\ngrade 1 anterolisthesis of L3 on L4.", "output": "1. Postsurgical changes from right partial colectomy with colonic wall\nthickening at the level of the right mid abdominal colonic anastomosis\nextending to the proximal transverse colon with extensive surrounding\ninflammatory change compatible with colitis. No evidence of bowel leak or\ndrainable fluid collection.\n2. No evidence of bowel obstruction.\n3. Cholelithiasis with gallbladder wall edema and surrounding fluid, likely\nsecondary to adjacent inflamed bowel." }, { "input": "LOWER CHEST: There is consolidation with air bronchograms in the bases\nbilaterally. There small bilateral pleural effusions. No pericardial\neffusion. A calcified mediastinal node is noted\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense lesions are seen throughout the liver compatible simple\ncyst. The largest measures up to 8.6 cm in segment 5. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. Status post cholecystectomy.\nThere is small volume high-density fluid in the cholecystectomy bed which\nextends along the liver and greater curvature of the stomach.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is mildly enlarged measuring up to 14.8 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall volume high-density fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is asymmetric subcutaneous edema along the right flank.", "output": "1. No acute intra-abdominal process. Small volume hemoperitoneum seen in the\ncholecystectomy bed extending along the liver and greater curvature of the\nstomach and small volume of blood in the pelvis is presumably postsurgical. \nNo other potential source is identified.\n2. Trace bilateral pleural effusions and bibasilar consolidations likely\nrepresenting atelectasis although superimposed infection is difficult to\nexclude.\n3. Asymmetric subcutaneous edema along the right flank.\n4. Mild splenomegaly." }, { "input": "LOWER CHEST:\n\nThere is re- demonstration of low density along the anterior and right lateral\naspect of the right atrium. Along the inferior aspect of the right heart\npericardium, there is a peripherally enhancing lesion measuring approximately\n4.2 cm in length. Partially visualized lung bases demonstrate bibasilar\npulmonary nodules, unchanged compared to recent CT chest. There is bibasilar\natelectasis.\n\nABDOMEN:\nThere are numerous hepatic lesions. The largest hepatic lesions have\nperipheral enhancement with central hypodensity suggestive of necrosis. The\nlargest lesion is located in the right hepatic dome measuring 2.9 x 3.5 cm\n(05:10). Additional lesions are seen in segment IV B (05:30), V, VI. There is\na 1.5 x 1.4 lesion of the junction of segments II and III (05:23). In there is\nno intrahepatic or extrahepatic biliary ductal dilatation. There is mild\nvicarious excretion of contrast within the gallbladder.\n\nThere are 2 lesions within the spleen measuring 2.9 x 3.6 cm and 2.9 x 3.1 cm.\nThere is a hyper enhancing lesion in the inferior aspect of the splenic hilum\nmeasuring 11 mm (05:27). There is symmetric renal enhancement. 11 mm\nhypodensity within the left interpolar region is consistent with renal cyst.\nThere is no evidence of renal mass or hydronephrosis. Urinary bladder is\nmildly distended without gross abnormality.\n\nThere are no dilated or distended loops of bowel. There is no bowel wall\nthickening. There are diverticula of the sigmoid colon without evidence of\ndiverticulitis. There is no intraperitoneal free air or free fluid.\n\nThere is mild dilatation of the infrarenal abdominal aorta measuring up to 2.3\ncm in diameter. There is moderate atherosclerotic calcification of the\nabdominal aorta and common iliac arteries. There are no enlarged inguinal,\niliac chain, retrocrural, or retroperitoneal lymph nodes. There is no\nsuspicious osseous lesion. There is mild S-shaped curvature of the\nthoracolumbar spine. There are degenerative changes of the lower lumbar spine.", "output": "1. Multiple hepatic and splenic metastases as described above.\n2. Hypodensity within the right atrium and along the right inferior aspect of\nthe pericardium adjacent to the right concerning for metastases.\n3. Visualization of multiple bibasilar pulmonary nodules, better seen and\ndescribed in recent CT chest ___.\n4. Sigmoid diverticula without evidence of diverticulitis." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver is shrunken with nodular borders. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent. The\nmain portal vein and its major branches are patent. The common hepatic artery\nand its major branches are patent. There are splenic and gastroesophageal\nvarices. There is moderate ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 14.9 cm in length across AP dimension\n(series 3:129)\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized but there are\nno secondary signs of acute appendicitis. There is a curvilinear\ncalcification in the left hemipelvis abutting bowel loops (series 3:204)\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nlarge volume ascites in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is moderate degenerative change in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Cirrhotic appearing liver with secondary signs of portal hypertension\nincluding splenomegaly, moderate ascites, and esophageal varices.\n2. No suspicious enhancing liver lesion. No evidence of portal venous\nthrombosis with patent liver vasculature.\n3. There is a curvilinear calcification in the left hemipelvis abutting bowel\nloops (series 3:204), nonspecific in etiology but without concerning features." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 6 mm right adrenal nodule, which is stable since at least\n___, and likely represents an adrenal adenoma. The left adrenal\ngland is normal in size and shape.\n\nURINARY: There is a 1.7 cm simple cyst within the upper pole of the right\nkidney. Otherwise, the kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of solid renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The bladder is decompressed, and cannot be a fully evaluated on this\nexamination. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Moderate to severe degenerative changes are seen within the lumbar\nspine. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. No specific evidence of metastatic disease within the abdomen or pelvis.\n2. 6 mm right adrenal nodule, stable since ___, likely an adenoma.\n3. Diverticulosis without diverticulitis.\n4. Small hiatal hernia.\n5. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Subcentimeter right adrenal nodule is unchanged from prior exam\n(05:52). The left adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n1.7 cm simple cyst in the right kidney is unchanged from prior exam. There is\nno hydronephrosis bilaterally. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is mild fascial thickening along the\ndescending colon down to the sigmoid colon with mild thickening of the sigmoid\ncolonic wall. Multiple diverticula in the sigmoid colon are again\ndemonstrated. No fluid collection is seen. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. The left adnexal region is adjacent to the region of fascial\ninflammation.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes of the lumbar spine is unchanged from prior\nexam.\n\nSOFT TISSUES: A small fat containing umbilical hernia is unchanged from prior\nexam.", "output": "1. There is left lower quadrant fascial thickening along the descending and\nsigmoid ___ represent colitis secondary to chemotherapy,\ndiverticulitis, or salpingitis. No complications.\n2. No specific evidence of metastatic disease within the abdomen or the\npelvis.\n3. Please refer to the chest CT report for the intrathoracic findings.\n\nNOTIFICATION: The findings were discussed with ___ , M.D. by\n___, M.D. on the telephone on ___ at 3:04 ___, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Severe cardiomegaly is unchanged. There is mild interlobular\nseptal thickening and reflux of contrast into the hepatic veins. The main\npulmonary artery is again enlarged to 3.7 cm suggestive of pulmonary\nhypertension. Small nonhemorrhagic left and trace right pleural effusions\nhave decreased in size. Multiple new peripheral nodular pulmonary ground\nglass opacities include a 1.0 x 0.6 cm subpleural opacity (02:34) within the\nlateral right middle lobe, and 0.8 x 0.6 cm ground-glass opacity (02:20) in\nthe posterior right upper lobe. In the inferior right upper lobe, there is a\n0.4 x 0.3 cm pulmonary nodule (02:32). A 0.7 cm calcified granuloma in left\nlower lobe is unchanged. There is no evidence of pericardial effusion. \nMedian sternotomy wires are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder has a small calcified\nstone in the neck. Peripheral calcification of the gallbladder fundus may be\nrelated to a large peripherally calcified stone or calcification within the\nwall. There is trace perihepatic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are nodular appearing, likely\nadenomatous hyperplasia. The inferior left adrenal gland has been previously\ncharacterized as an adenoma (2:81).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder is markedly distended, but otherwise unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Prominent mediastinal lymph nodes are essentially unchanged\nmeasuring up to 1.2 cm in short axis in the right pretracheal station. There\nis no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. A chronic dissection flap in\nthe infrarenal abdominal aorta is unchanged when compared to prior CTA\n(2:100). Extensive and diffuse atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nExtensive degenerative changes are seen throughout the visualized spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New peripheral nodular pulmonary ground glass opacities raise the\npossibility of septic emboli or fungal infection.\n2. Small calcified gallstone in the gallbladder neck. Peripheral\ncalcification of the gallbladder fundus may be related to a large underlying\ngallstone or porcelain gallbladder. No evidence of cholecystitis.\n3. Mild interlobular septal thickening, small pleural effusions, severe\ncardiomegaly, and reflux of contrast into the hepatic veins suggest a\ncomponent of heart failure.\n4. Trace perihepatic ascites.\n5. Nodular adrenal glands likely reflect adrenal hyperplasia.\n6. Severe atherosclerotic calcification and a chronic dissection flap of the\ninfrarenal abdominal aorta are unchanged.\n7. No acute traumatic injury identified including no fracture." }, { "input": "LOWER CHEST: Bilateral layering pleural effusions are incompletely imaged\nthough appear least moderate in size and simple. There is associated\ncompressive lower lobe atelectasis. The partially visualized heart is\nenlarged.\n\nABDOMEN: Small to moderate volume abdominal ascites is noted. The liver\nenhances homogeneously though appears hypodense relative to the spleen\nsuggesting steatosis. No discrete focal liver lesion is seen. The gall\nappears similar to prior with a contracted appearance and possibly containing\na rim calcified stone. The spleen appears normal. Adrenals are normal. \nPancreas is normal. The kidneys enhance symmetrically demonstrating prompt\nexcretion. No hydronephrosis, signs of pyelonephritis or worrisome renal\nlesion.\n\nThe abdominal aorta is densely calcified though normal in caliber. There is\nno retroperitoneal lymphadenopathy. The stomach and duodenum appear normal. \nNo free air.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is normal. The: Contains a mild fecal load and is thin walled\nwithout signs of acute inflammation or obstruction. Colonic diverticulosis is\nnoted without evidence of diverticulitis. There is no free air. The urinary\nbladder is only minimally distended though appears normal. The prostate gland\nappears normal in size. There is no pelvic sidewall or inguinal adenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Anasarca is noted.", "output": "1. Constellation of findings including cardiomegaly, moderate layering pleural\neffusions, small to moderate volume ascites and anasarca is concerning for\ndecompensated heart failure.\n2. Hepatic steatosis.\n3. Severe aortic atherosclerosis." }, { "input": "LOWER CHEST: There is small bilateral pleural effusions with associated\ncompressive atelectasis. There is slightly more non dependent airspace\ndisease within the left lower lobe which could reflect aspiration or\npneumonia.\n\nABDOMEN:\nThe study is slightly limited from artifact related to the patient's arm being\nat the side as well as the timing of imaging after contrast administration.\n\nHEPATOBILIARY: There are several new wedge-shaped hypodense lesions in the\nperiphery of segments 3 and 4b of the liver as well as posteriorly in segment\n3 that could be small areas of ischemia or related to injury from recent\nsurgery. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Calcifications of the gallbladder wall are again noted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric and size. The previously\nseen areas of wedge-shaped hypodensities in the right kidneys are not well\nvisualized on this exam because of streak artifact and contrast bolus timing,\nhowever there is slightly heterogeneous enhancement of the kidneys.\n\nGASTROINTESTINAL: The stomach is unremarkable. Visualized small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis apparent extraluminal contrast seen arising from the stomach near the\nsuperior aspect of the G-tube entrance site into the stomach and extending\nalong the liver edge rightward mostly between the dome of the liver and the\ndiaphragm with intermixed gas. Gas is seen extending along the anterior\nabdominal wall below the open wound site bilaterally with the inferior aspect\nof the open wound not seen on this study a right upper quadrant JP drain\ncourses below the liver and then along the posterior aspect of the left lobe\nto terminate between the left lobe in the stomach. Visualized portions of the\ncolon are within normal limits. Barium within the colon is seen from prior\nexam.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: The infrarenal aortic dissection is not well visualized due to poor\ncontrast timing. Aortic caliber is unchanged. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdomen is open with a wound VAC device in place.", "output": "1. Contrast appears to be outside of the stomach extending along the liver\nedge and may originate from the superior aspect of the G-tube entrance site\ninto the stomach. This tracks to the open wound and the wound VAC. No\ndefined collection.\n2. Peripheral hypodensities in the liver could be from areas of ischemic\ninjury or injury related to surgery.\n3. Previously described right renal infarcts are not well visualized on this\nexam due to poor contrast timing.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:40 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart\nis unremarkable.\n\nABDOMEN: The liver enhances normally without concerning focal lesion. The\nmain portal vein is patent. No biliary ductal dilation. The gallbladder is\nnormal. The pancreas appears normal. The spleen is normal in size. Adrenal\nglands are normal bilaterally. The kidneys enhance symmetrically. No\nworrisome renal lesion. The abdominal aorta is mildly calcified and normal in\ncourse and caliber. No retroperitoneal or mesenteric lymphadenopathy. The\nstomach and duodenum appear normal. No free air or free fluid.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix is not clearly visualized though there are no secondary signs of\nappendicitis. The colon contains diverticula though there is no evidence of\nacute diverticulitis. The colon is fairly decompressed throughout. The\nurinary bladder is markedly distended. The uterus and adnexal regions appear\ngrossly unremarkable. No pelvic free fluid. No pelvic sidewall or inguinal\nadenopathy.\n\nBONES: No worrisome bony lesion. Degenerative changes are most pronounced at\nL4-5 level.", "output": "No findings to account for melena. No acute intra-abdominal process. \nIncidental findings as above." }, { "input": "LOWER CHEST: Bibasilar subpleural ground-glass opacities are unchanged from\n___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa unremarkable.\n\nLYMPH NODES: There is borderline enlargement periaortic bilateral common iliac\nnodes. Bilateral obturator and inguinal lymph nodes measure up to 10 mm.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Borderline lymph node enlargement throughout the abdomen and pelvis likely\nsecondary to underlying rheumatologic disease.\n2. No additional evidence of malignancy within the abdomen and pelvis.\n3. Stable appearance of the lung bases, better evaluated on ___." }, { "input": "LOWER CHEST: Lung bases are clear. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Patient status post splenectomy, reportedly for trauma, with a small\namount of residual splenic tissue in the left upper quadrant. (02:13).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Bilateral\nextra renal pelves are again seen. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended. Proximal small bowel appears\ndecompressed. A moderate segment of dilated small bowel is noted with\nproximal and distal transition points concerning for internal hernia. Mucosal\nenhancement is preserved though note is made of mild mesenteric edema along\nthis segment in the left upper quadrant on series 601b, image 24 and in the\nright mid abdomen on series 601b, image 22. Distally, small bowel is\ndecompressed. The appendix is normal. The colon is thin walled containing a\nmild fecal load.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic deformity of the left superior and inferior pubic ramus is again seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "High-grade small bowel obstruction likely secondary to internal hernia. Small\nvolume free fluid and mild mesenteric edema." }, { "input": "LOWER CHEST: Bibasilar atelectasis. Otherwise, visualized lung fields are\nwithin normal limits. There is no evidence of pleural or pericardial effusion.\nHeart size is top normal with redemonstration of extensive aortic valvular and\nannular calcifications. There are extensive coronary artery calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 1.0 cm segment ___ hypodense lesion, measuring 1.0 cm with\nHounsfield units greater than expected for simple cyst, however, on the prior\nscan from ___, it was characterized as a simple cyst. Increased\nHounsfield units on today's scan is likely secondary to contrast bolus timing.\nMultiple other subcentimeter hypodensities are too small to characterize. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: The pancreas demonstrates fatty atrophy, without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple subcentimeter left peripelvic cysts. There are a few\nsubcentimeter left parapelvic cysts. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Moderate hiatal hernia. Otherwise, the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is scattered diverticulosis throughout the\ncolon. There is scattered equivocal subtle mesenteric haziness (for example,\n___, which can be seen in early diverticulitis, however, no inflamed\ndiverticulum is identified, and findings may be due to volume averaging. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nMild anterolisthesis of L4 on L5 and L5 on S1.\n\nSOFT TISSUES: Small fat containing umbilical hernia. Otherwise, the abdominal\nand pelvic wall is within normal limits.", "output": "1. Study was done with IV contrast, limiting the sensitivity for detecting\nrenal or ureteral stones. No hydronephrosis seen.\n2. Scattered subtle equivocal mesenteric haziness in the left lower quadrant,\nwhich can be seen in early diverticulitis, however, no inflamed diverticulum\nis identified. Early non-complicated diverticulitis cannot be excluded in the\nappropriate clinical setting. Alternatively, this apparent haziness may\nrepresent volume averaging.\n3. Extensive atherosclerosis of the aorta and its branches. Again seen are\nextensive aortic valvular and annular calcifications." }, { "input": "LOWER CHEST: There is a left effusion and bibasilar atelectasis. Coronary\nartery atherosclerotic calcifications noted.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver demonstrates a nodular contour, consistent with\ncirrhosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits. Recanalized umbilical vein, splenomegaly, ascites and\ngastroesophageal varices are consistent with portal hypertension. Hepatic\narterial anatomy is conventional.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring 14.6 cm. No focal splenic lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminates in the proximal duodenum. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Visualized large bowel is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Recanalized umbilical vein gastroesophageal varices noted. Hepatic\narterial anatomy is conventional.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stigmata of cirrhosis and portal hypertension, including a recannulized\numbilical vein, gastroesophageal varices, splenomegaly, and large volume\nascites.\n2. No focal liver lesions.\n3. Small left pleural effusion.\nAn addendum will be issued with liver volumes, following 3D reformatting." }, { "input": "The study is significantly degraded by patient motion and difficulty\npositioning.\n\nLOWER CHEST:\n\nThere are small bilateral pleural effusions. Minimal atelectasis at the left\nlung base is likely related to compression. On the right, there is opacity\nbeyond that expected for compression atelectasis, with air bronchograms highly\nsuggestive of infection. Aspiration pneumonia is a consideration in this\nlocation.\n\nABDOMEN:\n\nHEPATOBILIARY: The majority of the hepatic parenchyma demonstrates\nhomogeneous enhancement. There is a single focus of hypoattenuation seen\nsuperiorly within segment VIII (02:18). This has indistinct margins with\napproximate diameter of 1.3 cm, unchanged from the ___. Gallbladder is not\nabnormally distended. There is no intra or extrahepatic bile duct dilation.\n\nPANCREAS: Limited evaluation of the pancreas is unremarkable.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are bilateral low-density renal lesions, unchanged from prior\nand consistent with simple cysts. No concerning renal mass is identified.\n\nGASTROINTESTINAL: There bowel is decompressed, without abnormal caliber or\nwall thickening identified.\n\nPERITONEUM : Small volume of abdominal ascites is present.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder is partially decompressed with a Foley catheter. The wall\nis however a thicker than expected for and in a decompressed bladder,\nmeasuring over 2 cm in thickness (2:72)\n\nBONES AND SOFT TISSUES:\n\nNo concerning osseous lesion is identified.\n\nThere is diffuse third spacing of fluid with edema seen throughout the\nsubcutaneous tissues.", "output": "Limited examination due to motion and patient positioning.\n\n1. Right lung base consolidation, concerning for infection.\n2. Thickened bladder wall.\n3. Diffuse third spacing of fluid including subcutaneous edema, small volume\nabdominal ascites, and small bilateral pleural effusions." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The previously demonstrated metastatic lesion at the liver dome\nis grossly unchanged in size from prior study, measuring 5.7 x 3.3 cm (02:50).\nHypodensity at the liver dome measuring 1.0 cm (02:46), previously described\nas probable hemangioma remains grossly unchanged. Additional foci previously\ncharacterized as hemangiomas are grossly unchanged. No new focal lesions\nidentified. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral percutaneous nephrostomy tubes and bilateral ureteral\nstents are again demonstrated. Slightly delayed nephrogram on the right\nremains unchanged since at least ___. The kidneys are of normal\nand symmetric size with normal nephrogram. There is no evidence of focal\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post right colectomy with surgical clips\nand suture material again demonstrated in the right lower quadrant. There is\nre-demonstration of adjacent spiculated tissue which remains unchanged since\n___, and which could represent normal postsurgical change or may\npossibly be related to underlying malignancy. The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticulosis of the colon is noted, without evidence of wall\nthickening OR fat stranding. The appendix is not visualized.\n\nPELVIS: Re-demonstration of two distinct soft tissue masses in the lower\npelvis adjacent to the ureters, measuring 4.5 x 3.4 cm on the right and 3.9 x\n2.2 cm on the left (2:102), unchanged from prior study. The inferior portion\nof the left mass again appears contiguous with the left seminal vesicle. The\nurinary bladder is unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable. The above described pelvic\nmasses appear to involve the left seminal vesicle.\n\nLYMPH NODES: The previously described subcentimeter nodules in the right\npericolic gutter appear grossly stable in size from prior study and likely\nrepresent metastatic disease (2:78,80). A mildly prominent aortocaval lymph\nnode measures 1.0 cm in short axis (02:57), minimally decreased in size from\nprior study. There is no new retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small bilateral inguinal hernias containing fat are noted.", "output": "1. Stable appearance of metastatic disease within the abdomen and pelvis,\nincluding liver lesions, lymphadenopathy, soft tissue nodularity, and several\npelvic masses, not substantially changed since ___.\n2. Bilateral percutaneous nephrostomy tubes and ureteral stents remain in\nplace, with persistent slightly delayed right nephrogram.\n3. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day." }, { "input": "LOWER CHEST: Again seen is a 3.1 x 2.2 cm mass at the right lung base,\nunchanged. Bibasilar atelectasis. No focal consolidation. No pleural\neffusion. Trace pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The 6.4 x 3.6 cm right hepatic dome metastatic lesion is\ngrossly unchanged in size compared to ___, although better\nevaluated on prior contrast enhanced CT exam. The other known small\nhypodensity in more anterior hepatic dome is not well visualized given\nnoncontrast technique. The gallbladder is within normal limits.\n\nPANCREAS: Grossly unremarkable.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. \nBilateral hydroureteronephrosis has worsened despite appropriate position\nbilateral percutaneous nephroureterostomy tubes. There is no nephrolithiasis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The patient is status post\nright hemicolectomy with anastomosis seen in the right mid abdomen. Otherwise\nthe colon is unremarkable.\n\nPELVIS: The urinary bladder is unremarkable with appropriately positioned\ndouble-J nephroureteral stent. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged. Again seen are 2 large\npelvic masses adjacent to the bilateral distal ureters measuring 5.0 x 3.6 cm\non the right and 5.2 x 2.3 cm on the left, similar in size compared to ___. These pelvic masses likely represent the cause of bilateral\nureteral obstruction. The mass on the left again extends into the seminal\nvesicle.\n\nLYMPH NODES: No enlarged retroperitoneal lymph nodes. Again seen is surgical\nclips in mesentery adjacent to a small loop of bowel in the right lower\nquadrant with a spiculated lesion within the mesentery measuring 1.5 x 1.0 cm,\nsimilar to ___. there is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute\nfracture.Degenerative changes of the lumbar spine are moderate.\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias are noted.", "output": "1. Worsening bilateral hydroureteronephrosis despite appropriately positioned\nbilateral percutaneous nephroureterostomy tubes.\n2. Overall similar appearance of known metastatic neuroendocrine tumor\nincluding hepatic metastases, right lower pulmonary lobe mass, pelvic masses\n(one of which extends into the seminal vesicle), and small bowel mesentery\nlesion in the right mid abdomen." }, { "input": "LOWER CHEST: Re-demonstrated is consolidation at the right lung base. No\nevidence of pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. 1.0\ncm metastatic lesion at the hepatic dome is unchanged in size compared to the\nprior study (601:31). Multiple hyperenhancing foci are also unchanged\n(601:34) and likely represent hemangiomas. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is diffusely atrophic. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A small accessory splenule is again noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral percutaneous nephrostomy tubes and bilateral ureteral\nstents are in place. There has been interval improvement in bilateral\nhydronephrosis, however, there is a slightly delayed nephrogram on the right\nas before. There is no perinephric abnormality.\n\nGASTROINTESTINAL: No bowel obstruction is seen. The patient is status post\nright colectomy with surgical sutures seen in the right lower quadrant. \nSurgical clips in the right mid to lower abdomen are again present. Adjacent\nspiculated tissue could represent normal postsurgical change or may be related\nto underlying malignancy (02:52). However, this appears stable compared to\n___.\n\nPELVIS: Re-demonstrated are 2 soft tissue masses in the lower pelvis adjacent\nto the ureters measuring 4.6 x 3.5 cm on the right (previously 4.5 x 3.5 cm)\nand 3.9 x 2.2 cm on the left (previously 3.5 x 2.3 cm). As before, the\ninferior portion of the left mass is contiguous with the left seminal vesicle.\nThere is mild circumferential thickening of the bladder wall, which could be\nsecondary to underdistention.. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable. The above described pelvic\nmasses involve the left seminal vesicle.\n\nLYMPH NODES: The previously noted subcentimeter nodules in the right pericolic\ngutter likely represent metastatic disease and are unchanged (02: 44 and 45). \nSeveral aortocaval nodes are also unchanged (2: 23 and 30). There is no new\nretroperitoneal mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild thickening of the bladder wall could be secondary to underdistention,\nhowever, correlation with urinalysis is recommended. Otherwise, no acute CT\nfindings in the abdomen or pelvis.\n2. Interval improvement in bilateral hydronephrosis, however, there is a\npersistently delayed nephrogram on the right.\n3. No significant change in known metastatic disease, as described above." }, { "input": "LOWER CHEST: Large left pleural effusion with compressive atelectasis. Trace\nright pleural effusion. Opacities in the right lower lobe likely reflect\natelectasis. No pericardial effusion. Moderate atherosclerotic\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is extremely atrophic with innumerable calcifications\nconsistent with chronic pancreatitis. No evidence of suspicious focal lesions\nwithin the limitations of an unenhanced scan. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral native kidneys are atrophic with innumerable hypodensities,\nlikely renal cysts. There is no evidence of suspicious focal renal lesions\nwithin the limitations of an unenhanced scan. A left iliac fossa renal\ntransplant kidney is noted with moderate hydronephrosis similar to that seen\non prior MR pelvis (3; 53). There is no hydronephrosis of the native kidneys.\nThere is no nephrolithiasis. There is no perinephric abnormality.\n\nOf note, evaluation of the kidneys are severely limited without IV contrast.\n\nGASTROINTESTINAL: The stomach is unremarkable. There appears to be diffuse\nsmall bowel and large bowel wall thickening, which may be consistent with\nthird spacing. The thickening of the rectum and distal sigmoid is at a\nproportion to the rest the small and large bowel and findings may be related\nto long-term/chronic stercoral colitis given its appearance on the prior MRI\nof the pelvis dated ___. No evidence of obstruction. Appendix\nappears unremarkable (3; 40).\n\nDiffuse omental and mesenteric stranding consistent with third spacing.\n\nPELVIS: The urinary bladder is decompressed with a Foley catheter foci of air\nconsistent with recent instrumentation and distal ureters are unremarkable. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes are noted in the spine. Mild bilateral\ndegenerative hip changes are also noted.\n\nSOFT TISSUES: There is diffuse anasarca.", "output": "1. Diffuse anasarca and stranding in the omentum and mesentery consistent with\nthird spacing. Diffuse bowel wall thickening likely due to third spacing. \nDisproportionately increased wall thickening of the distal sigmoid and rectum\nmay reflect chronic stercoral colitis.\n2. Large left pleural effusion with compressive atelectasis. Trace right\npleural effusion.\n3. Moderate hydronephrosis of the right iliac transplant kidney is similar to\nthat seen on MR pelvis.\n4. No definite nephrolithiasis. Evaluation of the kidneys is limited without\nIV contrast." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Decreased attenuation of the liver suggests steatosis. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Pancreas is mildly atrophied with the presence of a punctate\ncalcifications in the distal body. No evidence of focal lesions or pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 14 mm simple cyst is seen in the superior pole of the right kidney. \nMultiple subcentimeter hypodensities in the right kidney are too small to\ncharacterize, likely simple cysts. There is no evidence of hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits noting a few scattered noninflamed\ndiverticula. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Chronic bilateral L5 pars defects noted with evidence of grade 1 L5 on\nS1 anterolisthesis.\n\nSOFT TISSUES: An supraumbilical hernia containing fat is noted.", "output": "No evidence of acute abdominal process." }, { "input": "LOWER CHEST: There is a 7 mm nodule in the left lower lobe, seen on image 3 of\nseries 5. Linear atelectasis noted at the left lung base. Lung bases are\notherwise unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Post-surgical changes are seen from partial colectomy,\nileostomy and mucous fistula. There is a large parastomal hernia, containing\nloops of small bowel, without evidence for obstruction. Additionally, there\nis a large herniation at the site of the patient's mucous fistula, containing\napproximately 10 cm of colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small, 2.3\ncm fluid collection adjacent to the left inguinal canal likely represents a\npostoperative seroma vs lymphocele.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.", "output": "1. Parastomal hernia at the site of patient's right lower quadrant ileostomy,\ncontaining small bowel, without evidence for obstruction.\n2. Prolapsing mucous fistula, containing approximately 10 cm of colon.\n3. 7 mm pulmonary nodule in the left lower lobe.\n\nRECOMMENDATION(S): 7 mm pulmonary nodule: For low risk patients, initial\nfollow-up\nCT at ___ months and then at ___ months if no change. For high risk\npatients - initial follow-up CT at ___ months and then at ___ and 24 months\nif no change." }, { "input": "LOWER CHEST: Compared to ___, there is an unchanged 0.9 cm\nnodule in the left lower lobe (___). There is consolidation in the bilateral\nlung bases, likely atelectasis. There are small bilateral, right greater than\nleft, non hemorrhagic pleural effusions. Status post aortic valve\nreplacement, as before. There are midline sternotomy wires. There is no\nevidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are bulky without definite nodule.\n\nURINARY: There are multiple bilateral simple cysts. The largest on the left\nmeasures up to 3.5 cm (___). The kidneys are of normal and symmetric size\nwith normal nephrogram. No hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient is\nstatus post ileocecectomy. The anastomosis is intact without evidence of\nleak, though rectal contrast has not reached the level of the anastomosis. \nThere is scattered fatty stranding in the anterior mesentery, likely related\nto prior surgery. There is a 9.2 x 1.6 cm fluid collection in the anterior\nabdominal musculature with a few punctate foci of gas, likely postsurgical\n(___). A right lower quadrant approach drain tracks along the anterior\nsubcutaneous tissues before terminating in the mid abdomen slightly to the\nleft of midline (___). The tip is not located in the above described fluid\ncollection. There is diverticulosis without evidence of diverticulitis. \nThere is a left inguinal hernia containing a loop of large bowel. The\nappendix is surgically absent.\n\nPELVIS: A Foley catheter limits evaluation of the urinary bladder. There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are a few prominent, though nonenlarged bilateral external\niliac and inguinal lymph nodes. Is no retroperitoneal or mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. The aorta is tortuous. \nModerate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are extensive degenerative changes of the visualized spine, not\nsignificantly changed compared ___.\n\nSOFT TISSUES: Please see above for description of anterior abdominal fluid\ncollection and left inguinal hernia.", "output": "1. The patient is status post ileocecectomy and repair of an 8 cm midline\nhernia.\n2. No evidence of anastomotic leak, as clinically questioned.\n3. There is a 9.2 x 1.6 cm fluid collection just deep to the anterior\nabdominal musculature with a few punctate foci of gas, likely postsurgical.\n4. The right lower quadrant approach drain tracks along the anterior\nsubcutaneous tissues before terminating in the mid abdomen slightly to the\nleft of midline and not in the above-described fluid collection.\n5. There is a left inguinal hernia containing a loop of large bowel. Rectal\nadministered contrast enters this hernia via a retrograde fashion but doesn't\ntravel further proximal than within the hernia." }, { "input": "LOWER CHEST: Mild centrilobular emphysema, unchanged. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The previously identified cystic hepatic mass in segment 4 has\nbeen resected and postsurgical changes are noted. The liver demonstrates\nhomogenous attenuation throughout. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreatic cystic lesions seen on prior MR are not well\nvisualized on the current exam. There is no evidence of pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSub cm hypodensity in the upper pole of the left kidney is too small\ncharacterize, unchanged since ___. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic\ndiverticulosis is present without evidence of acute diverticulitis. The\nappendix is not visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative disease of the thoracolumbar spine is noted.\n\nSOFT TISSUES: A small fat containing umbilical hernia is noted.", "output": "1. No evidence of a focal hepatic lesion.\n2. Postsurgical changes are noted following resection of the segment 4 cystic\nhepatic mass.\n3. Pancreatic cystic lesions are not well visualized on the current exam. \nPlease refer to liver MR." }, { "input": "VASCULAR:\n\nAn infrarenal abdominal aortic aneurysm, containing calcified and noncalcified\nplaque, measures approximately 6.5 x 6.3 cm in greatest dimension (601b:54). \nAtherosclerotic calcifications are present at the origins of the celiac, SMA,\nand renal arteries.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. Small region of focal fat adjacent to the\nfalciform. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS: Multiple hypodensities throughout the entire pancreas are present,\nconsistent with dilated side branches, without internal nodularity or apparent\nenhancement. In the pancreatic tail, 1 cystic lesion measures 1.1 by 0.8 cm\n(601b:54), and a second cystic lesion measures 0.9 x 2.1 cm (601b:55). \nSeveral hypodensities are located in the pancreatic head, of which the largest\nmeasures 10 mm (3a:32). There is no main pancreatic ductal dilatation. \nMultiple calcifications are present in the pancreatic head, body and tail, and\nscattered intraductal calcifications may be present suggesting sequelae of\nchronic pancreatitis. There is a periampullary duodenum diverticulum.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, except to\nnote a tiny wedge-shaped hypodensity in the lower pole (601b:75), that might\nrepresent a cyst or hemangioma, of doubtful significance, without concerning\nfocal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral renal hypodensities, some of which too small to\ncharacterize are statistically likely cysts. There is a 3.8 cm minimally\ncomplex cyst in the lower pole of the left kidney with single thin septation\nbut no nodularity (3 a: 55, 601b:73). There is no evidence of stones, focal\nrenal lesions, or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Incidental note of duodenal diverticuli. \nContrast, likely from a prior study, fills multiple colonic diverticuli. \nMultiple prominent mesenteric lymph nodes are not enlarged by CT size\ncriteria.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged with punctate calcifications, likely\nrelated to prior prostatitis.\n\nBONES: Patient is post total right hip replacement, causing streak artifact,\nand limiting evaluation of pelvic viscera. No focal sclerotic or lytic lesion\nconcerning for malignancy. Mild leftward lower lumbar scoliosis, with\nmultilevel severe degenerative changes, as seen on the prior CT. Lower median\nsternotomy wires are present.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.", "output": "1. Multiple pancreatic hypodensities are consistent with dilated side branch\nducts, and in the setting of diffuse calcifications throughout the pancreas,\nare favored to represent sequelae of chronic pancreatitis, although\nside-branch IPMNs cannot be excluded. No pancreatic head mass detected. No\nmain pancreatic duct dilation.\n\n2. Infrarenal abdominal aortic aneurysm measures approximately 6.5 cm in\ngreatest dimension.\n\n3. Diverticulosis without evidence of diverticulitis. Bilateral hypodense\nrenal lesions, some of which are too small to accurately characterize but\nstatistically likely represent cysts.\n\nRECOMMENDATION(S): MRCP in 6 months for follow-up of multiple pancreatic\ncystic lesions. Consider referral to pancreas center at ___.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:15 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. Trace right pleural effusion. \nSevere coronary artery calcifications. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones but\nis relatively decompressed. There is apparent wall thickening at the fundus\nwith not clearly defined margins.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a focally dilated\nloop of proximal jejunum measuring up to 4.3 cm in diameter with an apparent\ntransition point in the mid abdomen where there is apparent fibrosis and\ntethering of multiple loops of bowel (series 601b, image 28). There is\nextensive diverticulosis without focal wall thickening or adjacent fat\nstranding. The appendix is not visualized.\n\nPERITONEUM/OMENTUM: There is small volume ascites with areas of prominent\nperitoneal enhancement. There is extensive omental stranding and nodularity\nwith the single largest nodule located anterior to the inferior edge of the\nliver measuring 1.0 x 0.6 cm (series 2, image 44).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nsmall volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted. The adnexae are nonenlarged.\n\nLYMPH NODES: Retroperitoneal and mesenteric lymph nodes are prominent, but not\npathologically enlarged by size criteria. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted. Significant narrowing of the proximal left external iliac\nartery due to atherosclerosis (2:62)\n\nBONES: Severe left hip osteoarthritis includes osteophytosis, joint space\nnarrowing, subchondral sclerosis, and subchondral cyst formation.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Extensive omental fat stranding and nodularity with small volume ascites\nand areas of avid peritoneal enhancement. While these are findings most\ncommonly seen with ovarian and GI metastatic disease, no primary candidate is\nidentified. If infection is a strong clinical consideration, tuberculous\nperitonitis is a consideration, though metastasis with a nonvisualized primary\nremains more likely. Much less likely on the differential is primary\nabdominal mesothelioma.\n2. Wall thickening at the fundus of the gallbladder with poorly defined\nmargins. While this could be secondary to findings detailed above, dedicated\nimaging of the gallbladder is suggested to further characterize to exclude\npossible underlying primary lesion, preferably by MRI.\n3. A focal loop of proximal jejunum demonstrates dilation to 4.3 cm with a\ntransition point in the mid abdomen associated with tethering of multiple\nloops of bowel. This finding is concerning for partial small bowel\nobstruction, though the duodenum just proximal to this loop of jejunum is not\ndilated.\n4. Cholelithiasis.\n5. Severe left hip osteoarthritis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:38 pm, approximately\n20 minutes after discovery of the findings. Update of impression point 3\nsubsequently discussed with Dr. ___ by Dr. ___." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a small amount of perihepatic ascites, new since the prior study in\n___. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation. Wall\nthickening along the fundus of the gallbladder and adjacent to the hepatic\nflexure, which may be secondary to adjacent omental thickening vs primary\nlesion, unchanged since recent prior exam.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are regions of cortical thinning seen in the left kidney, which\nmay be due to prior insult. The right kidney is grossly normal. There is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is again extensive\nomental fat stranding and nodularity with small volume ascites and areas of\nperitoneal enhancement, concerning for metastatic disease. The small bowel\nloops are grossly normal in size without evidence of obstruction. There is a\nsmall amount of paracolic fluid bilaterally, right greater than left. \nDiverticulosis is noted in the sigmoid colon without evidence of acute\ndiverticulitis. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small amount\nof free pelvic fluid is seen.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. Prominent\nmesenteric lymph nodes are noted without meeting CT size criteria for\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Severe degenerative changes are re-demonstrated in the left hip.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Re-demonstration of extensive omental fat stranding and nodularity with\nsmall volume ascites and areas of peritoneal enhancement concerning for\nmalignancy. CT guided omental biopsy is recommended for further evaluation.\n2. Small amount of perihepatic ascites is new since the prior study in ___.\n3. Cholelithiasis with wall thickening along the fundus of the gallbladder,\nadjacent to the hepatic flexure, may be secondary to adjacent omental\nthickening vs primary lesion, unchanged since recent prior exam. As\npreviously mentioned, further evaluation by MRI could be obtained.\n4. Severe left hip osteoarthritis." }, { "input": "LOWER CHEST: There are severe emphysematous changes at the lung bases. There\nis a bed trace shin of the left hemidiaphragm. No pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Right adrenal gland is unremarkable. There is a 1.5 x 2.0 cm nodule\nof the left adrenal gland, previously characterized as an adenoma.\n\nURINARY: Status post left nephrectomy. With surgical clips seen in the\nnephrectomy bed. The right kidney is of normal size and shape. Several\nsimple and parapelvic cysts are noted measuring up to 2.9 cm lower pole. \nThere is no hydronephrosis or focal renal lesion seen. There are areas of\ncortical scarring seen in the lower interpolar region.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is mild\nwall thickening and minimal surrounding fat stranding of the sigmoid colon and\nrectum. The appendix is not visualized.\n\nPELVIS: Bladder is decompressed around a Foley catheter. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged. Seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Several upper abdominal midline ventral wall defects are noted\ncontaining fact. 1 just above the level lumbar iliacus into the left midline\ncontains a loop of small bowel without evidence of obstruction", "output": "1. Mild wall thickening of the sigmoid colon and rectum with minimal\nsurrounding inflammatory changes suggestive of mild proctocolitis of\ninfectious, inflammatory, or less likely ischemic etiology. No other acute\nintra-abdominal process.\n2. Unchanged left adrenal adenoma.\n3. Severe emphysema of the partially imaged lung base.\n\nIMPRESSION:\n\n\n1. Mild wall thickening of the sigmoid colon with minimal surrounding\ninflammatory changes suggestive of mild sigmoid colitis. No other acute\nintra-abdominal process.\n2. Unchanged left adrenal adenoma.\n3. Severe emphysema of the partially imaged lung base." }, { "input": "LOWER CHEST: Emphysema. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of hepatic mass within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains a small gallstone without evidence of\ncholecystitis\n\nPANCREAS: The pancreas is normal in bulk and homogeneous in attenuation. \nThere is no pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is top-normal in size measuring 13.4 cm, and homogeneous in\nattenuation.\n\nADRENALS: There is a 1.5 cm left adrenal nodule consistent with an adenoma. \nThe right adrenal gland is normal in size and shape.\n\nURINARY: The patient is status post left nephrectomy. The right kidney is\nenlarged. There are unchanged multiple areas of cortical scarring and mild\nsurrounding perinephric stranding. Multiple right renal cysts are also\nunchanged. There is moderate hydroureteronephrosis extending to the bladder,\nunchanged compared to prior CT from ___. Punctate nonobstructing\nstones are seen in the right kidney.\n\nGASTROINTESTINAL: Herniorrhaphy tacks are seen along the left hemidiaphragm\noverlying the stomach. The stomach is unremarkable. Small bowel loops are\nnormal in caliber. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding.\n\nPELVIS: Again seen is an approximately 2.6 x 2.0 cm mass along the\nposterosuperior bladder wall with punctate calcifications. Mild stranding\nposteriorly suggests extension beyond the bladder wall. Surgical clips are\nnoted in the left hemipelvis, likely from prior lymph node dissection. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diastasis recti. Small bilateral fat containing\ninguinal hernias are noted", "output": "1. Unchanged moderate right hydroureteronephrosis to the level of the bladder.\nRedemonstration of an approximately 2.6 x 2.0 cm mass along the\nposterosuperior bladder wall with punctate calcifications, concerning for\nrecurrent tumor. Mild stranding posteriorly suggests extension beyond the\nbladder wall.\n2. Cholelithiasis.\n3. Colonic diverticulosis." }, { "input": "LOWER CHEST: Emphysema, similar to prior exam. No evidence of pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Unchanged appearance of a 1.5 cm left adrenal adenoma (02:22). The\nright adrenal gland is normal in size and shape.\n\nURINARY: Patient is status post left nephrectomy. No soft tissue\nabnormalities noted in the surgical resection bed. The right kidney is\nenlarged with multiple areas of cortical scarring. There is slight interval\ndecrease in right perinephric stranding compared to ___. Multiple\nright renal cysts are unchanged compared to most recent prior exam. Again\ndemonstrated is moderate hydroureteronephrosis extending to the bladder,\nunchanged compared to at least ___. Tiny nonobstructing right\nrenal stones are again seen.\n\nGASTROINTESTINAL: Again seen are herniorrhaphy tacks along the left\nhemidiaphragm. The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: Again seen is a 2.2 x 1.5 cm mass along the posterosuperior bladder\nwall with internal punctate calcifications. Mild stranding posteriorly\nsuggests extension beyond the bladder wall, and is unchanged compared to most\nrecent prior exam. Surgical clips are again noted in the left hemipelvis,\nlikely from prior lymph node dissection. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable moderate right hydroureteronephrosis to the level of the bladder\nwith redemonstration of a 2.2 x 1.5 cm mass along the posterosuperior bladder\nwall, concerning for new malignancy or recurrent tumor.\n2. Nonobstructive right renal stones, similar to ___.\n3. Cholelithiasis.\n\nRECOMMENDATION(S): Less perinephric stranding" }, { "input": "LOWER CHEST: There is severe emphysematous changes the bilateral lung bases. \nThere is elevation of the left hemidiaphragm with numerous round surgical\nclips. There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Incidental note is made of 2 small accessory\nspleens.\n\nADRENALS: The right adrenal gland is normal in size and shape. An\napproximately 1.7 x 1.4 cm left adrenal adenoma is stable.\n\nURINARY: Evaluation the kidneys is limited on this unenhanced CT scan. Within\nthis limitation, multiple simple appearing renal cysts are unchanged. There\nis new gas within the collecting system (3:45, 3:47). There is no\nhydronephrosis or nephrolithiasis. The distal right ureter is dilated with an\nadditional focus of loculated gas (3:84). A Foley catheter is placed within\nthe prostate, likely the TURPT defect, with a small amount of dependent gas\nand a single locule of anti dependent gas (3:81). The patient is status-post\nleft nephrectomy. There are no abnormal soft tissue nodules within the left\nnephrectomy bed. Calcifications are noted within the bladder wall. On best\nseen on series 3, ___ 81 and 87.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nIrregularities of the posterior eleventh and twelfth ribs a post or fifth rib\nare compatible with prior, healed fractures.\n\nSOFT TISSUES: There is a large, fat containing ventral hernia (5b:45).", "output": "1. Locules of gas in the distal right ureter and within the right renal\ncollecting system are new, raising the possibility of emphysematous pyelitis.\n2. A Foley catheter is placed within the prostate, and should be advanced\napproximately 6 cm.\n3. Several renal cysts.\n4. Calcifications in the bladder wall may relate to chronic inflammation over\nbe due to be in known tumor recurrence. .\n\nNOTIFICATION: The findings concerning for emphysematous pyelitis were\ndiscussed with ___, M.D. by ___, M.D. on the telephone\non ___ at 12:02 ___, approximately 10 minutes after discovery of the\nfindings.\n\nThe findings related to the Foley catheter balloon were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 14:39,\napproximately 10 minutes after discovery of the findings." }, { "input": "LOWER CHEST: There is again severe bibasilar emphysema, right greater than\nleft. There is no evidence of pleural or pericardial effusion. Surgical\nclips are again seen projecting over the left diaphragm.\n\nABDOMEN:\nThe left hemidiaphragm is excluded from the exam as are portions of the\nspleen, stomach, and left upper quadrant fat, slightly limiting the exam.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas appears mildly atrophic, without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The included portions of the spleen show no definite abnormalities.\n\nADRENALS: The right adrenal gland is normal in appearance. There is a nodule\nin the left adrenal gland measuring 1.7 cm (series 3: Image 19), previously\ncharacterized as adrenal adenoma.\n\nURINARY: Patient is status post left nephrectomy. There is again moderate\nhydroureteronephrosis involving the right kidney extending to the level of the\nbladder. Multiple cortically based hypodense lesions are again seen in the\nright kidney,, the 3 largest of which are consistent with simple cysts\nincluding 1 parapelvic cyst. Smaller lesions are also likely cysts but too\nsmall to characterize definitively. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: There is a distorted lobulated appearance of the bladder, as before,\nlikely reflecting the sequela of treatment of known malignancy, similar in\nappearance to the prior study from ___. There is no free fluid in the\npelvis. There is again an enlarged prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nsclerotic focus seen in the left acetabular likely represents bone island.\n\nSOFT TISSUES: There is a moderate-sized ventral hernia that is bilobed with a\nsuperior portion containing fat and a portion of the transverse colon and the\nmore inferior portion omental fat and a loop of small bowel. There is no\ncomplication evident.", "output": "1. Similar appearance of moderate hydroureteronephrosis involving the right\nkidney and extending to the level of the lobulated bladder, compatible with\nknown bladder malignancy, as compared to prior study in ___.\n2. Patient is status post left nephrectomy.\n3. Severe bibasilar emphysema, unchanged.\n4. 1.7 cm adrenal adenoma, unchanged.\n5. Small hiatal hernia.\n6. Bilobed ventral hernia containing omental fat with the upper portion a part\nof the transverse colon and the lower portion a part of small bowel, without\ncomplication.\n7. Cholelithiasis." }, { "input": "LOWER CHEST: Severe emphysematous changes are seen at the bilateral lung\nbases, unchanged compared to prior. There is also linear scarring with\ncalcifications at the right lung base, some of which appears nodular. There\nis a 5 mm solid nodule at the right lung base (series 2, image 30). There is\nelevation of the left hemidiaphragm status post repair. No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is a single gallstone layering dependently within the\ngallbladder. There is no evidence of acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There are 2 small accessory spleens at the hilum.\n\nADRENALS: There is a left adrenal adenoma (series 2, image 32), unchanged. \nThe right adrenal gland is normal size and shape.\n\nURINARY: The patient is status post left nephrectomy. Multiple renal cysts\nare seen within the right kidney. Additional subcentimeter hypodensities\nwithin the right kidney are too small to characterize, but also likely\nrepresent simple cysts. There is no hydronephrosis. There is no\nnephrolithiasis. Mild perinephric stranding is unchanged compared to prior\nand within normal limits for patient of this age.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS AND REPRODUCTIVE ORGANS: The neobladder is lobulated appearance,\nunchanged compared to prior. Although the Foley tip appears to terminate\nwithin the bladder lumen, the balloon is inflated within enlarged prostate. \nThe prostate measures approximately 6.1 x 5.8 cm. There is no free fluid in\nthe pelvis. Surgical clips are seen throughout the left hemipelvis due to\nlymph node dissection.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is a chronic left posterior rib fracture (series 2, image 7). \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a moderate sized fat containing ventral hernia. a there\nis a small fat containing left inguinal hernia.", "output": "1. Although the Foley tip appears to terminate within the bladder lumen, the\nballoon is inflated within an enlarged prostate. Otherwise, no acute findings\nwithin the abdomen or pelvis.\n2. Incidental findings include cholelithiasis, and left adrenal adenoma, and\nprostatomegaly.\n3. 5 mm solid nodule at the right lung base.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: Again demonstrated are bilateral severe emphysematous changes and\nright lower lobe pulmonary nodule measuring up to 7 mm, unchanged compared to\nprior (2; 18). There is no pericardial effusion or pleural effusion. \nPostsurgical changes are noted at the left hemidiaphragm with chronic\nelevation similar to prior. Suture material is also noted in the right lower\nlung, likely from prior wedge resection.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions within\nthe limitations of an unenhanced scan. There is no pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is a 1.5\nx 1.8 cm left adrenal gland nodule, unchanged from prior, compatible with an\nadenoma.\n\nURINARY: Patient is status post left nephrectomy. Multiple renal cysts are\nagain noted in the right kidney, similar to prior. Additional subcentimeter\nhypodensities in the right kidney are too small to characterize, but likely\nrepresents renal cysts. There is no suspicious focal renal lesions within the\nlimitations of an unenhanced scan. There is no hydronephrosis. There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The bladder contains a Foley catheter and is decompressed, similar to\nprior. Air within the lumen is consistent with recent instrumentation. \nBalloon of the Foley is now within the lumen of the neobladder. there is no\nfree fluid in the pelvis. Surgical clips in the left hemipelvis is noted\nconsistent with prior lymph node dissection.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged, measuring 5.9 x 5.2 cm. And\nthe seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Two ventral hernias are noted, but the most superior contains a\nloop of the transverse colon without evidence of obstruction. Within this\nmost superior ventral hernia, there is also there is mild fat stranding (602;\n38) which may be seen with fat necrosis or infarction.", "output": "1. Two ventral hernias, the more superior contains a loop of transverse colon\nwithout evidence of obstruction. In addition, there is mild fat stranding\nwithin the most superior ventral hernia can be seen with fat necrosis or\ninfarction.\n2. Gallstones without evidence of cholecystitis." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions with bibasilar\natelectasis. Atherosclerotic calcification includes extensive coronary artery\ncalcification. Central venous catheter with tip terminating at the cavoatrial\njunction\n\nABDOMEN:\nThere is a small amount of perihepatic and a small amount of perisplenic\nfluid.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder wall is thickened and\nedematous. Interval placement of a cholecystostomy tube.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral small simple cysts. There is no solid lesion or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops \ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits.\n\nPELVIS: A Foley catheter is present in the bladder which contains a small\namount of air. There is a small amount of free fluid in the left pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is mildly enlarged. The seminal\nvesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate \natherosclerotic disease is noted.\n\nBONES: The patient is status post fusion of the lower lumbar spine from\nL3-L5. Rods and screws are in place. There are degenerative changes in\nthe spine compression deformity of the L1, L2 and L3 vertebral bodies\nwhich appears stable. There is again evidence of vertebroplasty at L1 and\nL2. There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small to moderate size umbilical hernia contains fat and is\nunchanged.", "output": "Interval placement of a transhepatic cholecystostomy tube which is well placed\nwithin the gallbladder. The gallbladder wall continues to show a small amount\nof edema and wall thickening. The gallbladder is decompressed.\n\nThere is trace perisplenic and perihepatic ascites. There is no free air.\n\nSmall bilateral pleural effusions with associated bibasilar subsegmental\natelectasis." }, { "input": "LOWER CHEST: Bibasilar atelectasis is new since ___. Punctate\ncalcifications in the bilateral lower lobes are likely from prior\ngranulomatous disease. Coronary calcifications are stable. The esophagus\nappears thickened at the GE junction, which may be due to collapsed hiatal\nhernia or esophagitis. Right posterior deformity is chronic.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains layering density, likely vicarious\nexcretion of previously administered IV contrast. There is stable amount of\nperihepatic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There has been interval\ndevelopment of colonic dilatation, measuring up to 7 mm, likely postop ileus. \nThere is no evidence of obstruction. The appendix is not visualized.\n\nPELVIS: The urinary bladder is collapsed with a Foley in place. The distal\nureters are unremarkable. There is interval increase in an intermediate\ndensity pelvic fluid measuring up to 35 Hounsfield units compared to prior\nexam.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: Scattered retroperitoneal lymph nodes are not enlarged by CT size\ncriteria. There is no mesenteric lymphadenopathy. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Patient status post open and surgical fixation of the pubic symphysis\ndiastasis with anterior approach plate and screws. There is no evidence of\nhardware or perihardware fracture. Previously described comminuted fracture\nof the right sacral a ala extending into the right SI joint appear grossly\nunchanged. No new fractures are seen.\n\nSOFT TISSUES: In the lower anterior pelvis, there is a heterogeneous\ncollection measuring 5.8 x 1.7 cm with small foci of hyperdensity posteriorly\n(3:81) and laterally on the left (3:78), likely reflecting surgical bed seroma\nand small amount of hematoma. Multiple foci of gas within this fluid\ncollection likely represent postsurgical changes. Additional small fluid\ncollection in the right anterolateral subcutaneous base also is likely\npostsurgical. Small foci of gas tracking along the anterior right rectus\nmuscle is likely postsurgical. Additional small collection of fluid in the\nantral lateral right subcutaneous tissue with small foci of gas is also likely\npostsurgical. There is diffuse subcutaneous stranding as well as\ninterdigitating between the right oblique abdominal muscles, likely due to\nanasarca and postsurgical changes. Skin staples are aligned. There is\ninterval decrease in thickened appearance of the abdominal rectus muscles. \nThere is a small amount of extraperitoneal hemo peritoneum, likely\npostsurgical.", "output": "1. Minimal increase in size of small intraperitoneal and extraperitoneal hemo\nperitoneum measuring 35HU at maximum density, likely postsurgical. No\nhyperdense component to suggest acute bleed.\n2. Distended large bowel without dilated small bowel loops most consistent\nwith ileus.\n3. Postsurgical changes along anterior suprapubic subcutaneous tissue with\nsmall underlying collection measuring 5.8 x 1.7 cm with locules of gas is most\nconsistent with small post operative hematoma.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:39 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Lung bases notable for emphysema and bibasal dependent\natelectasis. Abutting the distal esophagus is a intermediate density lesion\nmeasuring 6.2 x 5.3 x 5.1 cm well circumscribed lesion, new from prior exam. \nThis lesion appears homogeneous in attenuation with density approximately 50\nHounsfield units.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally and is without focal lesion of\nconcern. Main portal vein is patent. No biliary ductal dilation. \nGallbladder appears normal. Common bile duct is normal in caliber.\n\nPANCREAS: The pancreas is atrophic. A hypodense lesion is seen abutting the\ntail of the pancreas, series 601b, image 35 measuring 2.2 x 2.5 x 1.5 cm. \nOtherwise the pancreas is unremarkable.\n\nSPLEEN: The spleen is normal.\n\nADRENALS: Both adrenals are normal.\n\nURINARY: Multiple renal cysts are seen, largest in the lower pole of the left\nkidney measuring up to 7.2 cm in maximal diameter. There is also a left\nparapelvic renal cyst. No worrisome renal lesion, hydronephrosis or\npyelonephritis.\n\nGASTROINTESTINAL: As stated above, there is a periesophageal intermediate\ndensity lesion which is new from prior. In addition, there is a similar\ndensity lesion abutting the greater curvature of the stomach best seen on\nseries 602 B image 49 measuring 2.0 x 7.0 x 5.4 cm. This abnormality is also\nnew from the prior exam. There are prominent mesenteric lymph nodes in the\nleft upper quadrant measuring to 1.8 cm in short axis dimension, series 2,\nimage 32. These findings raise concern for malignancy, possibly lymphoma.\n\nSmall bowel loops demonstrate no signs of ileus or obstruction. In the right\nlower quadrant, there is inflammatory fat stranding with phlegmonous changes\nand a small fluid collection noted anteriorly abutting the ileocecal junction\nmeasuring 2.0 x 2.5 x 3.1 cm. A normal appendix is not visualized. Findings\nare suggestive of perforated appendicitis. There is reactive thickening and\nhyperemia involving an of adjacent small bowel loop and cecum. No free air. \nColonic diverticulosis without diverticulitis noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No pelvic\nfree fluid.\n\nLYMPH NODES: Prominent lymph nodes measuring up to 15 mm in short axis in the\nleft upper abdomen along the small bowel mesentery noted on 601 B image 20 no\nretroperitoneal, pelvic or inguinal adenopathy.-30.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Severe multilevel degenerative changes in the lower thoracic and lumbar\nspine loading chronic T12 anterior wedge compression fracture, and mild\nretrolisthesis of L5 on S1, unchanged since ___.\n\nSOFT TISSUES: Clips in the left inguinal region likely reflect prior hernia\nrepair. A tiny right fat containing inguinal hernia is present.", "output": "1. Phlegmonous changes in the right lower quadrant with small fluid collection\nis concerning for perforated appendicitis. Reactive thickening of the\nadjacent small bowel and cecum is likely secondary.\n2. Intermediate density masses adjacent to the distal esophagus and greater\ncurvature of the stomach with left upper quadrant mesenteric nodal\nenlargement. Findings concerning for malignancy, possibly lymphoma.\n3. Cystic lesion abutting the tail of the pancreas measuring up to 2.5 cm.\n\nRECOMMENDATION(S): MRI to further assess pancreatic tail cystic lesion. \nLesions abutting the distal esophagus and greater curvature of the stomach may\nalso be further assessed at the time of MRI. Endoscopic ultrasound may also\nbe considered once the acute symptoms resolve. Cap\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:29 pm, 1 minutes after\ndiscovery of the findings.\n\nThe updated findings updated recommendations were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 11:57 pm, 1 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: The other than a small amount of bibasilar atelectasis, the\nvisualized lower lungs are clear. There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneously attenuated throughout. There is no\nfocal hepatic lesion. The liver surface contour is smooth. There is no\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits, without stones or wall thickening. There is no ascites.\n\nPANCREAS: Two sub-centimeter hypodense, round lesions, one 6-mm lesion in the\nhead and one 9-mm lesion in the neck, are likely branch IPMNs (Series 2,\nImages 25 and 31). The pancreas otherwise has normal attenuation throughout\nwithout pancreatic ductal dilatation or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout, without\nfocal lesions. An accessory spleen is located at the hilum (Series 2, Image\n24).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and symmetric with normal nephrograms.\nA 3.2 x 3-cm, well-circumscribed, round lesion of simple fluid density (13 ___\nin the cortex of the right inferior renal pole is most consistent with a\nsimple cyst (Series 2, Image 49). A sub-centimeter cortical hypodensity in\nthe left upper pole is too small to characterize by CT but also likely a cyst\n(Series 2, Image 37; Series 601b, Image 43). There is no evidence of stones,\nconcerning focal renal lesion, hydronephrosis, or perinephric abnormality. \nThe ureters are not dilated and grossly normal appearing. The urinary bladder\nis moderately distended with urine and grossly unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is an umbilical hernia\nwith herniation of a small bowel loop but no evidence of obstruction (Series\n2, Images 54-58). Small bowel loops are normal in caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix contains air and is normal in caliber without evidence of fat\nstranding (Series 2, Image 59). There is no pneumatosis or pneumoperitoneum. \nThere is no bowel obstruction.\n\nRETROPERITONEUM: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Calcified atherosclerotic\nlesions are most prominent in the descending abdominal aorta, bifurcation, and\niliac branches. A small amount of vascular calcification is also noted at the\nceliac trunk but does not appear occlusive.\n\nPELVIS: There is no pelvic or inguinal lymphadenopathy. There is no free fluid\nin the pelvis. Bilateral fat-containing inguinal hernias, greater on the left\ncompared to the right, are demonstrated (Series 2, Image 80; Series 601b,\nImage 30). There is no herniation of bowel contents through the inguinal\nhernias.\n\nBONES AND SOFT TISSUES: There is no suspicious lytic or sclerotic bony\nlesion. Schmorl's nodes and intervertebral disc space narrowing at L4-L5 are\nconsistent with degenerative change (Series 601b, Image 45). Umbilical hernia\nand inguinal hernias are noted as above. The soft tissues are otherwise\nwithin normal limits.", "output": "1. Small umbilical hernia containing a loop of small bowel but without\nevidence of obstruction.\n\n2. Bilateral, fat-containing inguinal hernias, greater on the left compared\nto the right\n\n3. No evidence of acute appendicitis, diverticulitis, or colitis to explain\nthe patient's right lower quadrant pain.\n\n4. Two incidental cystic lesions likely IPMNs in the head and neck of the\npancreas for which follow-up imaging with MRI is recommended in ___ year.\n\n5. Incidental simple renal cysts, largest is 3.2-cm in the right inferior\npole.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 13:22 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: No suspicious lesion. No intra or extrahepatic ductal\ndilation. Contracted gallbladder with wall calcifications/cholelithiasis.\n\nPANCREAS: 1.7 x 1.9 x 2.2 cm hypodense pancreatic neck/body junction lesion\ndemonstrates mild postcontrast enhancement (measured 1.3 x 1.7 cm in ___. It\nis predominantly cystic with some septations/solid component. It compresses\nthe main pancreatic duct and causing proximal pancreatic ductal dilation up to\n6 mm. Minimal pancreatic atrophy compared to ___.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Fullness of bilateral adrenals without a discrete lesion\n\nURINARY: Bilateral nephrolithiasis without hydronephrosis.\n\nGASTROINTESTINAL: Scattered sigmoid diverticula. Nonvisualized appendix. \nUnremarkable small bowel. Minimal omental stranding without focal mass.\n\nRETROPERITONEUM: No adenopathy.\n\nVASCULAR: Patent major vasculature. Moderate arteriosclerosis.\n\nPELVIS: 7 x 9.8 x 9.9 cm left adnexal mass with heterogeneous solid and semi\ncystic component not seen in ___. Calcification is also noted in the\nanterolateral aspect of the mass measuring 1 cm, noted in ___. The mass\nextends to the lower abdomen and displaces the sigmoid colon superiorly and\nthe uterus right laterally. Engorged, prominent ipsilateral gonadal veins. \nNo mass in the right adnexa.\n\nHeterogeneous uterus, with limited evaluation of the endometrium by CT. \nMultiple spherical masses in the uterus with foci of calcifications suggestive\nof a uterine fibroids.\n\nUnremarkable rectum. 1.4 cm right-sided bladder diverticulum.\n\nBONES AND SOFT TISSUES: No acute fracture or suspicious osseous lesion.", "output": "1. Mild increase in size predominantly cystic lesion in the pancreas compared\nto ___, with interval pancreatic ductal dilation. This may represent IPMN\n/serous cystadenoma. Development of pancreatic ductal dilatation is worrisome\nfor malignant transformation, however slow growth of the lesion is against it.\n2. Large left adnexal mass (9.9 cm) with cystic and solid components\nconcerning for neoplasia. No adenopathy.\n3. Subtle omental stranding without masses.\n4. Fibroid uterus." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nUnchanged biliary hamartoma is noted at the dome of the liver. There is no\nevidence of additional focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. There is mild dilatation of the extrahepatic common bile\nduct to 9 mm, likely due to patient's post cholecystectomy state. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post left partial nephrectomy with no additional\nconcerning lesions of the left kidney. There are 2, stable, large simple cysts\nin the lower pole of the left kidney measuring 6.3 cm and 3.0 cm. No new\nlesions identified. No hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is otherwise\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Large, heterogeneous, nodular fibroid uterus is noted\nwith internal calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPreviously noted anterior left seventh rib lesion is likely due to healed rib\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Patient is status post left partial nephrectomy without evidence of\nadditional concerning renal lesions. No evidence of metastatic disease." }, { "input": "LOWER CHEST: There is subsegmental atelectasis in the bilateral lower lobes. \nThere is no suspicious pulmonary mass.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 7\nmm hypoattenuated focus in the right lobe near the dome (series 4:6) is too\nsmall to characterize and unchanged from CT ___. There is no new\nlesion. There is stable prominence of the common bile duct measuring up to\n0.8 cm likely secondary to prior cholecystectomy. The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A soft tissue focus measuring 7 mm inferior to the\nspleen (series 2:21) is unchanged and likely represents an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post left partial nephrectomy with no concerning\nlesion in the left kidney. There are two stable simple cysts in the right\nkidney, the larger which is an exophytic simple cyst measuring 6.3 cm (series\n2:31). There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is lobulated, enlarged, with internal\ncalcifications likely representing a fibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Status post partial left nephrectomy without evidence of local recurrence or\nmetastatic disease in the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple bilateral hypodensities which are too small to characterize\non CT but most likely represent simple cysts. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is degenerative change of the disc space at L5-S1.\n\nSOFT TISSUES: There is a large right lateral abdominal wall fat containing\nhernia with a 2 cm neck, as well as a fat containing right inguinal hernia.", "output": "1. Large fat containing hernia of the right lateral abdominal wall, with a 2\ncm neck.\n2. Fat containing right inguinal hernia." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion. Coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and has a nodular contour, which is\ncompatible with cirrhosis.There are perisplenic varices. There is no evidence\nof focal lesions within the limitations of an unenhanced scan. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits. There is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged, and measures 13.7 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a hiatal hernia. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: There is a small diverticulum noted in the dome of the bladder. The\ndistal ureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Ectasia of the common iliac arteries, measure up to 1.5 cm and 1.6\ncm on the right and left respectively. There is no abdominal aortic aneurysm.\nMild atherosclerotic disease is noted.\n\nBONES: There are acute anterior left seventh through ninth rib fractures.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted. Bilateral\nsmall fat containing inguinal hernias are noted and is status-post left\ninguinal hernia repair.", "output": "1. Acute left seventh through ninth anterior rib fractures.\n2. Cirrhotic liver with mild splenomegaly. No ascites.\n3. Ectatic common iliac arteries." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is nodular in contour, compatible with underlying that\ncirrhosis. There is a small amount of ascites. There is no intra or\nextrahepatic biliary ductal dilation. There is an 8 mm focus of arterial\nenhancement at the peripheral segment 2 of the liver, with no associated\nwashout. This does not meet criteria, but bears watching on future\nfollow-ups. Otherwise, no suspicious liver lesions are identified. The\nportal vein is patent. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a millimetric left upper pole renal hypodensity too small to\ncharacterize but statistically representing a small cyst. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Visualized small large bowel loops are unremarkable. There\nis a small hiatus hernia.\n\nLYMPH NODES: There are prominent porta hepatis and ___ lymph nodes,\nlikely reactive to the suspected underlying liver disease detailed above. No\ndefinite size significant or concerning lymphadenopathy is seen.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is recanalization of the paraumbilical vein, compatible with\na elevated portal pressures. Few tiny periesophageal varices are identified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRemote appearing fracture of the anterior left sixth rib.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Nodular and dysmorphic liver suggestive underlying cirrhotic change. Spot\nsmall to moderate amount of ascites. No portal vein thrombosis.\n2. Nonspecific 7 mm arterially enhancing lesion at the periphery of segment 2\nas detailed above, does not meet OPTN criteria. This should be reassessed on\nfuture follow-ups. No hepatic lesions meeting OPTN criteria are identified." }, { "input": "LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. There is stable pneumobilia, with air also noted in the\ngallbladder lumen, compatible with prior sphincterotomy. The gallbladder is\notherwise within normal limits. There is no ascites.\n\nPANCREAS: Again seen are dense calcifications throughout the pancreas which\nis otherwise atrophic, consistent with chronic pancreatitis. There is no\nevidence of focal lesions within the limitations of an unenhanced scan. There\nis no pancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic. Again seen are multiple small\nbilateral simple cysts arising from the native kidneys. There is a renal\ntransplant in the right lower quadrant. There is no hydronephrosis. There is\nno nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Mild diverticulosis of the\nsigmoid colon is noted, without evidence of wall thickening and fat stranding.\nThe appendix is normal (2:53).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 2.1 x 1.6 cm intramuscular lipoma in the right\nobturator externus muscle (2:85). A small umbilical hernia containing fat is\nnoted.", "output": "1. No acute intra abdominal or pelvic process to explain the patient's pain.\n2. Diverticulosis, with no evidence of acute diverticulitis.\n3. Unchanged chronic pancreatitis.\n4. Re- demonstration of pneumobilia and air within the gallbladder lumen\ncompatible with the prior history of sphincterotomy." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The dome of the liver is incompletely imaged. The imaged\nportion demonstrates homogenous attenuation throughout. There is no evidence\nof focal lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is incompletely imaged. The imaged portion shows normal\nsize and attenuation, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cysts measuring up to 3.2 cm in the left lower pole are noted.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nhyperemia and wall thickening involving the transverse colon and the distal\nascending colon (02:26). The appendix is normal.\n\nThere is a 5.3 x 1.8 cm rim enhancing fluid collection in the left gluteal\ncleft that is contiguous with the rectum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Prominent porta hepatis lymph nodes may be reactive. There is no\nretroperitoneal lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy. Several prominent right lower quadrant lymph nodes are\nnoted, for example (02:41).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nhemangioma is noted in the L2 vertebral body.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 5.3 x 1.8 cm rim enhancing fluid collection in the left gluteal cleft,\ncontiguous with the rectum, concerning for perianal abscess with fistulous\nconnection. If clinically warranted, may evaluate further with MRI.\n2. Inflammation of the transverse and distal ascending colon with sparing of\nthe descending colon is atypical for ulcerative colitis. Considerations\ninclude local therapy effect of the distal colon versus is alternative\ndiagnosis of Crohn's disease." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Dobbhoff with anchor terminates in the mid to distal gastric\nbody. The stomach is otherwise unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\nwithin normal limits. Large stool ball within the rectum measures 9 cm. The\nappendix is normal.\n\nPELVIS: The bladder is decompressed with Foley in place with a trace amount of\nurine. There is marked thickening of the urinary bladder which may be related\nto chronic obstruction, however , however. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLaminectomy L2 through L4 with bilateral pedicular screws and rods at L3-L4. \nSternotomy wires. Marked degenerative changes of the spine predominantly in\nthe lumbar spine. Focally severe degenerative disc disease at L2-L3. Status\npost right hip arthroplasty.\n\nSOFT TISSUES: Postsurgical changes of the lower back.", "output": "1. No acute intra-abdominal process.\n2. There is marked thickening of the urinary bladder which may be related to\nchronic obstruction, however infection cannot be entirely excluded. \nCorrelation with urinalysis is recommended.\n3. Prominent rectal fecal impaction. Disimpaction is advised.\n4. Additional findings as above." }, { "input": "LOWER CHEST: Imaged lung bases are clear. The imaged portion of the heart is\nunremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The unenhanced appearance of the liver is normal. There is\nhyperdense fluid which tracks inferiorly from the liver which is concerning\nfor hemo peritoneum, small to moderate in volume.\n\nPANCREAS: The unenhanced pancreas is normal.\n\nSPLEEN: Spleen is normal.\n\nADRENALS: Adrenals are normal bilaterally.\n\nURINARY: The kidneys contain no stones and there is no hydronephrosis. No\nworrisome renal lesion on this unenhanced exam.\n\nGASTROINTESTINAL: The stomach is decompressed. The duodenum appears normal. \nLoops of small bowel show no signs of ileus or obstruction. Patient status\npost recent appendectomy with suture material noted in the right lower\nquadrant. No free air or extraluminal fluid collection is seen. The colon is\nthin walled and is without a significant fecal load.\n\nPELVIS: Urinary bladder is moderately distended and appears normal.\n\nREPRODUCTIVE ORGANS: The uterus is grossly unremarkable. There is a left\nadnexal cystic structure which is similar to that seen on prior exam,\nmeasuring approximately 2.7 x 3.2 cm. Moderate volume hyperdense free fluid\nin the pelvis is concerning for hemo peritoneum. No pelvic sidewall or\ninguinal adenopathy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPectus at excavatum deformity of the sternum noted.\n\nSOFT TISSUES: Mild soft tissue thickening at the umbilicus likely reflects\nrecent laparoscopic surgery.", "output": "Moderate volume hyperdense free fluid in the abdomen/pelvis status post\nappendectomy is concerning for hemoperitoneum. Findings raise concern for\npostoperative bleeding/vascular injury. Recommend close monitoring of\nhematocrit levels. Please note differential considerations potentially\ninclude hemo peritoneum secondary to ruptured ovarian cyst." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Pectus deformity again noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Evaluation for collection in\nthe pelvis is significantly limited without intravenous contrast. Note that\noral contrast did not reached the colon. A postsurgical collection is not\nexcluded. The appendix is surgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Significantly limited examination secondary to lack of intravenous contrast\nand lack of intra-abdominal fat. The oral contrast did not reach the cecum. \nPostsurgical collection cannot be excluded completely, based on imaging. No\nobvious collection identified." }, { "input": "LOWER CHEST: Please refer to the separately dictated CT chest for detailed\nevaluation of the chest findings.\n\nHEPATOBILIARY: Hepatic enhancement is homogeneous with no suspicious masses. \nPortal vein and hepatic veins are patent. There is no biliary ductal\ndilatation. Layering sludge is present with no signs of acute cholecystitis.\n\nPANCREAS: Mildly atrophic pancreas with no pancreatic ductal dilatation or\nsuspicious masses.\n\nSPLEEN: No splenomegaly. Hypodensity at the edge of the spleen (2:66)\nmeasuring 1.1 cm, indeterminate, probably a cyst or hemangioma.\n\nADRENALS: There is mild bilateral adrenal gland thickening.\n\nURINARY:No hydronephrosis or suspicious renal masses. There is a\nsubcentimeter right inferior pole angiomyolipoma and scattered renal cortical\ncysts. Kidneys are atrophic.\n\nGASTROINTESTINAL: Stomach is under distended. Small bowel loops are not\ndilated. Appendix is normal. There are scattered colonic diverticulosis\nwithout diverticulitis.\n\nPERITONEUM: There is no free air or free fluid. There is no peritoneal\nstranding.\n\nLYMPH NODES: There is no adenopathy.\n\nVASCULAR: Abdominal aorta is moderately calcified with an infrarenal abdominal\naortic aneurysm measuring up to 3.9 cm. Intra-abdominal branches are patent\nalthough heavily calcified.\n\nPELVIS: Normal sized prostate. No pelvic adenopathy. Rectum is distended\nwith moderate amount of stool. Fat containing left inguinal hernia.\n\nBONES:No acute osseous abnormalities or suspicious osseous lesions.\n\nSOFT TISSUES: Unremarkable", "output": "1. No suspicious lesions for malignancy in the abdomen or pelvis.\n2. Infrarenal abdominal aortic aneurysms. Marked atherosclerotic\ncalcifications.\n3. Diverticulosis.\n4. Renal cysts and angiomyolipoma.\n5. 1 cm splenic hypodensity, indeterminate probably benign cyst or hemangioma." }, { "input": "LOWER CHEST: There is a new small left and trace right pleural effusion with\nassociated atelectasis. Patient is status post TAVR. Midline sternotomy\nwires are seen. Pacemaker is partially visualized in left anterior chest wall\nwith leads ending in the right atrium and right ventricle.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates nodular contours. There is no evidence\nof focal lesions. There is no evidence of intrahepatic biliary dilatation. \nThe gallbladder is surgically absent. There is mild dilatation of the common\nbile duct measuring 1.0 cm which tapers down inferiorly, unchanged from prior\nexam. There is a moderate amount of fluid in the abdomen and pelvis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Cortical scars are seen in the left kidney. The right kidney is of\nnormal and symmetric size with normal nephrogram.\n\nGASTROINTESTINAL: Patient is status post recent subtotal colectomy, resection\nof the rectum, right lower quadrant ileostomy, partial removal of omentum and\nleft salpingo-oophorectomy for resection of the previously seen rectosigmoid\nmass. The proximal small bowel is dilated measuring up to a 4.3 cm. There is\ngradual tapering of the small bowel loops in the region of the distal jejunum.\nThe remainder of the small bowel is normal in caliber. Moderate volume of\npostoperative free fluid is seen in the abdomen and pelvis. No definite\nloculated fluid collection is seen. There is no evidence of contrast leak.\n\nPELVIS: The urinary bladder is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMarked degenerative changes noted in lumbar spine.\n\nSOFT TISSUES: Midline abdominal wound is seen.", "output": "1. Status post recent subtotal colectomy, resection of the rectum, right lower\nquadrant ileostomy, partial removal of omentum and left salpingo-oophorectomy.\nNo evidence of an abscess or enteric contrast leak.\n2. Dilated loops of proximal small bowel with gradual tapering in the distal\njejunum which most likely represents postoperative ileus.\n3. Moderate amount of free fluid in the abdomen pelvis which most likely\nrepresents post surgical changes.\n4. New small left and trace right pleural effusions with associated\natelectasis." }, { "input": "LOWER CHEST: Trace left pleural effusion is decreased in size from CT abdomen\npelvis ___. The there is mild dependent atelectasis in the\nbilateral lower lobes. 2 pacer leads are partially visualized and an aortic\nvalve prosthesis is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is moderate volume ascites in the abdomen and pelvis with peritoneal\nthickening and enhancement likely representing peritonitis. There is possible\nloculation of the site is in the infrahepatic region (02:39).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Cortical thinning in the upper pole of the left kidney likely\nrepresents atrophy. There are sub-centimeter hypodensities in both kidneys\nwhich are too small to characterize. There is no hydronephrosis or\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post proctocolectomy and diverting\nileostomy in the right lower quadrant. Oral contrast is noted in a ___\npouch. Mildly dilated small bowel loops measuring up to 3.4 cm in the jejunum\nare decreased in degree of dilatation since ___.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nmoderate amount of ascites in the pelvis with associated peritoneal thickening\nenhancement likely representing peritonitis and a small amount of free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. Patient is status post left\nsalpingo-oophorectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is ectasia of the infrarenal aorta measuring up to 2.8 cm\nacross maximal diameter (02:35) grossly unchanged dating back to CT abdomen\npelvis ___.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: And ileostomy is noted in the right lower quadrant. Defect in\nthe subcutaneous tissues of the midline anterior abdominal wall is a new since\n___.", "output": "1. Mildly dilated small bowel loops measuring up to 3.4 cm is decreased, and\ndegree of dilatation, since ___, and likely represents an ileus. No\nevidence of obstruction.\n2. Moderate volume ascites in the abdomen and pelvis is decreased in size as\ncompared to ___. Possible loculated ascites in the\ninfrahepatic region. There is peritoneal enhancement and thickening likely\nrepresenting peritonitis.\n3. No evidence of abscess in the abdomen or pelvis." }, { "input": "CHEST:\nWith the exception of mild dependent atelectasis, the visualized lung bases\nare clear. No pleural effusion. The heart size is normal, and there is small\namount of pericardial fluid (2:4) similar to prior.\n\nABDOMEN:\nThe liver enhances homogeneously, and there are no suspicious focal lesions.\nPatient is status post cholecystectomy. A PTC drain is visualized and there is\npneumobilia in the left lobe. The spleen and adrenal glands are normal. There\nis normal enhancement of the kidneys, and symmetrical excretion of contrast is\nnoted. The known pancreatic head mass measures approximately in 3.2 x 1.6 cm\n(TV x AP), grossly unchanged compared to the prior MRCP dated ___. Two\nfluid collections are noted in close association with pancreas; The first is a\nheterogeneous predominately hypodense attenuation with peripheral areas of\nhigher density and appearance of septations measuring 6.5 x 5.9 x 5.8 cm. It\ninvolves the body of the pancreas and peripancreatic soft tissues (2:27), and\nhas the appearance of walled-off necrosis. A second homogeneous hypodense\ncollection is seen adjacent the gastric fundus measures 7.9 x 6.5 x 5.5 cm\n(2:18), most compatible with a pseudocyst. This fluid collection causes mass\neffect with narrowing of the gastric lumen. Given recent episode of acute\npancreatitis and relative short interval developed of these findings since the\nprior study, these findings are most suggestive of complications of\npancreatitis, and less likely due to tumor progression.\n\nThe small and large bowel are normal in caliber, and there is no focal wall\nthickening. Diverticulosis is noted without diverticulitis. The appendix is\nnormal. No ascites. No pneumoperitoneum. Atherosclerotic calcifications are\nnoted throughout the abdominal aorta and iliac branches. The aorta is normal\nin course and caliber. The celiac axis, SMA, renal arteries, and ___ appear\npatent. Compared to the prior CT on ___, the splenic artery appears\nattenuated where it courses posterior to the complex fluid collection in the\nbody of the pancreas, most notable on series 2, image 28; however, it appears\npatent. Of note, varices adjacent to the greater curvature of the stomach are\nmore apparent. There is a 2.2 x 0.9 cm heterogeneous partially low density\nstructure posteromedial to the complex fluid collection (2:30), lateral to\nthe SMA, which may be inflammatory in nature although metastatic involvement\nand subsequent necrotic node cannot be excluded. This is new since prior CT\nfrom ___.\n\nPELVIS:\nThe bladder is mildly distended. The uterus is not visualized. No adnexal\nabnormalities are identified. No free fluid within the pelvis.\n\nMUSCULOSKELETAL:\nDegenerative changes are noted throughout the lower thoracic and lumbar spine.\nDegenerative changes including partial fusion seen at the SI joints. There are\nno lytic or sclerotic bony lesions that are concerning for malignancy.", "output": "1. No small bowel obstruction. No pneumoperitoneum.\n2. A complex fluid collection involving the body of the pancreas is\ncompatible with walled off necrosis. A second homogeneous fluid collection\nadjacent to with secondary mass effect on the stomach, is likely a pseudocyst.\nGiven\nshort interval development of these findings and recent episode of acute\npancreatitis, these findings are most likely complications of acute\npancreatitis and less likely due to tumor progression.\n3. A 2.2 x 0.7 cm low-density soft tissue structure adjacent to the SMA, new\nsince ___, is also most likely inflammatory, although followup will be\nnecessary as metastatic involvement cannot be excluded.\n4. Known pancreatic head mass grossly unchanged.\n5. A portion of the splenic vein appears attenuated due to mass effect\nfrom adjacent changes of pancreatitis." }, { "input": "There is substantial new opacification of posterior basilar parts of the\nvisualized left lower lobe with air bronchograms in addition to a new small\npleural effusion on the left. The right lung base remains essentially clear\naside from minimal atelectasis.\nThere is an internal-external biliary catheter that appears unchanged. The\nliver is low in density suggestive of fatty infiltration. There is no biliary\ndilatation. Along the inferior margin of the right lobe of the liver, there is\nan area of increased relative hypodensity more so than background with mild\nvolume loss. The lesion appears geographic and although more distinctly seen\nthan before, probably due to differences in technique, probably not changed in\nextent. This area is suspected to represent an area of relative increase in\nfatty infiltration. A nasogastric tube is post-pyloric and terminates in the\nbeginning part of the third portion of the duodenum. The spleen is normal in\nsize but there is new inflammatory change about the spleen, upper left\npericolic gutter, and about the left pararenal space in association with a\npre-existing fluid collection located immediately posterior to the gastric\nfundus. On this study, the collection, which shows irregular rim enhancement,\nmeasures up to 91 x 81 mm in axial ___, compared to 82 x 63 mm before,\nwith somewhat increased wall thickening and inflammatory change. More inferior\nand located along the pancreatic tail is an additional irregular fluid\ncollection but without significant including no increase in wall thickening.\nThe latter collection measures up to 81 x 80 mm compared to 66 x 56 mm before.\nAlong the anterior pancreatic head itself, there is an unchanged suspicious\nhypodense mass whose borders are difficult to precisely defined, but it\nmeasures about 38 x 18 mm ( 2: 38). Adrenal glands are relatively thin.\nKidneys appear within normal limits. The patient is status post\ncholecystectomy. There are similar mildly prominent periportal and celiac\nlymph nodes without short-term change.\nThe mid to distal small bowel is unremarkable. The stomach is nondistended .\nThe appendix is identified and appears normal. The colon appears normal.\nThe uterus is not identifiable. No ovaries are identified. Bladder appears\nwithin normal limits. Mild vascular calcification is present. Major mesenteric\narteries and veins appear patent aside from persistent occlusion of the\nsplenic vein with collateral flow pathways, predominantly via a large omental\nveins interconnecting the splenic hilum and upper superior mesenteric vein. \nPeriaortic nodes measuring up to 8 mm in shortest axis dimension appear\nunchanged.\nBone windows:\nModerate degenerative changes affect sacroiliac joints. Anterior sacroiliac\njoints appear fused suggesting history of sacroiliitis. There are no\nsuspicious lytic or blastic bone lesions. Bones appear probably demineralized\nto some extent.", "output": "1. Increase in pancreatic and peripancreatic fluid collections including new\ninflammatory change which appears to primarily involve the upper collection\nand surrounding soft tissues. A superinfected pseudocyst could be considered\nversus recurrence of pancreatitis. Regarding the lower collection it may be\nprimarily a post-necrotic collection, noting replacement of pancreatic\nparenchyma.\n2. Suspicious mass in the pancreatic head.\n3. Splenic vein involvement by what is probably an inflammatory process has\nprogressed, now with occlusion of the vein.\n4. New opacification at the left lung base with small pleural effusion. This\ncan probably be explained by atelectasis associated with inflammatory process\nin the left upper quadrant although pulmonary infection is not excluded by\nthis study.\nFinal report discussed with ER resident in detail by telephone." }, { "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nLIVER: Hepatic steatosis is again noted. A subtle region of hypodensity along\nthe inferior right lobe of the liver (image 60___:25) is stable since at least\n___. Pneumobilia has slightly increased since prior study, which may be\nrelated to prior sphincterotomy. Metallic stent in the common bile duct is in\nunchanged position, terminating in the second portion of the duodenum. The\nportal vein is patent.\n\nPatient is status post cholecystectomy.\n\nSPLEEN: The spleen is homogeneous and normal in size. Splenic vein is again\nnot well seen.\n\nPANCREAS: 3.8 x 1.7 cm hypodense lesion in the pancreatic head is unchanged\n(image 2:35), with fiducial markers in again unchanged positions. Previously\nseen walled-off fluid collection in the pancreatic tail region has\nsignificantly reduced, and essentially resolved with possible minimal fluid\nremaining and residual reactive/inflammatory change. Cyst-gastrostomy stents\nare in seen.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI: Enteric tube terminates in the fourth portion of the duodenum. No bowel\nobstruction is seen. There is no free air or free fluid in the abdomen.\n\nRETROPERITONEUM: Aorta is normal caliber with scattered atherosclerotic\ncalcifications. No mesenteric or retroperitoneal lymphadenopathy detected.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.", "output": "1. CBD stent in unchanged location.\n2. Near resolution of pancreatic tail collection with cyst gastrostomy stents\nin place." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple nonobstructing stones are again noted the right kidney. There is a\ncomplete duplicated collecting system on the left and a partial duplicated\ncollecting system on the right. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Again noted is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. IVC filter is in unchanged position.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is an unchanged tiny fat containing umbilical hernia.", "output": "1. No evidence of lymphoma in the abdomen or pelvis.\n2. Multiple nonobstructing right renal stones are redemonstrated.\n3. Duplicated collecting system bilaterally, complete on the left and partial\non the right." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. There is an enlarged 2.8 x 3.0\ncm mediastinal lymph node.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 21 cm but shows normal attenuation,\nwithout evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys appear atrophic. There is no evidence of focal\nrenal lesions or hydronephrosis. Subcentimeter hypodensities in the right\nkidney are too small to characterize but likely represent simple cysts. There\nis set perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. There is a large, poorly defined, hypoenhancing\nmass abutting the right pelvic sidewall measuring approximately 6.9 x 13.7 x\n10.0 cm. The mass encases the right external and internal iliac arteries as\nwell as the right external and internal iliac veins.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is an enlarged mediastinal lymph node measuring up to 3.0\ncm. There are a few prominent portacaval nodes the largest of which measures\n1.3 cm (04:47). Large external iliac node measures up to 3.7 cm. There are\nmultiple prominent right inguinal nodes the largest of which measures 2.0 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is a destructive lytic lesion in the right pubic symphysis that\nmeasures 2.5 x 2.3 cm. There is a second lytic lesion in the right inferior\npubic ramus measuring 1.0 x 2.7 cm.\n\nSOFT TISSUES: There is asymmetric subcutaneous edema of the right lower\nextremity. Bilateral inguinal hernias containing fat are noted.", "output": "1. Large, poorly defined mass measuring up to 13.7 cm in the right hemipelvis\nencasing the right external and internal iliac vessels with associated right\niliac and inguinal lymphadenopathy concerning for lymphoma. This mass is\namenable to CT-guided biopsy. Prominent portacaval and mediastinal lymph\nnodes are also noted.\n2. Lytic lesions in the right pubic symphysis and right inferior pubic ramus\nconcerning for metastatic disease.\n3. Splenomegaly.\n4. Cholelithiasis.\n\nRECOMMENDATION(S): CT-guided biopsy of right pelvic mass.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:22 pm, 4 hours after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation. There is trace\nperihepatic ascites, decreased compared to prior.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged measuring 19.0 cm (previously 18.0 cm) without\nevidence of focal mass.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic. There is no focal renal lesion or\nhydronephrosis. These findings are unchanged compared to ___.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Persistent asymmetric enlargement of the iliopsoas and right obturator\ninternus muscles appears unchanged since ___. There is also unchanged\nsoft tissue encasement of the right external iliac vessels. The bladder\nappears unremarkable.\n\nREPRODUCTIVE ORGANS: Prostate is normal in size. The seminal vesicles are\nsymmetric.\n\nLYMPH NODES: A prominent lymph node in the porta hepatis is relatively\nunchanged in size (series 5; image 68), measuring 1.6 cm in short axis. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Again seen are lytic lesions in the right inferior pubic ramus and\nparasymphyseal region, unchanged. L4 vertebral body appears heterogenous and\nslightly sclerotic, which is unchanged from ___.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia which contains\na small amount of fluid.", "output": "1. Unchanged soft tissue thickening of the right iliopsoas and obturator\ninternus muscles compared with ___, have significantly decreased since\n___, in keeping with known diffuse large B-cell lymphoma. There is\nassociated, unchanged soft tissue encasement of the right external iliac\nvessels.\n2. Splenomegaly measuring up to 19.0 cm (previously 18.0 cm).\n3. Unchanged lytic lesions within the right inferior pubic ramus and\nparasymphyseal region. L4 vertebral body appears heterogeneous and slightly\nsclerotic, which is unchanged since ___.\n4. Decrease in trace ascites, most notable in the perihepatic region.\n5. Please see dictation from concurrent CT chest for intrathoracic findings." }, { "input": "LOWER CHEST: Several 2 mm pulmonary nodule in the right lower lobe and right\nmiddle lobe appear to correspond to granulomas on prior chest CTs and are\nunchanged (5:5, 7, 9). Mild left basilar atelectasis. No pleural or\npericardial effusion. Extensive coronary artery calcifications and mild\naortic valvular calcifications are partially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is markedly enlarged measuring up to 19.5 cm, not significantly\nchanged compared to prior.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys appear mildly atrophic. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. Few\nprominent portahepatis and portacaval nodes measures up to 8 mm (05:32),\nunchanged and not pathologically enlarged. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. Soft tissue stranding around the right external iliac\nvessels is unchanged compared to prior.\n\nBONES: Unchanged lytic lesions in the right inferior pubic ramus measuring up\nto 2.2 cm as well as in the right pubic symphysis, not significantly changed\ncompared to prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Minimal\nasymmetric enlargement of the right iliopsoas and right obturator internus\nmuscles relative to the left side is not significantly changed compared to\nprior (5:90, 5:74). A fat containing umbilical hernia is noted.", "output": "1. Unchanged minimal residual thickening of the right iliopsoas and right\nobturator internus muscles as well as soft tissue surrounding the right\nexternal iliac vessels.\n2. Unchanged lytic lesions in the right inferior pubic ramus and right pubic\nsymphysis.\n3. Unchanged splenomegaly.\n4. No new abdominopelvic lymphadenopathy." }, { "input": "LOWER CHEST: The lung bases are clear..\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. The gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The patient is status post partial left nephrectomy, the remnant left\nkidney is unremarkable. No new or recurrent disease. The right kidney is\nunremarkable.\n\nGASTROINTESTINAL: No evidence for bowel obstruction. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The adnexa are unremarkable for age. Known fibroid\nuterus is unchanged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: No evidence of worrisome osseous lesions.", "output": "No metastatic or recurrent disease within the abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post partial nephrectomy of the left kidney. The\nremnant left kidney is unremarkable. The right kidney is unremarkable. There\nis no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: In the right hemipelvis abutting the uterus, there is a\ncentrally hypoattenuated rounded focus measuring 5.8 x 6.4 cm (5:69),\nincreased in size from CT ___, previously measuring 4.6 x 3.9 cm\nand not clearly seen on pelvic ultrasound ___. There is a\nfibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. In the pelvis, there is a centrally hypoattenuated lesion measuring up to\n6.4 cm which has enlarged since the CT ___ and was not definitely\npresent on the pelvic ultrasound from ___. Given the central\nhypodensity within this lesion, this could represent a degenerating exophytic\nfibroid. Alternatively, this could represent a growing complex adnexal\nlesion. Pelvic MRI is recommended.\n2. Status post partial nephrectomy of the left kidney without evidence of\nlocal recurrence or malignancy in the abdomen or pelvis.\n\nRECOMMENDATION(S): Pelvic MRI.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 18:28 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Minimal atelectasis at the lung bases. There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. Punctate hypodensities in the bilateral kidneys\nare too small to characterize, but likely represent simple cysts. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a large sliding hiatus hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nPatient is with redundant mesocolon with the ileocecal valve existing left of\nmidline. The SMA and SMV axes are normal and hence not suggestive of\nmalrotation. In the ascending colon, there is a long segment with colonic\nwall thickening and minimal to mild surrounding fat stranding (examples exist\non series 2; image 55, and series 2; image 62). This may be suggestive of\ncolitis, likely of inflammatory or infectious etiology.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Redundant mesocolon with ileocecal valve existing left of midline. Long\nsegment of ascending colon with colonic wall thickening and minimal to mild\nsurrounding fat stranding, which may be suggestive of a mild colitis, likely\nof inflammatory or infectious in etiology. No small bowel obstruction.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 13:22, 90 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Increased left lower lobe atelectasis and unchanged right lower\nlobe atelectasis adjacent to a large hiatal hernia, nearly complete\nintrathoracic stomach.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is increased, mild intrahepatic\nand moderate extrahepatic biliary ductal dilation with a common bile duct\ndiameter of 9 mm within the pancreatic head. Possible obstructing stone or\nlesion the distal-most portion of the common bile duct. The gallbladder is\ndecompressed and unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSmall hypoattenuating lesions are too small to completely characterize and\nprobably reflect small simple cysts. No hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Large hiatal hernia, near complete intrathoracic stomach. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Mild colonic and terminal ileum diverticulosis without focal wall\nthickening or adjacent fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient appears probably status-post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Probably acute or subacute L1 burst fracture with 5 mm osseous\nretropulsion into the spinal canal.\n\nSOFT TISSUES: Small, fat containing bilateral inguinal hernias.", "output": "1. Increased intrahepatic and extrahepatic biliary ductal dilation extending\nto the distal most portion of the common bile duct with a possible obstructing\nstone or lesion. Recommend further evaluation with ERCP.\n2. Probably subacute or chronic L1 burst fracture with 5 mm osseous\nretropulsion into the spinal canal.\n\nRECOMMENDATION(S):\n1. Increased intrahepatic and extrahepatic biliary ductal dilation extending\nto the distal most portion of the common bile duct with a possible obstructing\nstone or lesion. Recommend further evaluation with ERCP." }, { "input": "A large hyperdense collection extends from the right common femoral artery\n(series 9, image 102), extending superficially to a right groin access site\n(series 9, image 100), and along the right retroperitoneum (series 9, image\n57). There is elevation of atherosclerotic calcifications of the vessel at\nthis level, likely secondary to intramural hematoma (series 9, image 105). No\nactive extravasation is detected on the arterial phase.\n\nA hyperenhancing lesion adjacent to the right common femoral vein (series 9,\nimage 102) is distant from the artery, and felt to be an enhancing lymph node,\nas other similarly-enhancing right external iliac nodes are seen on the\ndelayed phase only (series 9, image 87, 109). The right inferior epigastric\narteries well visualized, and appears patent (series 6, image 101, are 72).\n\nIncluded views of the lung bases demonstrates a small right pleural effusion\nwith adjacent compressive atelectasis (series 9, image 3). Pacemaker leads\nterminate within the right atrium and ventricle (series 9, image 3). There is\nno pericardial effusion. The heart size is top normal.\n\nThe liver density is normal. No concerning hepatic mass is detected. There is\nmild prominence of the intrahepatic bile ducts. Cholelithiasis is present\n(series 9, image 34); however, the gallbladder is otherwise normal. The CBD is\nnormal in caliber.\n\nThe pancreas, adrenal glands, stomach, and intra-abdominal loops of small and\nlarge bowel are within normal limits. There is a small hiatal hernia (series\n9, image 13). Numerous punctate calcified granulomas are scattered throughout\nthe spleen (series 9, image 24). There is no mesenteric or retroperitoneal\nlymphadenopathy.\n\nMultiple subcentimeter hypodensities scattered throughout both kidneys are\nstatistically likely cysts, but are too small for further characterization\nseries 15b, image 56, 64). Larger simple-appearing cysts arise from the upper\npole of the right kidney (series 9, image 15) and interpolar aspect of the\nleft kidney (series 9, image 35), the larger measuring 2.6 cm.\n\nThe bladder contains a Foley catheter and small mild of intracystic air\n(series 9, image 99). The rectum and intrapelvic loops of small and large\nbowel are normal. There is no intrapelvic lymphadenopathy.\n\nThe aorta and iliac branches are heavily calcified. There are two areas of\nectasia within the infrarenal abdominal aorta, the upper portion measuring up\nto 2.9 x 3.5 cm axially (series 9, image 35), and the lower portion measuring\nup to 3.0 x 2.5 cm axially (series 9, image 55). There is no dissection or\nflow-limiting stenosis.\n\nA tiny fat containing supraumbilical ventral hernia is present (series 9,\nimage 30). A tiny fat containing paraumbilical hernia is also seen (series 9,\nimage 60).\n\nThere are no osseous lesions concerning for malignancy or infection.", "output": "1. Large right pelvic hematoma arising from recent right femoral access site.\nNo active extravasation detected.\n2. Extensive atherosclerotic calcifications throughout the abdominal aorta\nand iliac branches, with two areas of ectasia within the infrarenal abdominal\naorta, measuring up to 3.5 cm.\n3. Cholelithiasis.\n4. Small hiatal hernia.\n5. Small right pleural effusion with adjacent compressive atelectasis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ in\nperson on ___ at 5:25 ___, 1 minute after discovery of the findings." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions, right greater than\nleft, and adjacent atelectasis. There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is slight peripheral hyperenhancement in the right lobe\nof the liver in the area of internal-external PTBD stent (2:30). The liver\notherwise demonstrates homogenous attenuation throughout. There is no\nevidence of focal lesions. There has been interval improvement in\nintrahepatic biliary dilatation. There is no evidence of biliary stent\nocclusion. There is pneumobilia consistent with recent ERCP with PTBD\nplacement and later cholangiogram and catheter exchange. The gallbladder\nmeasures 9.4 x 4.0 cm, similar to recent MCRP, and contains gallstones in the\nneck without wall thickening or surrounding inflammation (2:24).\n\nPANCREAS: The pancreatic duct is severely dilated, measuring up to 2.9 cm,\nsimilar to previous (2:24). There are scattered calcifications throughout the\npancreas. There are no focal pancreatic masses. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The PTBD stent terminates in\nthe duodenum. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis of uncertain etiology (602b:41,\n2:64). There is no abscess.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is a right hip prosthesis. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Patient is status post PTBD stent placement within no evidence of stent\nocclusion. There is pneumobilia consistent with recent ERCP, stent placement,\ncholangiogram and catheter exchange.\n2. Small area of peripheral hyperenhancement the right lobe of the liver is\nconsistent with recent catheter placement. No focal hepatic lesions.\n3. Severe pancreatic duct dilatation, unchanged from prior, and scattered\npancreatic calcifications, consistent with chronic pancreatitis.\n4. Cholelithiasis without evidence of cholecystitis.\n5. Small amount of free fluid in the pelvis of uncertain etiology. No\nabscess.\n6. Small bilateral pleural effusions, right greater than left, and adjacent\natelectasis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 2:30 ___, 3 minutes after\ndiscovery of the findings." }, { "input": "Examination is limited both by the lack of IV contrast as well as breathing\nmotion during acquisition.\n\nLOWER CHEST: There are small to moderate bilateral non hemorrhagic pleural\neffusions with associated atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The nodular liver demonstrates homogeneous attenuation\nthroughout. There is no evidence of focal lesions within the limitations of\nan unenhanced scan. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is difficult to visualize due to the limitations above\nbut appears to have normal attenuation throughout, without evidence of focal\nlesions within the limitations of an unenhanced scan. There is no pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring up to 16 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is significantly distended and contains a large\namount of ingested material. However, the stomach has a similar appearance to\nthat seen on prior CT examinations. There is extensive colonic diverticulosis\nwith no evidence of acute diverticulitis. There is no evidence of small bowel\nobstruction. There is no retroperitoneal hematoma.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is atrophic, age-appropriate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nPostprocedural fat stranding is seen in the left groin region.", "output": "1. No retroperitoneal hematoma identified in this unenhanced CT examination.\n2. Nodular and cirrhotic appearing liver. Splenomegaly.\n3. Small to moderate bilateral pleural effusions.\n4. Colonic diverticulosis." }, { "input": "LOWER CHEST: The lung bases are clear. There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic. There is mild central biliary duct\ndilation. The gallbladder is surgically absent. No focal liver lesions\nidentified. The portal vein is patent. There is extensive porta hepatic\nlymphadenopathy measuring up to 2.3 x 3.1 cm (series 2, image 24). Enlarged\nperigastric lymph nodes are also present measuring up to 1.4 x 3.8 cm (series\n2, image 24). Overall, lymphadenopathy not significantly changed from ___.\nThere is no intra-abdominal ascites.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\nSPLEEN: The spleen is enlarged measuring 14.9 cm.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: There is a small to moderate hiatal hernia. The small\nbowel is normal in caliber without focal wall thickening. The large bowel is\nalso normal in caliber without wall thickening. The appendix is\nwell-visualized, air-filled, and normal. There is misting of the mesentery\n(series 2, image 45), a nonspecific finding. Scattered enlarged mesenteric\nlymph nodes are present measuring up to 1.1 x 2.2 cm (series 2, image 33).\nRETROPERITONEUM: There are scattered mildly enlarged retroperitoneal lymph\nnodes with the largest left para-aortic node measuring approximately 1.0 x 1.2\ncm (series 2, image 54).\nVASCULAR: There is no abdominal aortic aneurysm. There are minimal aortic\ncalcifications. The major branches off of the aorta are patent. There are a\nextensive perigastric, perisplenic, and paraesophageal varices.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Mild degenerative changes are\npresent, most pronounced at the L5/S1 level.\nAbdominal and pelvic wall is within normal limits.", "output": "1. Cirrhotic liver with sequela of portal hypertension including splenomegaly\nand paraesophageal and intra-abdominal varices. No ascites. Please note\nhepatocellular carcinoma cannot be excluded on this single phase study.\n2. Extensive porta hepatic lymphadenopathy, likely related to chronic liver\ndisease however, other neoplastic processes are not excluded.\n3. Moderate hiatal hernia." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Please see chest CT report from\nsame day.\n\nABDOMEN:\n\nHEPATOBILIARY: The transplant liver demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. There is a small amount of\nperiportal edema and fluid and small amount of right perihepatic fluid which\nis expected status post liver transplant. The portal vein is widely patent. \nThe hepatic veins are patent. There is slight attenuation of the hepatic\nartery which may be related to the technique of the examination. Gastric and\nesophageal varices are again noted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: There is splenomegaly without focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Transplant liver with small amount of periportal and perihepatic fluid\nwhich is within expected limits. Portal and hepatic veins are widely patent. \nThe hepatic artery is not well visualized likely secondary to technique. A\nultrasound is recommended for further evaluation.\n2. No suspicious drainable fluid collections.\n\nRECOMMENDATION(S): Doppler ultrasound evaluate for hepatic artery patency." }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for a description of the thoracic findings.\n\nABDOMEN:\nEvaluation of solid organs is limited without the use of intravenous contrast.\n\nHEPATOBILIARY: The liver parenchyma demonstrates homogeneous attenuation\nthroughout. No evidence of a focal hepatic lesion. No evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is non-distended and\ncontains two tiny calcified non-obstructing gallstone (Series 3, Image 64). No\ngallbladder wall thickening, pericholecystic fluid collection, or ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size with normal attenuation throughout. No\nevidence of a focal splenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. An 1.5-cm hyperdense\nlesion in the right inferior renal pole with an attenuation of 52 ___,\ncorresponds to a cyst with hemorrhage, previously larger and of simple fluid\ndensity (Series 3, Image 73; Series 7, Image 19)). A 1.5-cm simple cyst in the\nright lower pole is overall stable (Series 3, Image 70). There is a possible\nrenal lesion with slightly increased attenuation compared to other areas of\nthe parenchyma in the left mid-inferior posterior kidney versus normal\nlobulated parenchyma (Series 6, Image 45). A tiny stone in the upper pole of\nthe left kidney is non-obstructive (Series 3, Image 55). No hydronephrosis or\nperinephric abnormality. The urinary bladder is moderately distended and\ngrossly unremarkable.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is air-filled and of normal caliber without evidence of\nfat stranding. No bowel obstruction, free air, or intra-abdominal fluid\ncollection.\n\nRETROPERITONEUM: No mesenteric of retroperitoneal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Severe atherosclerotic calcifications\nnoted throughout the abdominal aorta, bifurcation, iliac and femoral vessels.\n\nPELVIS: No pelvic or inguinal lymphadenopathy. No free fluid in the pelvis.\nThe prostate gland and seminal vesicles appear unremarkable.\n\nBONES AND SOFT TISSUES: Multiple lucent foci in the bones are compatible with\nhistory of multiple myeloma and largely unchanged from the prior exam, notably\nin the visualized spine, and bilateral pelvis. Specifically, the large\nosteolytic lesion is demonstrated in the right lower pelvis with adjacent\ncortical defect, unchanged (Series 6, Image 44). A mild pathologic compression\ndeformity of the L1 vertebral body is also unchanged. Severe multilevel\ndegenerative changes are overall unchanged, with loss of intervertebral disc\nheight, Schmorl's months, vacuum phenomenon, and endplate sclerosis. The\nabdominal and pelvic walls are unremarkable.", "output": "1. No specific finding on CT to explain the patient's new left lower\nabdominal and back pain.\n\n2. Stable multiple lucent osseous lesions compatible with known history of\nmultiple myeloma as detailed above. Stable L1 mild pathologic compression\ndeformity.\n\n3. Possible left mid-inferior renal pole mass verses lobular normal\nparenchyma. Further evaluation with renal ultrasound is recommended.\n\n4. Other findings as above.\n\n5. Please refer to the CT chest report from today for description of the\nabove-the- diaphraghm findings.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\nfrom the referring provider's office on the telephone on ___ at 12:30\n___, after discovery of the findings.\n\nThe findings were also again discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 5:36 ___." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The cecum\ncontains a moderate amount of fluid. Colon and rectum are otherwise within\nnormal limits. The proximal appendix is filled with air (601:19). The distal\n2.3 cm portion of the appendix is not air-filled, is dilated up to 10 mm in\ndiameter and demonstrates wall thickening with surrounding fat stranding and\nfascial thickening. This distal segment of the appendix was inflamed on the\nprevious CT as well. No intra-abdominal fluid collections or extraluminal air\nis seen. There is no free intra-abdominal air.\n\nPELVIS: The urinary bladder is mostly collapsed. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no abdominal, pelvic or inguinal lymphadenopathy by CT\nsize criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Persistent or recurrent appendicitis involving the distal aspect and tip of\nthe appendix. No evidence for perforation including no fluid collections or\nextraluminal air.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:09 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There are again two nonobstructing 2-3 mm stones in the\nright kidney and four 1-2 mm stones in the left kidney. These are unchanged\nin size and number. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable aside from a small hiatal\nhernia. Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. The colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Stable tiny bilateral nonobstructing renal stones." }, { "input": "LOWER CHEST: 4 mm right lower lobe pulmonary nodule is demonstrated (2:1). \nRemaining visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Coronary artery calcifications\nare noted in the right coronary artery. Heart size is normal. A small fat\ncontaining left Bochdalek's hernia is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains probable gallstones without wall\nthickening or evidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. \nRemainder of the colon and rectum are normal. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes are noted in the lumbar spine most\nnotable at L4-L5.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "1. No acute intra-abdominal pathology to explain patient's flank pain. No\nnephrolithiasis.\n2. Minimal colonic diverticulosis without diverticulitis.\n3. Probable cholelithiasis without acute cholecystitis.\n4. 4 mm right lower lobe pulmonary nodule. Please see recommendations section\nregarding the need for further follow-up.\n\nRECOMMENDATION(S): For incidentally detected nodules smaller than 6mm in the\nsetting of an incomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "LOWER CHEST: Right basilar atelectasis is noted. There is no pleural or\npericardial effusion. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is post left nephrectomy. Known massive right\nhydronephrosis is unchanged compared to prior studies from ___, with\nhydroureter extending to the level of the ureterovesicular junction. There is\nright renal cortical atrophy, as before. Previously described right\nperinephric fat stranding has improved compared to the prior CT from ___. \nThere is no evidence of nephrolithiasis or ureterolithiasis. Within the\nlimitations of this noncontrast examination, there is no evidence of large\nobstructing mass.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: A Foley catheter is present within the urinary bladder, which is\ndecompressed. Surgical clips are noted in the area adjacent to the superior\nbladder margin from prior bladder mass resection.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Severe right hydroureteronephrosis is unchanged in extent since ___, with\nno discrete obstructing mass identified on this noncontrast examination.\n2. Previously described right perinephric fat stranding on the prior exam has\nimproved.\n3. Postoperative changes related to prior left nephrectomy and bladder mass\nresection, as described above." }, { "input": "LOWER CHEST: There is mild dependent atelectasis. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Probable adenomyomatosis of the\ngallbladder fundus is noted. The gallbladder is otherwise unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is surgically absent. A right percutaneous\nnephrostomy tube is noted. There is a 5.4 x 3.8 x 6.5 cm heterogeneous,\nhypoattenuating structure in the region the right renal pelvis (2:33, 601:34),\ninseparable from the right kidney. This extends down along the proximal right\nureter. Adjacent fat stranding is noted. This is similar to mildly larger\nfrom prior MR abdomen pelvis from ___. A second enhancing mass\nspans a 4.5 cm portion of the distal right ureter (602:28).\n\nGASTROINTESTINAL: The stomach is unremarkable. There is no evidence of\ngastrointestinal obstruction or free intra-abdominal fluid. The appendix is\nnormal (2:62).\n\nPELVIS: A shrunken, dysmorphic appearance of the bladder is similar to priors.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is grossly unremarkable. No adnexal masses\nare seen.\n\nLYMPH NODES: Enlarged right caval and aortocaval lymph nodes measuring up to\n2.2 x 1.5 cm (2:28) are similar to prior. There is no pelvic or inguinal\nlymphadenopathy by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Normal appendix.\n2. Large heterogeneous, hypoattenuating area in the region of the right renal\npelvis with extension down the right proximal is similar to mildly bigger than\nprior MR abdomen pelvis ___, lying for differences and study\nmodality. This may represent perinephric hematoma related to prior\npercutaneous nephrostomy, underlying soft tissue difficult to exclude.\n3. 4.5 cm segment of enhancing soft tissue mass involving the distal right\nureter is concerning for malignancy, similar to prior.\n4. Shrunken, dysmorphic appearance of the bladder is similar to prior and also\nsuspicious for malignancy.\n5. Retroperitoneal lymphadenopathy with an enlarged right caval lymph node\nmeasuring up to 2.2 cm" }, { "input": "LOWER CHEST: There is mild atelectasis at the left lung base. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nhepatic hypodensity is unchanged, likely representing a cyst. No new focal\nhepatic lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. Thickening at the gallbladder fundus is unchanged, likely\nrepresenting adenomyomatosis. The gallbladder is otherwise within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Status post left nephrectomy. A right percutaneous nephrostomy tube\nhas been pulled back, and terminates in the posterior perirenal fat. There is\nsevere right hydroureteronephrosis along the entire length of the right ureter\nwith surrounding fat stranding. A previously seen hypodense lesion in the\nright renal pelvis is no longer visualized, likely representing a resolved\nperinephric hematoma related to prior percutaneous nephrostomy. A enhancing\nmass in the distal portion of the right ureter is difficult to measure,\nhowever spans at least 4.5 cm, as on prior.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal (2:62).\n\nPELVIS: There is severe dilation of the right ureter extending to the level of\nthe bladder which is shrunken and dysmorphic in appearance, similar to prior. \nThere is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: A right caval lymph node measures 2.3 x 1.5 cm compared with 2.2\nx 1.5 cm previously. A aortocaval lymph node measures 1.7 x 1.5 cm, compared\nwith 1.5 x 1.1 cm previously. An additional aortocaval lymph node measures up\nto 12 mm in the short axis, compared with 9 mm previously. Multiple\nadditional retroperitoneal lymph nodes are not significantly changed in size. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. There is unchanged high grade stenosis of the right common\niliac artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. A right percutaneous nephrostomy tube has been pulled back, terminating in\nthe right posterior renal fat.\n2. Severe right hydroureteronephrosis extending to the level of the bladder\nwhich is shrunken and dysmorphic in the appearance, with surrounding fat\nstranding.\n3. Interval slight increase in size of multiple retroperitoneal lymph nodes.\n4. A enhancing mass involving the distal right ureter is difficult to measure,\nhowever is not significantly changed from prior.\n5. A previously seen hypoattenuating area in the right renal pelvis is no\nlonger seen, likely representing a resolved perinephric hematoma related to\nprior percutaneous nephrostomy." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Normal uterus is noted with IUD present. Normal left\novary visualized with follicle.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No etiology identified to explain pain in the left lower quadrant.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:39 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis and trace bilateral\npleural effusions. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent. \nThere is a low-attenuation, non-organized fluid tracking from the gallbladder\nfossa along the medial margin of the right hepatic lobe, as well as moderate\nfree fluid in the bilateral pericolic gutters and pelvis, suspicious for bile\nleak in this patient status post cholecystectomy. This may be confirmed with\nHIDA scan or MRCP with Eovist.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n7 mm hypodensity in the lower pole of the right kidney (series 2:40) is too\nsmall to characterize but likely represents a simple cyst. There is no\nhydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stranding in the umbilical subcutaneous tissues is likely from\nprior surgery.", "output": "1. Low-attenuation, non-organized fluid in the pelvis tracking from the\ngallbladder fossa along the medial margin of the right hepatic lobe, as well\nas moderate free fluid within the bilateral paracolic gutters and pelvis,\nsuspicious for bile leak in this patient status post cholecystectomy. MRCP\nwith Eovist could be considered to evaluate site of leak.\n\n *** ED URGENT ATTENTION ***" }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries. There is mild stenosis of the\nceliac artery with post-stenotic dilatation\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. There is unchanged mild prominence of the pancreatic duct\nwithin the head of the pancreas, measuring up to 4 mm, with appropriate\ndownstream tapering. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. \nSimple cysts are seen in bilateral kidneys, the largest arises from the lower\npole of the right kidney and measures 2.3 cm. Subcentimeter hypodensities in\nbilateral kidneys are too small to characterize, but likely represent simple\ncysts. There are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is seen. Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. \nColonic diverticulosis is noted without evidence of diverticulitis. Appendix\nis not visualized. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Evaluation of the pelvis is limited secondary to streak artifact from\nhip arthroplasty. The urinary bladder and distal ureters are unremarkable. \nThere is no evidence of pelvic or inguinal lymphadenopathy. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: The patient is status post right hip arthroplasty. Degenerative\nchanges are seen throughout the lumbar spine. The grade 1 anterolisthesis of\nL3 on L4 and L4 on L5 is seen.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No evidence of pancreatic neoplasm.\n2. Stable mild prominence of the main pancreatic duct." }, { "input": "LOWER CHEST:\nBibasilar atelectasis is noted. Visualized lung fields are otherwise within\nnormal limits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions or hydronephrosis. \nBilateral renal cysts are similar to the prior examination. Multiple\nadditional bilateral punctate renal hypodensities are too small to\ncharacterize but likely cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Redemonstrated is a large paraesophageal hiatal hernia with\ninterval significant distension of the stomach. The distal portion of the\nstomach remains above the level of the diaphragm. Aside from this interval\ndilation, the patient's known gastric volvulus is largely unchanged. A\nnasogastric tube is not are properly positioned, with the tip terminating at\nor slightly above the level of the gastroesophageal junction. Colonic\ndiverticulosis is again seen. The remainder of the small and large bowel\notherwise appear within normal limits.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: The patient is status post total right hip\narthroplasty. Degenerative changes are noted at the left hip and lower lumbar\nsacral spine.", "output": "1. Unchanged gastric volvulus and large paraesophageal hiatal hernia but now\nwith significant interval distension of the stomach, suggestive of gastric\noutlet obstruction. The nasogastric tube is positioned at the GE junction\nonly.\n2. Colonic diverticulosis, bilateral renal cysts, and atherosclerotic disease." }, { "input": "LOWER CHEST: Please refer to the recent CT chest from ___ for\ndescription of thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere unchanged hypodense bilateral lesions that are too small to characterize\nbut likely represent cysts. There is otherwise no evidence of stones, focal\nrenal lesions, or hydronephrosis. There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\nGASTROINTESTINAL: There is a recurrent small hiatal hernia without\ncomplication. There is a small amount of residual fluid adjacent to the\nhernia within the posterior mediastinum, likely postoperative in nature. There\nis a gastrostomy tube within the stomach, also without complication. Small\nbowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout. Colon and rectum are within normal limits. There is no evidence of\nmesenteric lymphadenopathy.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. There is mild-to-moderate\ncalcium burden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are not seen.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. The patient is status post right\ntotal hip replacement. There are diffuse degenerative changes with\nanterolisthesis of L3 on L4 and L4 on L5.\nAbdominal and pelvic wall is within normal limits.", "output": "Small recurrent hiatal hernia with a small amount of adjacent fluid that is\nlikely postoperative in nature.\nNo other cause for patient's pain identified." }, { "input": "LOWER CHEST: Mild basal subsegmental atelectasis is noted, left greater than\nright. The imaged portion of the heart is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver contains a hypodense lesion within segment 8 best\nseen on series 2, image 13 measuring 12 x 9 mm, indeterminate. There is a\ntiny hypodensity in segment 3 of the liver on series 2, image 24 which is too\nsmall to characterize. No intrahepatic biliary ductal dilation. Main portal\nvein is patent. The gallbladder appears normal. The common bile duct appears\nnormal in caliber.\n\nPANCREAS: The pancreas enhances normally. No focal lesion or signs of\npancreatitis.\n\nSPLEEN: The spleen appears normal.\n\nADRENALS: Adrenal glands appear normal.\n\nURINARY: Kidneys enhance symmetrically and excrete contrast promptly. No\nsigns of pyelonephritis or hydronephrosis. No worrisome renal lesions seen.\n\nGASTROINTESTINAL: Stomach is decompressed. The duodenum appears normal. \nLoops of small bowel demonstrate no signs of ileus or obstruction. The\nappendix is normal. The colon contains a mild to moderate fecal load. There\nis thickening and hyperemic mucosa involving the distal sigmoid and rectum\nconcerning for proctocolitis. Mild adjacent fat stranding is noted. No free\nair.\n\nPELVIS: The urinary bladder is decompressed around a Foley catheter. The\nurinary bladder wall appears mildly thickened and correlation with UA\nrecommended to exclude infection. Patient status post hysterectomy. There is\nno adnexal mass. The ovaries appear grossly unremarkable.\n\nLYMPH NODES: No lymphadenopathy in the abdomen or pelvis.\n\nVASCULAR: The abdominal aorta is normal in course and caliber without\nsignificant atherosclerosis. There is an IVC filter in place, infrarenal in\nlocation.\n\nBONES: A mild superior endplate compression deformity at L1 appears new from\nCT chest dated ___. There is mild resultant loss of vertebral body\nheight. No bony retropulsion or malalignment.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Acute proctocolitis.\n2. Indeterminate hepatic hypodense lesion within segment 8 for which MRI is\nrecommended on a nonemergent basis to further assess.\n3. Mild L1 superior endplate compression deformity, new from ___. \nCorrelate for focal pain.\n4. No evidence of pyelonephritis. Mild thickening of the urinary bladder for\nwhich correlation with UA is advised to exclude underlying infection.\n\nRECOMMENDATION(S): MRI liver, nonemergent, to further assess indeterminate\nliver lesion." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Sub cm left adrenal not adenoma is unchanged. The right adrenal\ngland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The visualized esophagus appears normal. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcified fibroid measuring up to 4.5 cm is unchanged\nfrom prior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the spine appear\n\nSOFT TISSUES: Numerous soft tissue lesions are seen throughout the anterior\nabdominal wall most likely related to injections.", "output": "1. No evidence of recurrent or metastatic disease in the abdomen or pelvis.\n2. Numerous soft tissue lesions in the anterior abdominal wall are likely\nrelated to injections.\n3. Please refer to chest CT from same day for evaluation of thoracic findings." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. No pleural or\npericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is a\nleft adrenal nodule which measures approximately 2.5 x 1.3 cm.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. Note is made of a 2.5 cm simple cyst arising from\nthe interpolar region of the left kidney.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process. Small hiatal hernia.\n2. Left adrenal nodule is incompletely characterized on this exam. Recommend\nadrenal CT or MRI for further evaluation.\n\nRECOMMENDATION(S): Adrenal CT or Adrenal MRI for further evaluation.\n\nNOTIFICATION: Findings post to the critical results dashboard at 23:58 on ___ by Dr. ___. ED QA nurses were notified by ___ on ___ at 11:02" }, { "input": "The CT chest findings will be reported separately.\n\nCT ABDOMEN: An ill-defined hypoenhancing mass is again seen in the porta\nhepatis, encasing the main portal vein, at the site of the confluence of the\nright on left hepatic bile ducts compatible with known Klatskin tumor.\nAlthough difficult to measure in its most discrete region it is 3.7 x 3.6 cm,\nnot significantly changed from prior. Two biliary stents are again noted from\nthe right and left duct ending in the duodenum, in appropriate and unchanged\nposition. Intrahepatic biliary ductal dilatation and pneumobilia is stable and\nanticipated.\n\nHowever, compared to the previous exam, numerous hypodensities throughout the\nliver predominantly in the right lobe previously characterized as abscesses in\nrecent MR are ___ smaller or less conspicuous. For example, a cluster of\nhypodensities in the liver dome (6:69) do not longer show a discrete fluid\ncollection and is significantly decreased in size, now measuring 1.9 x 1.9 cm\ncompared with 2.5 x 2.2 cm in the previous exam.\n\nFat stranding and soft tissue density adjacent to the gallbladder consistent\nwith a history of a contained gallbladder perforation. The previously seen\nloculated fluid collection just inferior to the gallbladder has resolved in\nthe interval from of ___.\n\nThe spleen, pancreas and right adrenal gland are unremarkable. Multiple\nhypodensities are seen in the kidneys bilaterally consistent with renal cysts\nand are unchanged. Other subcentimeter hypodensities are too small to\ncharacterize but likely also represent cysts.\nThe kidneys are otherwise unremarkable. There is a 2.3 x 1.9 cm left adrenal\nadenoma which is unchanged in size and character from the prior examination.\n\nThe small bowel is unremarkable. The large bowel is grossly normal. There is\nmoderate atherosclerosis of the abdominal aorta. There is no aneurysmal\ndilatation of the aorta and its major branches are patent. There are no\npathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\n\nCT PELVIS: The bladder is unremarkable. The sigmoid colon and rectum are\nnormal\nappearing. There is no pelvic sidewall lymphadenopathy\n\nOSSEOUS STRUCTURES: A small sclerotic focus in L4 is again demonstrated and is\nlikely a bone island. There is moderate degenerative change at L5-S1. No\nsuspicious lytic sclerotic lesions are identified", "output": "1. No significant interval change in ill defined hypoenhancing mass in the\nporta hepatis compatible with known cholangiocarcinoma. Unchanged biliary\nstents. Patent portal vein.\n\n2. Interval decrease in size and conspicuity of clusters of small fluid\ncollections, more prominent in the right liver lobe, previously characterized\nas abscesses by MR.\n\n3. Fluid collection just inferior to the gallbladder fundus has resolved in\nthe interval. Gallbladder wall thickening and stranding is unchanged." }, { "input": "The visualized lung bases appear clear aside from areas of minor atelectasis. \nCalcifications are noted along coronary arteries as well as the aortic valve.\n\n\nA small hiatal hernia is present.\n\nPneumobilia is present in the liver, expected with stent placement. In\naddition to two metallic stents there is a plastic stent throughout each one,\nnew since the prior CT. The left lobe shows relatively early enhancement, as\nwell as the caudate. This can be explained by occlusion of the left portal\nvein similar to prior findings.\n\nThe gallbladder is mostly empty. Soft tissue thickening about the gallbladder\nthat extends to the anterior lateral abdominal wall and appears very similar. \nSoft tissue stranding also extends to the nearby hepatic flexure. Although not\nexplicitly shown, fistulous tracts are not excluded. There is a more clearly\ndefined small rim-enhancing loculation adjacent to the gallbladder fundus\nmeasuring 11 mm in diameter which may be part of newly open sinus track. It is\nnot clear whether it may communicate with the gallbladder fundus.\n\nIll-defined soft tissue and narrowing of portal venous branches in addition to\nocclusion of the left portal vein are unchanged findings. The spleen is\nnormal in size. There are number of hypodense renal lesions that are too\nsmall to characterize, in addition to a few simple cysts that can be defined,\nthe largest measuring up to 58 x 51 mm in axial ___ and located along\nthe lower pole. Also along the lower pole a hypodense lesion with a thin\nperipheral septation is consistent with a benign mildly complicated cyst.\n\nA left adrenal mass measures up to 30 by 24 mm in axial ___ (6:50),\nvery similar in size allowing for small differences in technique. Second left\nadrenal nodule measuring 11 mm in diameter is also stable in the left.\n\nSecond portion of the duodenum is collapsed and difficult to assess but part\nof it is in continuity with abnormal soft tissue along the hepatic hilum and\nthe gallbladder. There is again hazy fat stranding in the vicinity of the\nceliac trunk. There is no bowel obstruction.\n\nTrace free fluid has decreased in the pelvic cul-de-sac. Ovaries are not\ndefinitely visualized. Atherosclerotic calcification is moderate. Common and\nexternal iliac arteries are mildly tortuous. Each renal artery shows mild\nnarrowing.\n\nThere are no suspicious lytic or blastic bone lesions. Moderate degenerative\nchanges affect lower lumbar facet joints.", "output": "Very small new definable rim enhancing loculation of 11 mm along abnormal soft\ntissue near the gallbladder fundus. This may be inflammatory in etiology and\nthe possibility of sinus tracts or fistulous tracks among the duodenum,\ngallbladder and hepatic flexure cannot be excluded. Stable findings\nassociated with malignancy." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\ntiny hypodensity seen in segment 4 a of the liver most likely presenting a\nsmall hamartoma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSmall renal cysts are identified in the right kidney with the largest 1\nmeasuring 11 mm. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient status post Roux-en-Y gastric bypass surgery. A\nshort segment nonobstructing intussusception is identified level of the\njejunum (sequence 2 image 48) this is most likely a transient intussusception.\nThe colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa normal in size for the age of the\npatient.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nold rib fracture is identified in the left posterior chest wall.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post Roux-en-Y gastric bypass surgery. A short segment,\nnonobstructing intussusception is identified in the mid jejunum. This is most\nlikely transient in nature. 2. Status post cholecystectomy." }, { "input": "LOWER CHEST: There is minimal dependent atelectasis involving the bilateral\nlower lobes. No pleural effusion.\n\nHEPATOBILIARY: The liver is normal in size and attenuation on this unenhanced\nscan. There is no biliary dilatation. There is cholelithiasis without\nevidence of cholecystitis.\n\nSPLEEN: The spleen is normal in size and attenuation.\n\nPANCREAS: The pancreas is within normal limits. There is no peripancreatic\nfat stranding.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: There is no hydronephrosis in either kidney. Perinephric stranding\nas increased from the prior examination in ___. There is no\nevidence of hydronephrosis in either kidney.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The stomach is otherwise\nwithin normal limits. Loops of small bowel are normal in caliber. There is\nscattered colonic diverticulosis. The appendix is normal.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nVASCULAR: The abdominal aorta is normal in caliber and shows moderate to\nsevere calcified atherosclerosis.\n\nPELVIS: The bladder is thick-walled and there is notable stranding surrounding\nthe bladder within the pelvis. There is no pathologic pelvic or inguinal\nadenopathy. There are brachytherapy seeds seen within the prostate gland. No\ndrainable abcess seen. Sutures are seen invovling the rectum.\n\nBONES AND SOFT TISSUES: There are no suspicious lytic or blastic lesions seen\nin the visualized osseous structures. There is a large ventral hernia\ncontaining predominantly fat ventral, but also a focal anterior aspect of\nlarge bowel consistent with a small Richter's hernia.", "output": "1. Thick-walled bladder with minimal stranding adjacent to the bladder in the\npelvis as well as bilateral perinephric stranding which has increased from the\nprior examination concerning for cystitis, pyelonephritis not excluded given\nlack of IV contrast. Increased perinephric stranding could be related to\ninfection and/or patient's acute renal failure.\n2. Cholelithiasis without evidence of acute cholecystitis." }, { "input": "LUNG BASES: Small pleural effusions layer posteriorly with compressive\natelectasis in the lower lobes, mild. Within the imaged portion of the heart,\nthere is partially visualized mitral annular calcification.\n\nABDOMEN: The liver enhances normally without concerning focal liver lesion. \nMain portal vein is patent. No biliary ductal dilation. The gallbladder is\nnormal. The spleen is normal in size. Adrenal glands are normal bilaterally.\nThe pancreas enhances normally. The kidneys enhance normally without\nhydronephrosis or worrisome lesion. The abdominal aorta is mildly calcified\nand normal in caliber. There is no retroperitoneal lymphadenopathy. There is\na retroaortic left renal vein. The stomach is decompressed. The duodenum\nappears normal. No free air or free fluid.\n\nPELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is not definitively visualized though there are no secondary signs of\nappendicitis. The colon contains a large fecal load. No signs of colitis or\npericolonic inflammation. Colonic diverticulosis is noted. The uterus is\natrophic. There is no adnexal mass. No pelvic sidewall or inguinal\nadenopathy. The urinary bladder is well distended containing a few locules of\ngas likely reflecting recent catheterization.\n\nBONES: No worrisome lytic or blastic osseous lesion. There is a mild\ndextroscoliosis of the lumbar spine. Bones appear slightly demineralized\ndiffusely. No fracture.", "output": "1. No acute findings to account for symptoms.\n2. Small pleural effusions with mild compressive atelectasis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRedemonstrated is subtle nodularity along the inferior marginal liver,\ncompatible with known cirrhosis. There is no evidence of focal lesions. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent. There is no ascites.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: The spleen is enlarged measuring up to 13.4 cm, with multiple enlarged\nperisplenic venous collaterals, compatible with portal hypertension. Two\nsplenules are noted. A punctate hypodensities noted within the inferior\naspect of the spleen, incompletely characterized but of dubious clinical\nsignificance.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. A\nduplicated right collecting system is noted, extending to the mid-segment of\nthe ureter. Similarly, a left duplicated system appears to joing in the\ndistal segment of the ureter. A 1 cm exophytic cyst is noted extending from\nthe mid portion of the right kidney. Multiple additional renal hypodensities\nare too small to characterize but likely cysts. There is no perinephric\nabnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nRETROPERITONEUM: Multiple prominent retroperitoneal lymph nodes are stable\nfrom the prior examination and not pathologically enlarged by CT size\ncriteria.\nVASCULAR: There is no abdominal aortic aneurysm. There is heavy calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: A superior endplate deformity involving the L1\nvertebral body is stable from prior examination. There is no suspicious\nosseous lesion identified.", "output": "1. Hepatic cirrhosis without suspicious focal lesion. No ascites.\n2. Splenomegaly and multiple perisplenic varices, compatible with chronic\nportal hypertension." }, { "input": "LOWER CHEST: Mild dependent atelectasis is noted bilaterally. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Stomach appears distended, and the entire small bowel is\nmarkedly distended with air-fluid levels. A diverting loop ileostomy is seen\nin the right lower quadrant with small bowel distended both proximal and\ndistal to the stoma site. There are multiple surgical sutures seen at the\nsite of ileal pouch with anal anastomosis, with a nearby drain projecting from\nleft lower quadrant. There is an area of bowel just above the ileal pouch\nwhich appears externally compressed between bladder and dilated loops of\ndistended bowel. There is no evidence of focal transition point or vascular\ncompromise. Appearance is consistent with likely postoperative ileus of the\nsmall bowel.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Marked distension of entire small bowel with air-fluid levels, with no\nevidence of focal transition point or vascular compromise, consistent with\nlikely postoperative ileus. There is no evidence of focal obstruction near\nthe diverting loop ileostomy site or ileal pouch site.\n2. No evidence of intra-abdominal infection or fluid collection." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is a\nsmall intermediate density left-sided pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. There is thickening\nand nodularity of the omentum (02:52 and 602b:50). There is also thickening\nand nodularity along the right superior peritoneum (601:47, 52, 55, 61) in the\nsubhepatic space. There is large volume ascites.\n\nPELVIS: There is thickening of the peritoneum along the presacral space\n(602:46, 2:84) The urinary bladder and distal ureters are unremarkable. There\nis a large volume ascites in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are grossly unremarkable.\n\nLYMPH NODES: There is thickening and nodularity along the right peritoneum\n(601:47, 52, 55, 61). There is thickening nodularity of the omentum (02:52\nand 602b:50). There is thickening of the peritoneum along the presacral space\n(602:46, 2:84)\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is thickening and nodularity along the right peritoneum (601:47, 52,\n55, 61), thickening nodularity of the omentum (02:52 and 602b:50), and\nthickening of the peritoneum along the presacral space (602:46, 2:84) likely\nrepresenting peritoneal carcinomatosis.\n2. Large volume ascites and intermediate density small left-sided pleural\neffusion which are likely malignant.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ in person on ___ at 2:35 pm, 5 minutes after discovery of\nthe findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan.\n\nThere is mild, predominantly central, intrahepatic biliary dilatation. The\ncommon bile duct is dilated up to 2.1 cm (602:29), with tapering noted in the\npancreas head. Subtle hyperdense material in the distal CBD (02:33) is\nnonspecific, but may represent sludge/stones. The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No nephroureterolithiasis.\n2. Common bile duct is dilated up to 2.1 cm, with tapering seen in the\npancreas head. Subtle hyperdense material seen in the distal CBD is\nnonspecific, may represent sludge/stones. MRCP is recommended for further\nevaluation.\n\nRECOMMENDATION(S): MRCP." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed 1 day\nprior. There are bilateral pleural effusions, large on the left and trace on\nthe right. Small pericardial effusion is also noted. The visualized right lung\nbase is well aerated.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is normal in size and contour without morphologic\nfeatures of. Significant fibrosis or cirrhosis. There is hypoattenuation along\nthe anterior aspect of the falciform ligament consistent with focal steatosis.\nOtherwise no focal abnormality is identified.\n\nThere is no intra or extrahepatic bile duct dilation. Note is made of\ncholelithiasis without gallbladder wall thickening, pericholecystic fluid or\ninflammatory changes to suggest acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, or hydronephrosis. Tiny bilateral low-density\nlesions are seen along the cortex, a statistically most likely to represent\ncysts There are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding.\n\nPERITONEUM: No ascites or lymphadenopathy is identified.\n\nVASCULAR: Multifocal atherosclerotic calcifications are seen throughout the\nabdominal aorta and pelvic arteries. There is focal fusiform infrarenal\nabdominal aortic aneurysm with total maximum diameter 4.3 cm. This ulcerated\nplaque. No periaortic inflammatory change is seen.\n\nPELVIS: The urinary bladder, prostate and seminal vesicles are unremarkable in\nappearance.\n\nBONES AND SOFT TISSUES:\n\nDegenerative changes of the lower lumbar spine are identified, without\nconcerning lytic or blastic lesion.\n\nThere is diastases of the abdominal rectus musculature with widening of the\nlinea ___. No discrete defect is present.", "output": "1. No malignancy identified within the abdomen or pelvis.\n2. Atherosclerotic disease including 4.3 cm infrarenal abdominal aortic\naneurysm and ulcerating plaque.\n3. Large left pleural effusion. Please refer to the dedicated chest imaging\nfrom 1 day prior.\n4. Cholelithiasis.\n5. Diverticulosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nDetailed evaluation of the solid organs, soft tissues, and vessels is limited\nwithout the use of intravenous contrast. Evaluation of the abdomen is limited\nby streak artifact from the patient's arms being on the side and over the\nanterior abdominal wall. Within this limitation:\n\nABDOMEN:\n\nHEPATOBILIARY: The gallbladder is surgically absent with clips in the\ngallbladder fossa creating streak artifact that limits evaluation of the\nsurrounding liver parenchyma. The liver otherwise demonstrates homogeneous\nattenuation throughout. No evidence of focal lesions within the limitations\nof an unenhanced scan. No evidence of intrahepatic or extrahepatic biliary\ndilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. No pancreatic\nductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 6-mm fat-containing lesion in the right adrenal gland apex is\nconsistent with an adrenal myelolipoma (series 2, image 50). The left adrenal\ngland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. No evidence of focal\nrenal lesions within the limitations of an unenhanced scan. There is mild\nbilateral pelvicaliectasis. No frank hydronephrosis. No nephrolithiasis. No\nperinephric abnormality.\n\nGASTROINTESTINAL: A hiatal hernia is small. The nasogastric tube tip ends\nproximal stomach. Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Cecal and ascending colonic wall edema with surrounding\nmoderate fat stranding is consistent with a short segment of colitis. \nEvaluation of wall enhancement cannot be performed on this non contrasted\nexam. The appendix is not definitely visualized. No bowel obstruction, free\nair, or pneumatosis. The rectum has a rectal tube. No fluid collections.\n\nPELVIS: The urinary bladder is distended. A small amount of anti-dependent\nair within the bladder lumen is nonspecific and probably related to recent\ninstrumentation (series 2, image 106). No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits. No adnexal masses.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted. The abdominal aorta is tortuous near the bifurcation with aneurysmal\ndilation of the bilateral common iliac arteries measuring up to 2 cm on the\nleft. An 1-cm splenic artery aneurysm has rim calcification (series 2, image\n51).\n\nBONES: No evidence of worrisome osseous lesions. Left curvature of the lumbar\nspine is mild. Multilevel degenerative changes in the spine are severe. \nRetrolisthesis of L1 on L2 is mild, likely degenerative. Anterolisthesis of\nL4 on L5 is mild, also likely degenerative. Mild loss of anterior T11\nvertebral body height is age indeterminate but does not appear acute; no\nassociated prevertebral soft tissue swelling or hematoma. Patient has a left\nhip prosthesis, incompletely imaged.\n\nSOFT TISSUES: Small amount of soft tissue stranding and subcutaneous emphysema\nin right lower abdominal wall is likely related to subcutaneous injections\n(series 2, image 97).", "output": "1. Findings consistent with mild ascending colitis. The differential includes\ninfectious, less likely ischemic or inflammatory. The appendix is not\ndefinitely visualized. No fluid collection or free air.\n2. Bilateral common iliac artery aneurysms up to 2 cm.\n3. 1-cm calcified splenic artery aneurysm.\n4. Tiny amount of air in urinary bladder is probably from recent intervention.\nCorrelate with clinical assessment.\n5. Small hiatal hernia.\n6. 6-mm right adrenal myolipoma.\n\nRECOMMENDATION(S): Clinical assessment for recent bladder instrumentation.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 5:25 am, 25 minutes after\ndiscovery of the findings.\n\nMs. ___ was not the correct person to contact and as such ___ N.P\nwas contacted by Dr. ___ on the telephone at 06:10 on ___,\napproximately 70 minutes after discovery of the finding." }, { "input": "LOWER CHEST: Mild bibasilar subsegmental atelectasis is noted.\nABDOMEN:\n\nHEPATOBILIARY: Multiple hemangiomas and left hepatic cyst are again noted. \nThere is hepatic steatosis, evidenced by regions of sparing. There is no\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: Unremarkable. There is no peripancreatic stranding.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: A focus of hyperenhancement in the right interpolar region may be a\nearly excretion of contrast versus nonobstructing sub-3 mm nephrolithiasis. \nThe kidneys are otherwise unremarkable without hydronephrosis.\n\nGASTROINTESTINAL: There is a small amount fluid in the colon reflective of the\nreappear mild hypervascularity and wall thickening involving most of the colon\nis also noted. No significant soft tissue stranding. No bowel obstruction or\nfree air.\n\nPELVIS: There is no free fluid in the pelvis. Again seen is an enlarged,\nlikely fibroid uterus.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Diffuse soft tissue stranding in the subcutaneous soft tissues\nof the lower back and gluteal regions is stable and could be correlated with\nprior instrumentation. Atrophic changes to the bilateral gluteal muscles,\nsimilar in appearance to prior study.", "output": "1. Mild colitis without significant soft tissue stranding or bowel\nobstruction.\n2. Moderate hepatic steatosis and likely fibroid uterus, as on prior." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple scattered hypodensities are seen in the liver, the largest measuring\nup to 6 mm, too small to fully characterize but likely hepatic cysts or\nbiliary hamartomas. There is otherwise no evidence of focal lesions. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys appear atrophic, compatible with known history of\nend-stage renal disease. There is a hypodense lesion in the right upper renal\npole measuring 2.7 x 2.8 cm. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized. A small\namount of fluid is seen tracking along the paracolic gutters, right greater\nthan left. There is a trace amount of mesenteric fluid, likely related to\nvolume status.\n\nPELVIS: The urinary bladder is decompressed, however, the urinary bladder wall\nappears circumferentially thickened, which can be seen in chronic outlet\nobstruction (series 2: Image 108). There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.8 x 5.0 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen in the lumbosacral spine.\n\nSOFT TISSUES: There are bilateral inguinal hernias containing fat and small\namount of fluid.", "output": "1. Trace amount of free fluid tracking along the pericolic gutters.\n2. Prostamegaly with collapsed urinary bladder with a circumferentially\nthickened wall, which may be secondary to chronic outlet obstruction." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. The\nknown segment four hemangioma is again noted as well as a smaller hypodensity\nnear the dome on the right as previously seen. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 2.1 cm\nsimple cyst at the lower pole of the right kidney. There is mild left\nhydronephrosis. 3 mm nonobstructing stones are noted in the interpolar region\nof the kidneys, bilaterally. There is no perinephric abnormality. There is\nmild left ureteronephrosis as well.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. No evidence of complication at\nthe patient's low sigmoid anastomosis. The appendix is not visualized.\n\nPELVIS: There is a punctate 3 mm calcification in the urinary bladder, likely\nwithin a ureterocele, seen on prior ultrasound and CT. There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus contains fibroids. The adnexae are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic focus in the left iliac bone is similar compared to prior exam from\n___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Mild left hydroureteronephrosis, related to a 3 mm stone in the distal left\nureter within the ureterocele." }, { "input": "LOWER CHEST: There are trace bilateral pleural effusions and bibasilar\natelectasis. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. The gallbladder contains gallstones without\nwall thickening or surrounding inflammation. Patient is status post TIPS from\nthe right hepatic artery to the portal confluence, which appears patent. \nThere is residual nonocclusive clot in the distal main portal vein at the\nconfluence, and just distal to the TIPS (3:162). The proximal SMV just distal\nto the confluence is patent, however there is occlusive thrombosis in the\ndistal branches of the SMV (604b:60). The proximal splenic vein appears\npatent, however some distal residual clot remains (3b:147, 162). There is\ntrace perihepatic and perisplenic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout. Again seen is a 9\nmm hypodensity in the pancreatic neck, likely representing a side branch IPMN\n(3a:54). There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.2 cm simple cyst in the interpolar region of the right kidney. \nAn additional subcentimeter hypodensity in the right lower pole is too small\nto characterize, however likely represents a cyst. There is no\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Again seen is a duodenal\ndiverticulum. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the colon is noted, without\nevidence of wall thickening and fat stranding. The appendix is normal.\n\nPELVIS: Small locules of air in the bladder likely secondary to recent Foley\ncatheter placement. The distal ureters are unremarkable. There is a small\namount of simple free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains coarse calcifications, the seminal\nvesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes the lumbar spine with mild retrolisthesis of L3\non L4 are not significantly changed. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: There is bilateral symmetric gynecomastia. There is diffuse\nsubcutaneous edema. An umbilical hernia containing fat is noted.", "output": "1. Patent TIPS, with residual nonocclusive clot at the portal confluence. \nThe SMV is patent, however there is occlusive thrombosis of its distal\nbranches. The proximal splenic vein is patent, with residual thrombosis in\nthe distal portion of the splenic vein.\n2. Trace bilateral pleural effusions and adjacent atelectasis.\n3. Trace perihepatic and perisplenic ascites, and small amount of free fluid\nin the pelvis." }, { "input": "LOWER CHEST: There is mild dependent atelectasis.. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The heterogeneous enhancement of the liver with central\nhypoenhancement is similar to the late arterial phase of the prior exam and\nmay reflect perfusional differences. No evidence of focal lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nThe TIPS is seen in stable position extending from the main portal vein to the\nright hepatic vein and appears patent, as before, though there mild peripheral\nhypodensity could reflect non-occlusive periphery thrombus. As before, the\nportal venous confluence just proximal to the TIPS is slightly diminutive but\nthere does not appear to be thrombus present proximal to the TIPS as was\nsuspected on the prior study. The portal vein beyond the TIPS is not well\nopacified and the patency of these vessels is uncertain. On the prior study\nthe left portal vein was patent and a diminutive right portal vein was likely\npatent but this is uncertain on this study. Some of the inferior peripheral\nbranches of the SMV are occluded as on prior exam. The major branches of the\nportal vein are not visualized consistent with occlusive thrombus. There is\npartial cavernous transformation of the portal vein. The hepatic veins are\npatent.\n\nThere is stranding around an area of the distal SMA which is stable from prior\nexam and ikely related to atherosclerotic disease.\n\nPANCREAS: The pancreas has normal attenuation throughout A 1.0 cm hypodense\nlesion in the neck of the pancreas is stable from prior exam and likely\nrepresents a side branch IPMN. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. A 1.3 cm hypodense lesion in the upper pole the\nright kidney is stable and likely represents a cyst.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. A periampullary\nduodenal diverticulum is noted. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. There are calcifications within the prostate gland. \nThe seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There are degenerative changes of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Patent TIPS. This superior portion of the SMV, the splenic vein, and the\nportal vein confluence proximal to the TIPS are diminutive but appear patent\nand without thrombus. The left and right portal vein outside the TIPS are\nlikely patent and diminutive as before, however the slightly early timing\nlimits the evaluation. Persistent heterogeneous hepatic enhancement with\ncentral hypoenhancement similar to the late arterial phase on the prior study.\n2. Stable 1.0 cm hypodense lesion in the pancreatic neck, likely a side branch\nIPMN" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSimple hepatic cysts are unchanged from prior MR. ___ is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: 6 mm hypoattenuating lesion in the pancreatic head is better\ncharacterized on recent MR, likely represents a side branch IPMN. No new\npancreatic lesions or ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 1.4 cm cyst noted in the lower pole of the right kidney. No\nconcerning renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nextensive diverticulosis involving the descending colon and sigmoid colon. No\nfocal inflammation to suggest diverticulitis. The appendix is normal. \nCalcific changes in the mesentery are consistent with biopsy proven sclerosing\nmesenteritis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Extensive colonic diverticulosis without evidence for acute diverticulitis.\nNormal appendix.\n2. 6 mm hypoattenuating lesion in the pancreatic head, as on recent MR, most\nlikely a side branch IPMN.\n3. Sclerosing mesenteritis." }, { "input": "No prior relevant imaging is available on PACS at the time of this dictation.\n\nLOWER CHEST: Atelectasis in the partially imaged lower lungs is moderate. \nThere is no evidence of a pleural or pericardial effusion.\n\nABDOMEN:\n\nThe ventriculoperitoneal shunt is only partially imaged. Imaged portions of\nthe shunt is seen coursing in the subpleural portion of the right chest just\nto the right of the sternum (series 2, image 2) into the right lower chest and\nright upper abdomen subcutaneous fat and subsequently entering into right\nupper abdomen (series 2, image 34; series 602b, image 41). Within the\nabdomen, the catheter courses peripherally and superiorly into the right upper\nabdomen in the perihepatic space anterior to the liver in under the hepatic\ndome. The tip of the catheter ends in the left upper quadrant (series 601b,\nimage 17). There is no evidence of catheter discontinuity or kinking.\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. A\ntiny hypodensity in the right hepatic lobe dome is too small to accurately\ncharacterize on CT but could be a cyst or biliary hamartomas (series 2, image\n12). There is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder contains gallstones without wall thickening or evidence of\ninflammation. There is no free fluid in the upper abdomen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis, nephrolithiasis, or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is underdistended, limiting evaluation. The\nimaged small large bowel in the upper abdomen is unremarkable. There is no\nevidence of free air in the imaged upper abdomen.\n\nLYMPH NODES: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy in the imaged upper abdomen.\n\nVASCULAR: There is no upper abdominal aortic aneurysm in the imaged upper\nabdomen. No calcified atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild anasarca. The ventriculoperitoneal shunt is as\ndetailed above. No soft tissue fluid collections or soft tissue gas.", "output": "1. Cholelithiasis.\n2. Partially imaged VP shunt largely in the right upper abdomen without\nevidence of discontinuity or kinking.\n3. No CT evidence of hepatosteatosis.\n4. Tiny right hepatic dome hypodensity is too small to characterize, likely a\ncyst." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A small focus of hypoattenuation adjacent to the groove the\nfalciform ligament reflects a transient hepatic attenuation difference. \nOtherwise, the liver enhances homogeneously. No focal lesions. The portal\nveins are patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypoattenuating right renal lesions are too small to completely characterize,\nlikely simple cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild\ndiverticulosis. The colon and rectum otherwise appear unremarkable. The\nappendix is normal. No pneumoperitoneum. No hemoperitoneum.\n\nPELVIS: A small urachal remnant extends superiorly from the anterior bladder. \nThe bladder otherwise appears unremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted. Incidental note is made of a replaced\nhepatic artery arising from the superior mesenteric artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are 2 puncture wounds in the soft tissues of the anterior\nwall of the right lower quadrant. The more medial puncture wound has a larger\nskin defect and a 2.4 x 0.9 x 1.8 cm underlying hematoma within the\nsubcutaneous fat (series 2, image 93). The hematoma abuts the rectus sheath. \nNo rectus hematoma. Notably, the puncture wound and small subcutaneous\nhematoma are lateral to the course of the right inferior epigastric artery. \nThe smaller, probable puncture wound is associated with a tiny skin defect and\ntiny focus of subcutaneous emphysema (series 2, image 93; series 602, images\n36 and 37). No associated hematoma. Incidental small, fat containing\numbilical hernia.", "output": "Two small puncture wounds in the right lower quadrant abdominal wall with a\nsmall 2.4 cm subcutaneous hematoma. No definite rectus abdominus abnormality.\nThe right inferior epigastric artery is spared. No evidence of peritoneum\nviolation." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for a description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: No overall interval change in the multiple hepatic cysts, the\nlargest of which measures 2.2 x 1.4 cm in segment ___ (Series 8, Image 8).\nThere is no concerning focal hepatic lesion. There is no intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening. There is no ascites. The main\nportal vein, SMV, and splenic vein are patent.\n\nPANCREAS: The pancreas is normally attenuated throughout. There is no lesion,\npancreatic ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation throughout. There is no\nfocal splenic lesion. Again seen are multiple accessory splenules that appear\nstable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status-post left total nephrectomy. There is no\nevidence of local recurrence. The right kidney is unremarkable with a normal\nnephrogram and no evidence of a focal mass. There is no evidence of a renal or\nureteral stone or hydronephrosis. There is no perinephric abnormality. The\nurinary bladder is grossly unremarkable.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The colon and rectum are within normal limits.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: There is no evidence of pelvic or inguinal lymphadenopathy. There is\nno free fluid in the pelvis. Physiologic follicular activity in the ovaries\nare noted.\n\nBONES AND SOFT TISSUES: There is no suspicious lytic or sclerotic bony lesion.\nThe abdominal and pelvic walls are within normal limits.", "output": "No evidence of local disease recurrence or metastasis." }, { "input": "Chest: The bases of the lungs are clear bilaterally. There is no pericardial\neffusion.\n\nAbdomen: The liver appears diffusely low in attenuation to suggest hepatic\nsteatosis. A triangular hypodensity within segment ___ (2:23) of the liver may\nreflect focal fatty deposition. There is no intrahepatic biliary ductal\ndilatation. The portal vein is patent. No radiopaque cholelithiasis is\npresent. The pancreas, spleen, and bilateral adrenal glands are unremarkable.\nThe kidneys present symmetric nephrograms and excretion of contrast with no\nfocal lesion identified. There is no hydronephrosis.\n\nThe stomach, duodenum, and loops of small bowel are grossly unremarkable. No\nevidence of bowel wall thickening or obstruction. The appendix is visualized,\nunremarkable in appearance (601b:17). The colon is without pericolonic\nstranding and appears otherwise unremarkable.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation. A few\natherosclerotic calcifications are noted in the common iliac arteries.\nAccessory left renal artery is incidentally noted. There is no retroperitoneal\nor mesenteric adenopathy.\n\nPelvis: The bladder is not well distended but grossly unremarkable. Ovaries\nappear within normal limits in patient of reproductive age. The uterus is\nnormal in appearance. Trace pelvic free fluid is physiologic. There is no\ninguinal or pelvic sidewall adenopathy.\n\nOsseous structures: A sclerotic focus within the left lesser trochanter is\nincompletely imaged, but with benign features to suggest a bony island.", "output": "1. Liver appears diffusely low in attenuation suggestive of hepatic steatosis\nwith a segment of focal fatty deposition within segment ___ of the liver.\n2. Normal appendix. No acute intra-abdominal abnormality detected." }, { "input": "LOWER CHEST: There is elevation of the left hemidiaphragm. There is mild\natelectasis at the right lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is somewhat atrophied, without evidence of focal\nlesions within the limitations of an unenhanced scan. There is no pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. The superior aspect of the spleen is incompletely\nvisualized due to elevation of the left diaphragm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a cyst in the\nleft upper pole. There is no hydronephrosis. A 9 mm calcification in the\nleft renal pelvic region is most likely vascular.\n\nGASTROINTESTINAL: The stomach and small bowel are grossly unremarkable. There\nis moderate diverticulosis of the distal colon.\n\nPELVIS: The bladder is somewhat underdistended but grossly unremarkable. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy. No adnexal\nmasses are seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: The there is severe osteopenia. There are fractures of the left\nsuperior and inferior pubic rami and the left pubic tubercle as demonstrated\npreviously. There is a mildly displaced left zone 1 sacral ala fracture at\nthe level of the mid sacroiliac joint. There are severe compression fractures\nof the L1 and L3 vertebral bodies without significant wedge deformity. These\nare age indeterminate.\n\nSOFT TISSUES: Mild extraperitoneal left pelvic hematoma related to the pelvic\nfractures is unchanged from prior. There is also a subcutaneous hematoma\noverlying the left greater trochanter, also grossly stable.", "output": "Stable small left pelvic and subcutaneous proximal thigh hematomas. No new\nintra-abdominal or worsening pelvic hematoma to account for hemoglobin drop.\n\nRedemonstration of left-sided pelvic fractures. Age indeterminate compression\ndeformities of L1 and L3. Clinical correlation is recommended." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation without evidence of focal\nlesions. Pancreatic duct measures at the upper limits of normal. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia is incidentally noted. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There appears to be circumferential wall\nthickening, mural edema, and mucosal hyperemia (06:38) involving the\nrectosigmoid junction. Proximal to this level, the sigmoid and descending\ncolon are decompressed, but there also appears to be inflammation with wall\nthickening and mucosal hyperemia involving these segments as well to the level\nof the mid descending colon. The appendix is not visualized. Remainder of\nthe colon is unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Visualized uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: Patient is status post placement of 2 lag screws across the right\nsacroiliac joint without evidence hardware complication. There is moderate\nlevoscoliosis of the lower lumbar spine with apex at L3. There is rightward,\nlateral subluxation of L2 on L3 and L1 on L2. remote right inferior pubic\nramus fracture is noted.\n\nSOFT TISSUES: Small umbilical hernia containing fat is noted.", "output": "Wall thickening, mucosal hyperemia, and edema from the mid descending colon to\nthe rectosigmoid junction consistent with colitis. Differential includes\nischemic, inflammatory, or infectious etiologies." }, { "input": "LOWER CHEST: Heart size is normal without significant pericardial fluid. \nThere are small to moderate right greater than left pleural effusions with\nadjacent compressive bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 6.1 x 4.3 cm simple left interpolar parapelvic cyst. There is no\nevidence of solid focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Postsurgical change from right\nhemicolectomy with primary anastomosis. No evidence of obstruction at the\nanastomotic margin. A percutaneous drain extends through the known\nenterocutaneous fistula which appears to arise at the ileocolic anastomotic\njunction with tip of the drain terminating at this level. Injected enteric\ncontrast opacifies the residual large bowel without evidence of new leak. \nDense material is seen within the central right mesenteric and left anterior\nmesenteric (2:39, 46) which appears unchanged in configuration as compared to\nthe ___ examination likely representing extravasation of contrast at this\ntime. Scattered loops of small bowel appear thickened (02:52) as well as\nthickening of some of the residual large bowel, likely inflammatory. .\n\nPELVIS: Bladder is decompressed around a Foley catheter. There is no free\nfluid in the pelvis. Rectal tube is in place.\n\nREPRODUCTIVE ORGANS: Prostate is unremarkable.\n\nLYMPH NODES: Scattered mesenteric and retroperitoneal lymph nodes are mildly\nprominent but not enlarged by CT size criteria. There is no pelvic or\ninguinal lymphadenopathy. There is a small amount of free abdominal fluid\nwith fat stranding of the majority of the mesenteric. There is no organizing\nfluid collection.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a postsurgical open abdomen with a percutaneous\nabdominal drain in place.", "output": "1. A percutaneous drainage catheter placed through the known enterocutaneous\nfistula appears to connect with the bowel at the site of the ileocolonic\nanastomosis with injected enteric contrast opacifying the residual large\nbowel, without evidence of leak on today's exam. Dense material seen\nscattered throughout the mesentery, appears unchanged in configuration\ncompared to the prior exam, likely related to leak at that time.\n2. Persistent diffuse inflammatory stranding of the mesenteric fat as well as\nwall thickening of loops of small and large bowel. Small to moderate volume\nascites without organizing or drainable fluid collection.\n3. Small to moderate right greater than left pleural effusions.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:41 ___, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Pneumobilia is again seen the gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen has decreased in size since the previous exam the measuring\n10.6 x 12.5 cm (compared to 13.5 x 13 cm).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid focal renal lesions or hydronephrosis. Left\nrenal cyst, 3.5 cm, again seen. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There has been complete resolution of the previously described\nlymphadenopathy including portacaval, porta hepatis, periaortic, iliac,\nbilateral pelvic and bilateral inguinal lymphadenopathy. All nodes have been\nreduced to below 10 mm in short diameter, almost all around 5 mm.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted in the common iliac arteries..\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Resolution of lymphadenopathy to normal levels.\n2. Decreased in size of the spleen to near normal.\n3. Incidental post-cholecystectomy and pneumobilia likely from previous a\nbiliary intervention." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent. \nPneumobilia seen on the prior CT of the abdomen/pelvis from ___\nhas resolved.\n\nPANCREAS: There is mild fatty atrophy of the pancreatic head. Otherwise, the\npancreas has normal attenuation throughout, without evidence of focal lesions\nor pancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size, measuring 12.1 cm in length, without\nfocal lesions. Incidental note is made of a small accessory spleen (02:58).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A left simple renal cyst is unchanged compared to prior. The kidneys\nare of normal and symmetric size with normal nephrogram. There is no\nsuspicious renal lesion. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Note is made of a small calcified fibroid in the\nposterior uterus. No adnexal abnormality is seen.\n\nLYMPH NODES: There are borderline bilateral external iliac lymph nodes\nmeasuring up to 8 mm on the left and 7 mm on the right (2:101, 99), unchanged\nfrom prior. There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate calcified and\nnoncalcified atherosclerotic disease is noted at the aortic bifurcation.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Anterior subcutaneous soft tissue nodules and locules of gas\nlikely represent injection granulomas, increased compared to prior.", "output": "1. Borderline external iliac lymph nodes are unchanged compared to CT of the\nabdomen/pelvis from ___. No new abdominopelvic lymphadenopathy.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Striated nephrograms are noted in both kidneys diffusely without\nfocal abscess. Both kidneys excrete contrast symmetrically. There is no\nevidence of focal renal mass or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no\nevidence of adnexal abnormality bilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Bilateral striated nephrograms concerning for pyelonephritis. No renal\nabscess.\n\n2. Normal appendix.\n\nNOTIFICATION: Updated findings from original wet read were discussed with Dr.\n___. by ___, M.D. on the telephone on ___ at 7:11 ___,\n5 minutes after discovery of the findings." }, { "input": "LUNG BASES: The imaged lung bases are clear aside from a calcified left lower\nlobe granuloma again noted. The imaged portion of the heart is unremarkable. \nThere is a small hiatal hernia.\n\nABDOMEN: Geographic areas of hypodensity within the liver likely reflect\nsteatosis. No definite concerning liver lesion. Main portal vein is patent. \nNo biliary ductal dilation. The gallbladder is normal. There is however\npersistent prominence of the CBD measuring approximately 9 mm in diameter, not\nsignificantly changed. The pancreas is unremarkable. The spleen is normal in\nsize. The adrenal glands appear normal. The kidneys enhance symmetrically\nthough there is slight left renal atrophy compared to the right. A left\nureteral stent is in place which appears well positioned. No hydronephrosis\nor concerning renal lesion. The abdominal aorta is mildly calcified and\nnormal in course and caliber. There is a hyperenhancing retroperitoneal lymph\nnode measuring 9 x 17 x 31 mm best seen on series 7 image 39, which appears\nslightly increased from the prior exam. The stomach and duodenum appear\nnormal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is not visualized. The colon contains a mild fecal load. \nDiverticulosis is present without evidence of diverticulitis. There is a\nperipherally enhancing mass along the left pelvic sidewall measuring 3.0 x 3.7\nx 6.2 cm. This lesion is more clearly visualized and slightly increased in\nsize compared with prior exam. Differential considerations include abscess\nversus postop seroma, difficult to exclude metastatic disease. This\ncollection appears to encase branches of the left internal iliac artery and\nclosely abuts the left external iliac artery along its proximal segment. The\nright pelvic sidewall is unremarkable. No inguinal abnormality. The uterus\nis surgically absent. No right adnexal mass. Urinary bladder is well\ndistended containing the distal end of the left pigtail ureteral stent.\n\nBones: There are no worrisome lytic or blastic osseous lesions.", "output": "1. Status post total abdominal hysterectomy and bilateral salpingo\noophorectomy with intraperitoneal and pelvic sidewall lymph node dissection.\n2. Peripherally enhancing lesion/collection along the left pelvic sidewall is\nincreased in size, currently 3.0 x 3.7 x 6.2 cm, and more clearly defined\ncompared with prior and could represent a postoperative infectious collection,\nseroma, difficult to exclude residual tumor.\n3. Increased size of a hyperenhancing retroperitoneal lymph node measuring up\nto 9 x 17 x 31 mm, potentially concerning for nodal metastasis.\n4. Stable prominence of the common bile duct at 9 mm in diameter.\n5. Left ureteral stent appears well positioned." }, { "input": "CHEST: 4 mm and 2 mm pulmonary nodules in the left lower lobe (6:4) are not\nsignificantly changed since the prior CT from ___. These and\nother intrathoracic findings are better described on the concurrently obtained\nCT of the chest, reported separately.\n\nABDOMEN: HEPATOBILIARY: The liver enhances normally with no focal mass\nlesions and no intra or extrahepatic bile duct dilatation. No ascitic fluid\nis seen in the upper abdomen. No perihepatic nodes are seen. The gallbladder\nis normal with no stones or wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric size, with normal with\nenhancement pattern and symmetric excretion. No perinephric abnormalities are\nidentified.\n\nRETROPERITONEUM: A 2.6 x 2.2 cm enhancing aortocaval lymph node (4:73) and a\n2.1 x 2.1 cm heterogeneously enhancing and centrally necrotic lymph node\nadjacent to the aortic bifurcation on the right (4:77) are suspicious for\ndisease recurrence.\n\nVASCULAR: The abdominal aorta is normal in caliber throughout its course,\nwith a widely patent celiac axis, superior mesenteric and inferior mesenteric\nartery. The portal vein is patent.\n\nThe loops of large and small bowel in the upper abdomen are of normal caliber,\nwith no wall thickening or obstruction.\n\nPELVIS: A 2.4 x 1.8 cm hyper-enhancing left common iliac lymph node (4:87) is\nnoted, along with a 7 mm right pelvic sidewall lymph node (4:102) and a 6 mm\nanterior left pelvic lymph node (4:104). The uterus is surgically absent.\nThere is no pelvic free fluid.\n\nBONES AND SOFT TISSUES: No concerning lytic or blastic lesions are seen\nthroughout the skeleton. A very small fat containing umbilical hernia is again\nseen, with slightly increased prominence of the soft tissues anterior to the\nhernia, at the level of the umbilicus (4:73). Overlying midline anterior\nabdominal and pelvic wall soft tissue changes related to prior surgery are\nnoted (4:77, 4:81).", "output": "1. Heterogeneously enhancing and partially necrotic retroperitoneal and pelvic\nlymphadenopathy, as described above, compatible with disease recurrence.\n2. Soft tissue prominence anterior to small fat containing umbilical hernia\nmay represent normal umbilical tissue, however in the setting of likely\nrecurrent malignancy, clinical correlation is recommended to exclude the\npossibility of metastasis.\n3. Intrathoracic findings are reported separately on dedicated chest CT." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus and ovaries are not visualized.\n\nLYMPH NODES: There is new retroperitoneal lymphadenopathy, mainly in the aorto\ncarpal region between the renal artery and ___. 3 prominent nodes are\nmeasured:\nAortocaval lymph node, just below the renal artery (image 4; 69) measures\n18.7 x 25 mm\nAortocaval lymph node, inferior to the above (image 4; 72) measures 13.9 x\n21.2\nRight para-aortic lymph node at the level of the ___ (image 4; 75)\nmeasures 13.4 x 14.2 mm\nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New retroperitoneal aortocaval lymphadenopathy.\n\nNOTIFICATION: The findings were entered into radiology's critical results\nnotification page." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric contrast reaches the distal small bowel. The\nstomach is unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. No bowel obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: Multiple retroperitoneal lymph nodes have grown in the interim\nand appear more rounded. For example: an 1.4 x 1.1-cm aortocaval node at the\nlevel of the renal hilum previously measured 1 x 1 cm (series 5, image 69), an\n1.9 x 1.2-cm right retrocaval lymph node previously measured 1.9 x 1 cm\n(series 5, image 64, 66, 63). The retroperitoneal fat stranding in the\naortocaval region is moderate and has progressed since the prior exam and now\nextends from the low the origin of the celiac to below the level of the iliac\nbifurcation (e.g. series 5, image 81, 70, 69). There is blurring of the fat\nplane with the IVC.\n\nMultiple right common iliac and external iliac chain lymph nodes are now\nprominent. For example, an 8 mm right common iliac node is new (series 5,\nimage 80). Several right external iliac lymph nodes are new or have grown\nfrom the previous exam, measuring up to 1 cm in short axis (series 5, image\n105, 99). No right inguinal lymphadenopathy. No left inguinal or pelvic\nsidewall lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Calcification in the right lower abdominal wall is unchanged,\nlikely related to prior surgery (series 5, image 80). Soft tissue\nhyperdensities bilaterally with corresponding linear soft tissue gas in the\nright lower abdomen suggests sequelae of subcutaneous injection.", "output": "New and enlarging retroperitoneal (largely aortocaval) and right iliac chain\nlymph nodes along with increased retroperitoneal fat-stranding are concerning\nfor disease progression.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:02 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and\nsalpingo-oophorectomy.\n\nLYMPH NODES: Previously seen periaortic enlarged lymph node is not\nwell-visualized on the current study. Right external iliac chain lymph nodes\nand left pelvic sidewall lymph nodes are no longer enlarged by CT size\ncriteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.\n\nBONES: Sclerotic lesion at the inferior endplate of T11, anterior S1 vertebral\nbodies, and posterior left ilium are unchanged since ___ which\nmay represent osseous metastatic disease.\n\nSOFT TISSUES: Soft tissue densities within the anterior abdominal wall,\nmeasuring up to 2.0 cm, may be secondary to recent subcutaneous injection.", "output": "1. Periaortic, right external iliac, and left pelvic sidewall lymph nodes are\nno longer enlarged by CT size criteria.\n2. Sclerotic lesions in T11, S1, and posterior left ilium likely represent\nosseous metastatic disease, unchanged compared to prior study." }, { "input": "LOWER CHEST: There is bibasilar atelectasis. There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensity in segment VII of the liver (series 2, image 29) is\ntoo small to characterize. There is mild periportal edema, likely from fluid\nresuscitation. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA subcentimeter hypodensity in the lower pole of the left kidney is too small\nto characterize (series series 2, image 37) There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal without a hiatal hernia. \nSmall bowel is normal in caliber without focal wall thickening. Large bowel\nis also normal in caliber without focal wall thickening. There is an\nappendicolith at the appendiceal base. Distally the appendix is dilated up to\n13 mm with associated surrounding fat stranding. There is air in the tip of\nthe appendix, without evidence of extraluminal air. There are no\nintra-abdominal fluid collections.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. There is dilation of the left gonadal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLimbus vertebra is seen at L4. There is mild anterolisthesis of L4-L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute appendicitis. No intra-abdominal fluid collections or extraluminal air." }, { "input": "LOWER CHEST: Please refer to the dedicated CT chest report from the same day\nfor description of thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous, scattered hypodensities with peripheral enhancement\nthroughout the liver have increased overall in size and number since the prior\nexam, concerning for progression of known metastatic disease. Index example\nincludes a 4.4 x 3.3-cm lesion in segment 8 that previously measured 3 x 2.2\ncm (series 2, image 55). A left anterior abdominal approach PTBD traverses\nthe left hepatic lobe and eventually enters into the common bile duct, through\nthe common bile duct stent, and ending in the third portion of the duodenum at\nmidline, unchanged. The common bile duct stent position is also overall\nunchanged, ending in the duodenum. Moderate pneumobilia predominantly in the\nantidependent portions of the liver are unchanged, compatible with\nstent/catheter patency. There is mild diffuse intrahepatic biliary ductal\ndilation, unchanged. The gallbladder is decompressed and unremarkable.\n\nThe main, left, and right portal veins are patent.\n\nPANCREAS: An ill-defined, infiltrative heterogeneous-density ampullary mass\nmeasures approximately 3.4 x 2.8 x 4.6 cm, previously 3.7 x 2.4 x 4.6 cm, not\nappreciably changed from the prior exam (series 2, image 77; series 601b,\nimage 26). The downstream main pancreatic duct remains markedly dilated and\ntortuous up to 19 cm (Series 601b, image 20), similar the prior exam. The\ndistal pancreas remains atrophic. Extensive infiltrative soft tissue density\nabuts the right aspect of the SMA, surrounds the proximal right renal artery,\nsignificantly compresses the left renal vein as it enters into the IVC (series\n2, image 68). The soft tissue density mass abut the main portal vein and\nSMV-splenic vein confluence but these vessels are patent. The celiac trunk and\nits major branches as well as the S an a air patent. The SMV is patent. The\nbilateral renal veins and arteries are patent, however as noted above there is\nsignificant narrowing of the left renal vein as it enters the IVC secondary to\nmass effect, slightly worse from the prior exam (series 2, image 68). The\nsplenic artery is patent.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A small accessory spleen is noted at the hilum\n(series 2, image 66).\n\nADRENALS: A 2 x 1.4-cm nodule arising from the lateral limb of the left\nadrenal gland was previously characterized as an adenoma on the MR from\n___ (series 2, image 64). The right adrenal gland is normal in size\nand shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNo evidence of concern focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is distended with ingested oral contrast and\nfood contents. The proximal duodenum prior to the entry of the percutaneous\ndrain is moderately distended with contrast. The third portion of duodenum is\nrelatively decompressed with the drain in place. Distal loops of small bowel\nare normal in caliber and contain oral contrast. The colon is unremarkable. \nThe rectum is also unremarkable. Oral contrast reaches the distal small bowel.\nNo evidence of bowel obstruction. The bowel wall enhances normally\nthroughout. No free air.\n\nPELVIS: The urinary bladder is decompressed but grossly unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is unremarkable.\n\nLYMPH NODES: Extensive lymphadenopathy surrounding the ampullary mass is\nagain seen, and of note, the right paracaval node now measures 11 mm,\npreviously 7 mm (series 2, image 78). No definite pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: The abdominal aorta is tortuous, but there is no abdominal aortic\naneurysm. Mild atherosclerotic disease is noted. Other findings related to the\nampullary mass are described under the Pancreas section of this report.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Superior\ncompression deformity of the L2 vertebral body is unchanged (series 602b,\nimage 40). There is a pseudointervertebral disc space between S1 and S2.\n\nSOFT TISSUES: Hypodense subcutaneous fluid need the percutaneous drain site in\nthe left abdomen are noted (series 2, image 63, 66). No subcutaneous emphysema\nor drainable fluid collection.", "output": "1. Interval disease progression with increase in number and size of numerous\nhepatic metastasis, probable slight increase in size of the infiltrative\nampullary neoplasm and surrounding soft tissue density, and increase in size\nof retroperitoneal lymphadenopathy.\n\n2. Major adjacent vessels remain patent, however, compression of the left\nrenal vein as it enters the IVC is significant and slightly more since the\nprior exam. Kidney enhancement is normal.\n\n3. PTBD catheter in similar position. No bowel obstruction.\n\n4. 2-cm left adrenal nodule was previously characterized on MR as an adenoma.\n\n5. Unchanged appearance of L2 vertebral body compression deformity.\n\n6. Please refer to the dedicated CT chest report from the same day for\ndescription of thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is status post left percutaneous biliary drain\nplacement with the tip seen in the third portion of the duodenum and metallic\nstenting of the distal common bile duct and ampulla. Innumerable\nhypodensities are again seen scattered in the liver, which are mild to\nmoderately improved compared to prior exam from ___. For example, as\nan index comparison, the largest hypodense nodule measures 3.0 x 3.2 cm,\npreviously 3.3 x 3.6 cm in ___ (2:58). Mild intrahepatic biliary\ndilatation is unchanged. Pneumobilia is not unexpected following percutaneous\nbiliary drain placement. The gallbladder is within normal limits.\n\nPANCREAS: The ampullary mass appears mildly decreased in size, measuring 2.4 x\n2.9 cm, previously 2.8 x 3.4 cm in ___ (2:79). There is continued\nsevere dilatation of the pancreatic duct, measuring up to 2.1 cm. The\nampullary mass abuts the main portal vein and SMV-splenic confluence without\nnarrowing or compressing the vessels. The ampullary mass does continue to\ncompress and narrow the left renal vein, however, there is no evidence of\ninvasion or occlusion (2:70).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There stable\nappearance of the known 1.3 x 1.8 cm left adrenal nodule, previously\ncharacterized as an adenoma on MRI from ___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The tip of the biliary drain\nis seen in the third portion of the duodenum. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: The retroperitoneal lymphadenopathy is improved compared to\nprior exam. For instance, there is a para-aortic nodal conglomerate which\nmeasures 1.9 x 2.4 cm, previously 2.4 x 2.6 cm (2:74). There is no mesenteric\nlymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. S/Post left percutaneous biliary drain placement and stenting of the common\nbile duct and ampulla\n2. Interval improvement of known ampullary mass, multiple hepatic metastatic\nlesions, and retroperitoneal lymphadenopathy compared to prior exam from ___.\n3. Stable vascular involvement of the ampullary mass with narrowing of the\nleft renal vein, and abutting the main portal vein, and SMV-splenic confluence\nwithout evidence of vascular invasion or occlusion.\n4. Unchanged left adrenal adenoma.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Transplant liver appears unremarkable without evidence of focal\nlesions within limitations of unenhanced scan. Mild, predominantly left-sided\npneumobilia is noted and presumably related to the CBD stent which appears\nappropriately position. Distal aspect of the CBD stent is opacified with\ndebris, some of which is hyperdense suggesting possible hemorrhagic\ncomponents. Gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Spleen is enlarged measuring up to 17.3 cm, but otherwise\nunremarkable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality. Unremarkable appearance of right lower quadrant transplant\nkidney which contains a ureteral stent which appears appropriately position. \nAdjacent nonhemorrhagic fluid collections in the region of the transplant\nrenal hilum and along the right pelvic sidewall measure 4.3 cm and 3.4 cm\nrespectively and may reflect postoperative lymphocele lower seromas.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. An enteric tube terminates in\nthe jejunum. The colon and rectum are within normal limits. Enteric contrast\nextends the level of the sigmoid colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Extensive paraesophageal and upper abdominal varices are noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild scoliosis of the lumbar spine.\n\nSOFT TISSUES: Postsurgical changes along the anterior abdominal wall are\nnoted. A right lower quadrant approach surgical drain terminates along the\nright lower quadrant transplant kidney.", "output": "1. Simple appearing fluid collections adjacent to the right lower quadrant\ntransplant kidney hilum and along the right pelvic sidewall measuring up to\n4.3 cm likely reflect postoperative seromas or lymphoceles.\n2. Debris is noted within the distal aspect of the CBD stent, though\npneumobilia and lack of intrahepatic biliary dilation suggest stent patency.\n3. Splenomegaly, small volume abdominopelvic ascites, and extensive\nparaesophageal and upper abdominal varices." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: A few subcentimeter hypodensities are too small to characterize\nare stable. There is no biliary dilatation. The gallbladder is within normal\nlimits.\n\nPANCREAS: Unremarkable. There is no peripancreatic stranding.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: There is a 3.1 cm simple cyst within the left lower renal pole\n(02:32). Additional hypodensities within the right renal cortex are too small\nto characterize. A hypodense lesion in the right interpolar region (02:30,\n601:37), may represent a cyst, however too small and intrarenal in location,\nnot further characterized and indeterminate. No hydronephrosis.\n\nGASTROINTESTINAL: There is a moderate sized hiatal hernia. There is a large\ninflamed small bowel diverticulum with nearby edema, soft tissue stranding\n(02:39) and multiple locules of free intraperitoneal air concerning for\nperforation.\n\nPELVIS: There is no free fluid in the pelvis. Again seen is an enlarged,\nfibroid uterus.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions.", "output": "1. Findings are compatible with perforated small bowel diverticulitis.\n2. Bilateral renal cysts and additional hypodense lesions that are\nindeterminate or too small to characterize.\n3. Moderate-sized hiatal hernia.\n4. Colonic diverticulosis without evidence of diverticulitis.\n\nNOTIFICATION: The updated findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 08:55 am, shortly\nafter discovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy. Nodular implant along the vaginal cuff measures up to\n1.7 cm along the right side, unchanged in size and appearance since ___.\n\nLYMPH NODES: Adjacent right pelvic lymph node measures 1.8 x 1.3 cm (2:103),\nunchanged since ___. A left periaortic lymph node measures 7 mm in\nshort axis, minimally decreased in size compared to prior study. There is no\nevidence of additional retroperitoneal, mesenteric, or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stable appearance of midline abdominal wall incisional changes\nand ventral hernia containing small bowel.", "output": "1. Stable size and appearance of soft tissue nodularity along the vaginal cuff\nand mildly enlarged right pelvic lymph node. Otherwise no evidence of disease\nprogression within the abdomen or pelvis.\n2. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis. There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 1.6 x 1.6 cm bulk fat containing lesion in the left\nadrenal gland, which is consistent with myelolipoma. Right adrenal gland is\nunremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is sigmoid\ndiverticulosis without surrounding inflammation to suggest acute\ndiverticulitis. The colon and rectum are otherwise unremarkable. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus appears unremarkable. Pessary appears in situ. \nThere is no evidence of adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No etiology identified for night sweats and elevated CRP.\n2. Sigmoid diverticulosis, without evidence of acute diverticulitis.\n3. Left adrenal myelolipoma." }, { "input": "LOWER CHEST: There are bilateral intermediate density pleural effusions right\ngreater than left with associated bibasilar opacity, which may represent\natelectasis although pneumonia is possible in the correct clinical setting.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. Pneumobilia is present as expected. The\ngallbladder surgically absent. There is moderate volume perihepatic and\nperisplenic ascites.\nPANCREAS: Postsurgical changes from Whipple procedure are present. Pancreatic\ntail is unremarkable. Anastomotic sites are intact. No fluid collections are\nidentified adjacent to the hepatojejunostomy or pancreaticojejunostomy. There\nis no extraluminal identified.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no focal renal lesions, or hydronephrosis. A 4 mm nonobstructing\nstone is present in the lower pole of the left kidney. There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL: There is no evidence of bowel obstruction. Visualized small\nand large bowel loops are unremarkable.\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nFoci of free air, most likely postsurgical.\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.\nAbdominal and pelvic wall is within normal limits.", "output": "1. Expected postsurgical changes after Whipple procedure. Pneumoperitoneum\nand moderate volume perihepatic and perisplenic ascites is likely postsurgical\nhowever, if there is continued clinical concern for a bile leak HIDA scan\nshould be obtained.\n2. Bilateral small nonhemorrhagic pleural effusions with bibasilar opacities,\nmost compatible with atelectasis although pneumonia, specifically aspiration,\nis possible in the correct clinical setting.\n3. 4 mm nonobstructing left lower pole renal stone.\n\nRECOMMENDATION(S): If there is continued clinical concern for a bile leak,\nHIDA scan should be obtained.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 1130AM, 5 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST: Mild dependent atelectasis bilaterally. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Again visualized is the soft tissue and fat stranding\nanterosuperiorly to the bladder status post debridement. The extent of\ninflammatory fat stranding has decreased compared to the CT dated ___. There is persistent lobulated soft tissue measuring approximately 2.2 x\n1.6 cm (series 3, image 63), which appears to be contiguous with the bladder,\nalthough it does not fill with contrast on the prone delayed images. There is\nan adjacent large calcified exophytic uterine fibroid, but the soft tissue\ndescribed above appears to be independent from the uterus. The constellation\nof findings most likely represent a urachal sinus with superimposed infection\nstatus post debridement.\n\nREPRODUCTIVE ORGANS: There is a large calcified exophytic fibroid anteriorly,\nwhich is stable. Stable smaller calcified and noncalcified uterine fibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: The sclerotic focus within the right iliac bone adjacent to the\nsacroiliac joint (series 3, image 57) likely represents a bone island. There\nare mild degenerative changes within the lumbar spine. There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Persistent soft tissue and fat stranding anterosuperiorly to the bladder\nstatus post debridement, most likely representing a urachal sinus with\nresolving superimposed infection. However, a urachal remnant adenocarcinoma\ncannot be ruled out, therefore follow-up CT to ensure complete resolution is\nrecommended.\n\nRECOMMENDATION(S): Follow-up CT in ___ months to ensure complete resolution\nof the above findings is recommended.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:02 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are innumerable ill-defined subcentimeter hepatic\nhypodensities. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size, measuring 11 cm, and attenuation\nthroughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are cysts in the bilateral kidneys, measuring up to 2.5 cm in the lower\npole of the left kidney. There is a hyperdense cystic lesion along the\nanterior left kidney measuring up to 1.2 cm, incompletely characterized\n(5:66). There is no hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is diffuse bulky retroperitoneal, mesenteric, pelvic and\ninguinal lymphadenopathy (8:25, 5:63). For reference, a periportal node\nmeasures 3.6 x 3.4 x 7.7 cm (5:55, 8:19). An aortocaval node measures 3.8 x\n3.0 x 5.7 cm (5:63, 8:25). Bilateral external iliac nodes measure up to 4.4 x\n3.8 cm on the right and 3.7 x 2.2 cm on the left (5:101). Bilateral inguinal\nnodes measure up to 2.9 x 2.2 cm on the right and 2.1 x 1.6 cm on the left\n(5:114).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is a mild superior endplate compression deformity of the T11\nvertebral body, of undetermined age (9:34). Punctate sclerotic foci in the\nT12 and L3 vertebral bodies likely represent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diffuse bulky homogenous retroperitoneal, mesenteric, pelvic and inguinal\nlymphadenopathy, concerning for lymphoma.\n2. Innumerable ill-defined subcentimeter hepatic hypodensities, concerning for\nlymphomatous infiltrates.\n\n3. A 1.2 cm hyperdense left renal lesion may represent a hemorrhagic or\nproteinaceous cyst, however is incompletely characterized on single phase\nscan, attention on follow-up is recommended.\n4. Please refer to separate reports of CT chest and CT neck performed on the\nsame day for description of the thoracic and neck findings.\n5. Mild superior endplate compression deformity of the T11 vertebral body, of\nundetermined age.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:15 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n1.8 cm simple cyst and 1.0 cm simple cyst the upper pole of the right kidney\nare stable. A 3.0 cm hypodensity in the interpolar region of the left kidney\nis unchanged, likely representing hemorrhagic cyst, not demonstrating\nappreciable FDG avidity on the prior PET-CT. There is no evidence of\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: A retrocaval lymph node measures 1.1 cm (4:72), new from the\nprior CT. A 1.5 cm portacaval lymph node (04:55) is also new from prior. \nMultiple additional prominent retroperitoneal lymph nodes are seen, which do\nnot meet CT size criteria. A right external iliac lymph node measures 2.0 cm\n(4:103), previously 1.4 cm. A left external iliac lymph node measures 1.7 cm\n(4:101), previously 6 mm, and an additional left external iliac lymph node\nmeasures 1.0 cm (4:105), previously 7 mm. Multiple enlarged and prominent\nbilateral inguinal lymph nodes are seen, including some inferior nodes that\nare only partially visualized. The largest measures 2.2 cm (4:114),\npreviously 8 mm. Growth of these nodes is also demonstrated when compared to\nthe more recent PET-CT from ___.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nsclerotic focus in the vertebral body of L3 is again seen, as well as in the\nleft iliac crest, consistent with bone islands.\n\nSOFT TISSUES: Unchanged umbilical hernia containing fat is noted.", "output": "1. Retroperitoneal, pelvic and inguinal lymphadenopathy has progressed since\nthe CT from ___ and PET-CT from ___.\n2. Stable 3 cm indeterminate density lesion in the left kidney, likely\nrepresenting a hemorrhagic cyst. Ultrasound could be considered for\nconfirmation.\n3. Please see separate report of CT chest performed same day for description\nof thoracic findings.\n\nRECOMMENDATION(S): Renal US.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:46 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 3.2 x 3.1 cm round, well-circumscribed, exophytic lesion arising from the\ninterpolar left kidney is intermediate in density, similar to prior\nexaminations, and notably did not demonstrate FDG avidity on prior PET-CT. A\nright upper pole simple cyst measures 1.9 x 1.3 cm. Interpolar simple cyst\nmeasures 1.2 x 1.0 cm. Other hypoattenuating lesions are too small to\ncompletely characterize, but statistically likely reflect simple cysts. No\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted. The adnexae are unremarkable.\n\nLYMPH NODES: Substantial interval improvement in retroperitoneal, pelvic, and\ninguinal lymphadenopathy. Left external iliac lymph nodes now measure 1.3 cm\nand 1.0 cm. Right external iliac lymph nodes now measure 1.1 cm. There are\notherwise no remaining pathologically enlarged lymph nodes.\n\nVASCULAR: No infrarenal abdominal aortic aneurysm. Mild calcified\natherosclerosis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nT12 compression deformity is unchanged.\n\nSOFT TISSUES: There are small fat containing ventral and umbilical hernias.", "output": "Substantial interval improvement in lymphadenopathy with few remaining\nborderline enlarged pelvic lymph nodes. No new lymphadenopathy." }, { "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.9 cm simple cyst arises from the upper pole the right kidney. \nIntermediate attenuation, round, well-circumscribed lesions measuring up to\n3.2 cm in the posterior interpolar left kidney are unchanged and not FDG avid\non same day and prior PET-CT scans, probably hemorrhagic or proteinaceous\ncysts. No hydronephrosis. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted. The adnexae are unremarkable\nfor patient age.\n\nLYMPH NODES: 1.2 cm celiac axis lymph nodes are slightly enlarged since\n___, previously 1.0 cm short axis. A 0.9 cm gastrohepatic ligament\nlymph node has enlarged and previously measured 0.7 cm 5 weeks prior. No\nmesenteric lymphadenopathy. Right external iliac lymphadenopathy is\nsignificantly increased since ___, but unchanged compared to 5 weeks\nprior measuring 1.6 cm short axis. Left external iliac lymphadenopathy is\nsignificantly increased since ___, but unchanged compared to 5 weeks\nprior, measuring 2.5 cm short axis. Left internal iliac lymphadenopathy is\nminimally increased compared to 5 weeks prior, measuring 1.1 cm and previously\nmeasuring 0.9 cm. Right inguinal lymphadenopathy is significantly increased\nsince 5 weeks prior with representative lymph nodes measuring 1.7 cm and 2.4\ncm short axis, previously 1.0 cm and 1.5 cm short axis. Left inguinal\nlymphadenopathy is unchanged measuring 1 cm short axis.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. Incidental accessory or replaced left hepatic artery\narising from the left gastric artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nT12 compression deformity is unchanged. Tiny unchanged vertebral body bone\nislands are noted.\n\nSOFT TISSUES: Small incidental fat containing umbilical/periumbilical hernias.\nSubcutaneous emphysema in the right and left anterior pelvic wall probably\nreflect sequela of medication injection.", "output": "1. Right inguinal lymphadenopathy has markedly enlarged. Celiac,\ngastrohepatic ligament, and left internal iliac lymphadenopathy are minimally\nenlarged. Lymphadenopathy elsewhere is unchanged. Please see the same day\nPET-CT report for description of FDG avidity.\n2. Intermediate attenuation renal lesions are non FDG avid and probably\nreflect hemorrhagic or proteinaceous cysts." }, { "input": "LOWER CHEST: Please refer to the dedicated chest CT from the same day for a\ndescription of thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cortical hypodensities, some of which are cysts and others of\nwhich are too small to accurately characterize on CT, are unchanged. No\nhydronephrosis, or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal. No bowel\nobstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Bilateral\nureter jets of excreted intravenous contrast are visualized. No free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa are within normal limits.\n\nLYMPH NODES: An 8-mm right inguinal lymph node previously measured 5 mm\n(series 4, image 110). No retroperitoneal, mesenteric, pelvic, or inguinal\nlymphadenopathy by size criteria.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. Superior\nendplate compression fracture of the T11 vertebral body is unchanged (series\n10, image 30). Lucency with surrounding increased sclerosis and callus\nformation in the right tenth lateral rib is consistent with a prior fracture\nand corresponds to the area of increased FDG uptake on the prior exam (series\n4, image 65). Sclerosis of the right eighth lateral rib is unchanged (series\n4, image 52; series 10, image 11). Several small sclerotic lesions are\nunchanged since at least ___ (e.g. Series 4, image 51, 73, 87, 95,\n101).\n\nSOFT TISSUES: A fat-containing umbilical hernia is small (series 10, image\n36). A fat-containing periumbilical hernia just superior to the umbilicus is\nsmall (series 10, image 36; series 4, image 77).", "output": "No evidence of lymphadenopathy in the abdomen or pelvis. Slight interval\nincrease in an 8-mm right inguinal lymph node, previously 5 mm." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple bilateral cortical cysts, the largest measuring 3 cm in the\nleft interpolar region which is unchanged. No suspicious renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is mild\nthickening of the cecal wall with enhancement, which is new from the prior\nstudy (2:99). The remainder of the colon and rectum are unremarkable.\nAppendix is not seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no abdominopelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is lumbarization of the S1 vertebral body. Mild height loss of the T12\nvertebral body is unchanged.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.", "output": "1. No lymphadenopathy in the abdomen or pelvis.\n2. Mild thickening of the cecal wall is nonspecific. Attention on follow-up\nis recommended.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions and compressive\natelectasis in the lower lobes.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse heterogeneous enhancement of the liver\nparenchyma. There is no evidence of focal lesions. There is mild dilatation\nof the central intrahepatic bile ducts. The CBD is also mildly distended\nmeasuring up to 11 mm. There is no distal obstructive mass or calculus. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas is slightly atrophic. There is no focal pancreatic\nlesion. Main pancreatic duct is within normal limits. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The ascending and\ntransverse colon are fluid filled and mildly dilated. Descending colon is\ncollapsed. There is no evidence of colitis. Rectal catheter noted in place. \nThe appendix is not visualized.\n\nPELVIS: The urinary bladder is collapsed around a Foley catheter. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Note is made of prior left mastectomy. Soft tissue defect in\nthe anterior abdominal wall is likely from recent ___ flap breast\nreconstruction. There is no abdominal wall fluid collection.", "output": "1. No clear source of infection identified in the abdomen and pelvis.\n2. Heterogeneous enhancement of the liver is nonspecific and may be secondary\nto mild congestion.\n3. Mild biliary duct dilatation with no obstructive cause.\n4. Small bilateral pleural effusions and bibasilar atelectasis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains tiny layering\ngallstones but evidence of gallbladder wall thickening or distention.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stones, focal renal lesions, or hydronephrosis. Tiny\nbilateral renal hypodensities are too small to characterize but likely cysts. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Appendix is not visualized. There is no evidence\nof mesenteric lymphadenopathy.\n\nLYMPH NODES: There are nonenlarged retroperitoneal lymph nodes. Scattered\nretrocrural lymph nodes are also noted. There are lymph nodes measuring up to\n6 mm at dated GE junction (5: 40 ___. .\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions.\nAbdominal and pelvic wall is within normal limits.", "output": "1. No evidence of acute intra-abdominal process. Nonvisualized appendix.\n2. Cholelithiasis without evidence of acute cholecystitis.\n3. Scattered nonenlarged lymph nodes. Cluster of nonenlarged lymph nodes is\nnoted near the GE junction. If clinically indicated, consider endoscopy." }, { "input": "LOWER CHEST: Limited assessment of lung bases again demonstrates bilateral\nlower lobe atelectasis superimposed on chronic fibrosing interstitial lung\ndisease. The heart is notable for a stable ascending aortic stent graft. \nNormal heart size. No pericardial effusion. Mild coronary artery disease is\npresent.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: Stable 1.1 x 0.9 cm pancreatic tail hypodensity is present (03:28).\nThe pancreas otherwise has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Few diverticula of the sigmoid\nand descending colon is noted, without evidence of wall thickening and fat\nstranding. Normal terminal ileum. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized and likely surgically\nabsent. No large adnexal mass.\n\nLYMPH NODES: Stable 1.2 x 1.5 cm (03:23) (previously 1.9 x 1.4 cm) periportal\nlymph node and 1.2 x 1 cm (03:36) right para-aortic lymph node (previously 1.4\nx 0.8 cm) since ___ and has decreased since ___ FDG PET. \nThere is no new retroperitoneal or mesenteric lymphadenopathy. There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Moderate degenerative changes of the thoracolumbar spine are noted\nincluding subchondral sclerosis, disc space loss and anterior osteophytes. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stable 0.5 cm coarse calcification within the right gluteal\nsubcutaneous tissues consistent with a prior trauma or injection granuloma. \nThe abdominal and pelvic wall is within normal limits.", "output": "1.\n 1. No acute intra-abdominal process. Specifically, normal appearance of the\nsmall and large bowel.\n 2. Stable mesenteric and retroperitoneal lymphadenopathy since ___ which has decreased since ___ FDG PET.\n 3. Other stable findings including lower lobe chronic fibrosing interstitial\nlung disease.\n 4. Stable 1.0 cm cystic lesion in the tail the pancreas, statistically\nlikely representing a side branch IPMN.\n 5. Stable ascending aortic stent graft." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere has been interval resolution of the left hydronephrosis and left\nperinephric fat stranding. The left ureteral stent is seen in satisfactory\nposition extending from left renal pelvis to the bladder. A 4 mm stone is\nagain seen in the left mid ureter. There is no evidence of focal renal\nlesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. There is diverticulosis of the sigmoid and\ndescending colon without evidence of diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval resolution of left hydronephrosis and perinephric stranding. \nSatisfactory positioning of left ureteral stent and stable position of left\nmidureteral stone.\n2. No other renal, ureteral, or bladder stones definitively appreciated.\n3. Diverticulosis.\n4. Cholelithiasis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver demonstrates replacement with multiple hepatic masses,\nconsistent with metastatic disease. Some of these lesions are now more\nhypodense compared to the prior exam, consistent with necrosis. For example,\nin the left lobe of liver the, there is a lesion measuring 3.7 x 3.3 cm. This\nappears unchanged in size compared to the prior exam. A conglomerate lesion\nin the right lobe liver measures 3.8 x 3.5 cm. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: In the body and tail of the pancreas is largely replaced by tumor\nwhich now demonstrates marked hypoattenuation, consistent with necrosis. The\ncomponent within the body measures approximately 6.4 x 4.9 cm. The component\nextending into the tail measures approximately 6.5 x 3.2 cm. There is an\nexophytic nodular component extending from the superior aspect of the tumor\nmeasuring 2.0 x 2.3 cm (02:59). The head and uncinate process are normal in\nappearance.\n\nThere is hypoattenuating intravascular tumor within the superior most aspect\nof the superior mesenteric vein extending into the proximal aspect of the main\nportal vein measuring a length of approximately 6.2 cm. There is persistent\nexpansion of the superior aspect of the inferior mesenteric vein. The splenic\nvein is thrombosed with multiple upper abdominal collateral vessels noted. \nThe splenic artery appears patent.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple hypoattenuating lesions within the kidneys bilaterally are too small\nto definitively characterize. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Moderate hiatal hernia. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. No evidence of\nbowel obstruction. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding.\n\nModerate volume ascites is demonstrated.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Marked stranding within the subcutaneous soft tissues is\nconsistent with anasarca.", "output": "1. Large mass replacing the body and tail of the pancreas demonstrates new\nhypoattenuation, consistent with tumor necrosis.\n2. Intravascular tumor within the proximal portion of the main portal vein and\nsuperior aspect of the SMV also demonstrates new hypodensity but not\nsignificantly changed in size. Stable thrombosis of the splenic vein.\n3. Innumerable hepatic metastases are not significantly changed in size. \nSeveral lesions demonstrate new hypodensity, consistent with necrosis.\n4. No evidence of bowel obstruction.\n5. Moderate volume ascites.\n6. Please refer to separate report of CT chest performed the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: There is trace dependent atelectasis in the bilateral lower\nlobes. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is long segment mural thickening of the distal ileum\nwith associated mesenteric edema and engorgement. Proximal to the ileum,\nthere are diffusely dilated small bowel loops measuring up to 4.0 cm (series\n2:26). There is no evidence of a transition point. Large bowel loops are\nunremarkable. Appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There are multiple scattered mesenteric lymph nodes measuring up\nto 0.9 cm (series 2:42), not pathologically enlarged by CT size criteria. \nThere also scattered retroperitoneal lymph nodes which are not pathologically\nenlarged by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are bilateral fluid containing umbilical hernias.", "output": "Mural wall thickening of a long segment of the distal and terminal ileum with\nassociated mesenteric engorgement, mesenteric edema, and reactive mesenteric\nlymphadenopathy, is compatible with an acute Crohn's flare. More proximally\nin the small bowel, there is diffusely dilated small bowel loops measuring up\nto 4.0 cm in the jejunum which likely is secondary to a functional ileus. \nThere is no extraluminal disease." }, { "input": "LOWER CHEST: There are small bilateral pleural effusions with adjacent\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is a 7 mm calculus in the mid left ureter. There is\nan additional punctate calculus versus vascular calcification in the upper\npole of the left kidney. There is no significant perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is increased soft tissue\nin the region of the rectum which could potentially the partially related to\nintraluminal contents and possibly varices. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Severe multilevel degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is a unchanged 7 mm calculus in the mid left ureter without\nsignificant hydronephrosis or hydroureter. An additional punctate\nnonobstructing calculus versus vascular calcification is noted in the upper\npole collecting system the left kidney.\n2. Increased soft tissue in the area of the rectum is concerning for wall\nthickening and direct inspection is recommended." }, { "input": "Examination is severely degraded by streak artifact in the upper abdomen due\nto arms being in the down position. Evaluation of the intrapelvic structures\nis also severely degraded by streak artifact from right total hip\narthroplasty. Particularly, the UVJ and distal ureters are not well seen.\n\nLOWER CHEST: Heart size is mildly enlarged without significant pericardial\nfluid. There are severe coronary artery and moderate aortic annular\ncalcifications. There are small layering bilateral pleural effusions with\nadjacent compressive atelectasis. There is bilateral lower lobe are,\nsegmental, and subsegmental airways thickening with distal bronchiectasis,\nslightly greater on the right, with mild scarring. There is a 3 mm nodule in\nthe left lung base (4:4, that is unchanged since ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is grossly unremarkable, though suboptimally\nevaluated. There is no obvious lesion given confines of a noncontrast\nexamination and pre-existing streak artifact. There is no evidence of obvious\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is grossly\nunremarkable\n\nPANCREAS: The pancreas is atrophied and otherwise grossly unremarkable. There\nis no frank pancreatic ductal dilatation. There is no obvious peripancreatic\nfat stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: As compared to the prior study, there is new mild to moderate right\nhydroureteronephrosis, with no frank stone seen in the well visualized portion\nof the ureter to the mid to distal level, though the distal ureter, and\nureterovesicular junction are not well seen due to streak artifact in the\npelvis. It is possible that there is a stone at the level of the UVJ. There\nis no left-sided hydroureteronephrosis. There is no nephrolithiasis or\nureterolithiasis in the visualized portions of the ureters. Subtle\ncalcifications in the left renal hilus are thought to be vascular in nature. \nThe kidneys are otherwise grossly symmetric without obvious solid mass given\nconfines of a noncontrast examination.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable. The duodenum and\ndistal small bowel loops are normal caliber without evidence of obstruction. \nThere is prominent rectal fecal loading. There are scattered colonic\ndiverticula without diverticulitis. The large bowel is otherwise remarkable\nonly for moderate fecal loading without surrounding fat stranding or fluid\ncollection. The appendix is not definitely visualized however there is no\nsecondary evidence for appendicitis.\n\nPELVIS: The bladder and distal ureters are not well seen due to streak\nartifact, however there appears to be a Foley catheter in place with expected\nair in the bladder. There is no gross free fluid in the pelvis though\nexamination is limited by streak artifact in.\n\nREPRODUCTIVE ORGANS: The prostate is not well visualized due to streak\nartifact.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRight total hip arthroplasty is in place, without failure of the visualized\nportion of hardware. There is moderate left hip osteoarthritis. There is\ngrade ___ anterolisthesis of L4 on L5. There are changes from prior lower\nlumbar laminectomy. Otherwise there are background severe lumbar degenerative\nchanges. The bones appear diffusely demineralized.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. New mild-to-moderate right-sided hydroureteronephrosis without stone seen\nin the visualized portion of the right ureter, though the level of the UVJ and\nbladder is not evaluated due to streak artifact from right total hip\nreplacement. It is suspected that there is a right UVJ stone. Ultrasound may\nbe useful for better assessment after clamping the Foley catheter in order to\nfill the bladder.\n2. Prominent rectal fecal impaction.\n3. Small bilateral effusions with bilateral lower lobe bronchiectasis and\nchronic airway inflammation. The known hilar mass is not seen on the included\nimages, better characterized on the prior chest CT.\n4. Unchanged 3 mm left lower lobe pulmonary nodule.\n5. Severe lumbar degenerative changes and changes from prior laminectomy.\n\nRECOMMENDATION(S): Bladder ultrasound after clamping the Foley catheter in\norder to fill the bladder may be useful in order to visualize a possible UVJ\nstone in the setting of degraded CT examination due to artifact from right hip\nhardware.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:55 pm, 3 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: There is mild basilar atelectasis. There is a perifissural left\nupper lobe pulmonary nodule requiring no specific followup (series 2, image\n4). The descending thoracic aorta is tortuous. Heart is mildly enlarged. \nThere are moderate to severe coronary artery calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is fatty in attenuation. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains a large gallstone. There is no evidence\nof acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are bilateral simple renal cysts with the largest measuring 2.8\nx 2.9 cm in the left interpolar kidney. In addition, there are scattered\nsubcentimeter hypodensities in the bilateral kidneys which are too small to\ncharacterize but statistically likely represent simple cysts. The kidneys\nenhance symmetrically. No perinephric abnormality is seen. There is no\nhydronephrosis.\n\nGASTROINTESTINAL: There is a small hiatal hernia. There is no small or large\nbowel obstruction. There is no bowel wall thickening. There is moderate\nfecal retention. Appendix is not visualized. There is no intra-abdominal\nfree fluid or free air.\n\nPELVIS: The urinary bladder is distended and unremarkable. There is no\nbladder wall thickening. There is no free fluid.\n\nREPRODUCTIVE ORGANS: The uterus is absent. There is no pelvic free fluid.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic sidewall lymphadenopathy. There are stable mildly enlarged\nbilateral inguinal lymph nodes measuring up to 1.4 cm on the left, likely\nreactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is severe multilevel degenerative change of the lumbar spine most\npronounced at L4-5 and L5-S1. Mild anterolisthesis of L4-5 is stable.\n\nSOFT TISSUES: Note is made of fluid adjacent to the right ischial tuberosity,\nas seen previously.", "output": "1. No acute intra-abdominal or pelvic process.\n2. Cholelithiasis.\n3. Moderate to severe degenerative changes of the lumbar spine, unchanged from\n___.\n4. Chronic right ischial bursitis." }, { "input": "CHEST: Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. New pneumobilia is seen. The gallbladder is\nsurgically absent with clips in the gallbladder fossa. The hepatic veins, main\nportal vein, and splenic vein are patent, however the mass is again seen\nabutting the anterior aspect of the portal vein and superior mesenteric veins\n(6: 125, 137).\n\nPANCREAS: The distal pancreatic body and tail are remarkable. Again seen in\nthe pancreatic head is a large ill-defined abnormally enhancing soft tissue\nmass. No pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are of normal and symmetric size with normal nephrogram.\nNo renal stones or hydronephrosis. No perinephric stranding or focal fluid\ncollection. A 0.8 x 0.5 cm (6: 135) (previously 0.8 cm) hypodense lesion\nwithin the interpolar region of the left kidney is stable since ___,\nhowever is too small to characterize. No additional renal lesions.\n\nGI: Visualized esophagus and stomach are unremarkable without distension.\nAgain seen is a large heterogeneous ill-defined mass with some areas that have\nundergone necrosis and calcifications. This mass appears slightly larger than\nprevious examination now measuring approximately 11.5 x 9.2 cm (6:154)\n(previously 11.0 x 7.8). This mass is again seen enveloping the first, second,\nand third portions of the duodenum with fluid and gas within this mass which\nlikely represents the duodenum with possible soft tissue infiltration into the\nduodenum (6: 164) Patient is status post Roux-en-Y gastric bypass with a\ngastrojejunostomy. Suture material is seen within the left upper abdomen at\nthe anastomosis site. Oral contrast is seen passing distally into the jejunum.\nNo oral contrast seen within the duodenum. The visualized colon is\nunremarkable without mucosal hyper enhancement, fat stranding, focal mass\nlesion, or obstruction. The appendix is normal without evidence of acute\nappendicitis. No ascites, free intraperitoneal air, or abdominal wall hernia.\n\nRETROPERITONEUM: No mesenteric lymph node enlargement. Interval increase in\nprominence of retroperitoneal lymph nodes however these do not meet CT size\ncriteria for enlargement. Largest measuring 0.9 cm in short axis (6:129).\n\nVASCULAR: The abdominal aorta is normal in caliber without aneurysmal\ndilatation. The celiac axis, SMA, ___, and renal arteries are patent. Mild\natherosclerotic disease seen throughout the abdominal aorta. The mass is again\nseen encircling the common hepatic artery with continued contact along the\nproper hepatic artery after the takeoff of the GDA. The GDA is patent and\nremains enveloped by the mass. Additionally this mass is again seen\nsurrounding the SMA at the takeoff of several smaller vessels (6: 152, 144).\n\nPELVIS: The urinary bladder is decompressed. The distal ureters are\nunremarkable. There is no evidence of pelvic or inguinal lymph node\nenlargement. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo focal lytic or sclerotic lesions concerning for malignancy. Multilevel\ndegenerative disease is again noted in the thoracolumbar spine.", "output": "1. Interval increase in size of a 11.5 cm ill-defined heterogeneous pancreatic\nhead mass which continues to envelop and likely invades the first, second, and\nlikely third portion of duodenum. No pancreatic duct dilatation.\n2. Status post Roux-en-Y gastric bypass with gastrojejunostomy. No evidence of\nobstruction.\n3. New pneumobilia without dilated intrahepatic or extrahepatic biliary ducts.\nEtiology unknown. No documented surgeries to explain pneumobilia.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 14:39 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "LOWER CHEST: The visualized lung parenchyma is within normal limits. There is\nno pleural effusion or pericardial effusion. Subtle hypodense appearance of\nthe blood pool relative to the intraventricular septum is likely due to\npatient is anemic state.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 1.5 cm accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is a nonobstructing 2 mm renal stone the upper pole\nof the right kidney (02:24). There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized. There is fecalized with the\ndistal ileum terminal ileum, suggestive of slow transit/poor PO intake.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A tiny umbilical hernia containing fat is noted.", "output": "1. No acute intra-abdominal or intrapelvic abnormalities.\n2. 2 mm non-obstructing renal stone in the right upper pole. No\nhydronephrosis.\n3. Appendix not visualized, though no secondary signs to suggest appendicitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Again seen is a 1.5 cm accessory spleen\ninferiorly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. Re-demonstrated is a 3 mm, nonobstructing stone in the\nright upper pole (02:23). There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not identified with confidence though no\ninflammatory changes identified in its expected location.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic process.\n2. Redemonstration of a 3 mm, nonobstructing renal stone in the right upper\npole. There is no hydronephrosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal process to explain the patient's symptoms. No\nevidence for pancreatitis\n2. Fibroid uterus" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen are subcentimeter hypodensities, the largest in\nhepatic segment 4B, too small to completely characterize, likely representing\na cysts or hemangiomas. No suspicious liver lesions. No intrahepatic or\nextrahepatic biliary ductal dilatation. The gallbladder is normal in\nappearance.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Postsurgical\nchanges are seen status post right hemicolectomy. Prominent mesenteric lymph\nnodes are seen, not meeting size criteria for adenopathy. For example: Image\n18 of series 8.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Postsurgical changes status post partial colectomy, without evidence for\nrecurrent or metastatic disease." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a focal hypodensity in segment 4 of the liver adjacent to the\nfalciform ligament, which is most likely a pseudolesion or focal fatty\ninfiltration. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions. The pancreatic duct is dilated to 5.5 mm in the body. There\nis no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a focal\nthickening of the mid ascending colon with an adjacent clip is likely a biopsy\nsite (2:43, 601b:22). Correlation with recent colonoscopy findings is\nrecommended. The distal sigmoid colon and rectum appears edematous with\nsurrounding fat stranding, which is compatible with proctitis or proctocolitis\nversus post-procedure changes if this is in the area of a biopsy. There is no\nfree intraperitoneal air. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. Bilateral tubal ligation clips are noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes noted at L5-S1 with facet joint hypertrophy and grade 1\nanterolisthesis of L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Edematous distal sigmoid colon and rectum is compatible with proctitis or\nproctocolitis versus post-colonoscopy changes related to a biopsy.\n2. Focal thickening of the mid ascending colon with clips is compatible with\npost-polypectomy changes. Correlation with recent colonoscopy findings is\nrecommended.\n3. Diffuse pancreatic ductal dilatation. Non emergent MRCP is recommended for\nfollow-up.\n\nRECOMMENDATION(S): Nonemergent follow-up MRCP is recommended to further\nevaluate diffuse pancreatic ductal dilatation." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. Of note, the distal esophagus\nis distended with oral contrast and appears slightly thick wall, suggesting as\nnoted on prior fluoroscopic functional studies, esophageal dysmotility (series\n601b, image 37; series 2, image 31).\n\nABDOMEN:\n\nHEPATOBILIARY: A 3-cm hypodensity in segment 3 of the liver is a unchanged\nfrom the prior MR where it was characterized as a sclerosed hemangioma (series\n601b, image 18). A 3-mm hypodensity in segment ___ is unchanged from the MR\nand consistent with a cyst or biliary hamartoma (series 2, image 30). No\nadditional or concerning focal hepatic lesions. The remaining hepatic\nparenchyma is homogeneously attenuated but decreased throughout, consistent\nwith steatosis. No evidence of intrahepatic biliary ductal dilation. The CBD\nmeasures up to 7 mm and tapers normally proximally and distally (series 601b,\nimage 32). The gallbladder is within normal limits. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout. There is focal\nprominence of the pancreatic parenchyma in the posterior body-tail junction\n(series 2, image), based on prior MR likely normal variant. No discrete or\nconcerning mass. No main pancreatic duct dilation. No peripancreatic\nstranding.\n\nSPLEEN: The spleen is not enlarged. Multiple splenic hypodensities measuring\nup to 1.8 cm in the superior anterior mid spleen are overall unchanged from\nthe prior MR where they were characterized as hemangiomas or benign splenic\nlesions (e.g., series 2, image 43). A 6-mm hypodensity in the inferior spleen\nis unchanged and did not enhance on the prior MR, thought to be a cyst (series\n2, image 49).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nThe right renal pelvis is prominent without frank hydronephrosis. No evidence\nof focal renal lesions or perinephric abnormality.\n\nGASTROINTESTINAL: As above, the distal esophagus is distended with oral\ncontrast and has circumferential wall thickening. Ingested oral contrast\nreaches the descending colon. No evidence of a hiatal hernia. The stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. \nThe appendix measures up to 6 mm in the midportion and tapers at the tip and\ncontains air and oral contrast (series 2, image 75). No surrounding fat\nstranding. No bowel obstruction. No pneumoperitoneum or pneumatosis. No\nintra-abdominal fluid collection.\n\nPELVIS: The urinary bladder is unremarkable. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits. An 1.7-cm right\novarian cyst is demonstrated (series 601b, image 40; series 2, image 94).\n\nLYMPH NODES: A right lower quadrant mesenteric lymph node is nonspecific and\nmeasures up to 7 mm (series 2, image 70). No retroperitoneal lymphadenopathy.\nNo pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Calcified atherosclerotic disease is\nmild. There is an incidental replaced right hepatic artery, arising off the\nSMA (series 2, image 47, 50).\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. There is\nmild left curvature of the lumbar spine. Posterior surgical fixation hardware\nspans T10 through S2 with bilateral pedicle screws at T10-T12 and L1-S2. No\nevidence to suggest hardware complication.\n\nSOFT TISSUES: A fat-containing umbilical hernia is small (series 602b, image\n43).", "output": "1. No bowel obstruction.\n2. Distended distal esophagus with mild wall thickening and retained oral\ncontrast may reflect sequelae of esophageal dysmotility noted on the\nesophagram from ___.\n3. Incidental replaced right hepatic artery.\n4. Hepatosteatosis.\n5. 1.7-cm right ovarian cyst for which further evaluation with pelvic\nultrasound is recommended as clinically indicated if the patient is\npost-menopausal.\n\nRECOMMENDATION(S): Further evaluation of 1.7-cm right ovarian cyst with\nnon-emergent pelvic ultrasound is recommended as clinically indicated if the\npatient is post-menopausal.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:58 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST:\n\nMild to moderate atelectasis at the lung bases is compatible with sedation.\nThere is no pleural effusion. The visualized heart and pericardium are\nunremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation without focal lesion.\nThe gallbladder is absent. Mild prominence of the common bile duct is likely\nrelated to cholecystectomy. There is no intrahepatic bile duct dilatation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without focal lesion\nor pancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size with normal attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. Renal enhancement and excretion is symmetric\nbilaterally. No stone or mass is identified in either kidney.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. The colon and rectum are within normal\nlimits. Scattered oval densities within the colon likely reflect ingested\ntablets.The appendix is not identified, but there is no inflammatory stranding\nabout the cecum to suggest appendicitis.\n\nPERITONEAL CAVITY: There is no free air or free fluid within the abdomen. No\nmesenteric lymphadenopathy is identified.\nRETROPERITONEUM: There is no retroperitoneal lymphadenopathy.\nVASCULAR: The abdominal vasculature including the portal venous system is\npatent. The abdominal aorta is non aneurysmal.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. The uterus and\novaries are within normal limits for age. No adnexal mass, lymphadenopathy, or\nfree fluid is seen within the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo focal osseous lesion or fracture is identified. The abdominal and pelvic\nbody wall is within normal limits.", "output": "Normal CT of the abdomen and pelvis post cholecystectomy. No findings to\nexplain chronic abdominal pain." }, { "input": "LOWER CHEST: The imaged lung bases are clear aside from mild dependent\natelectasis. The imaged portion of the heart is unremarkable. There is mild\nthickening of the distal esophagus, correlate clinically.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally without focal concerning lesion. \nMain portal vein is patent. No intrahepatic or extrahepatic biliary ductal\ndilation. The gallbladder appears normal without hydropic distension or\nradiopaque gallstone. Mild thickening at the gallbladder fundus may reflect a\nfocal adenomyomatosis.\n\nPANCREAS: The pancreas enhances normally without focal concerning lesion,\nsigns of inflammation or ductal dilation.\n\nSPLEEN: The spleen is normal in size without focal abnormality.\n\nADRENALS: Right and left adrenal glands are normal in size and configuration.\n\nURINARY: The kidneys enhance symmetrically and demonstrate prompt excretion of\ncontrast. Bilateral renal parapelvic cysts are noted left greater than right.\nNo signs of pyelonephritis or hydronephrosis. No worrisome renal lesion.\n\nGASTROINTESTINAL: The stomach contains enteric contrast and is unremarkable in\nappearance. The duodenum is normal. Patient has undergone prior colectomy\nwith ileoanal J-pouch reconstruction again noted. Small bowel loops appear\nnondilated and without convincing evidence for mural edema. In this patient\nwith known perianal fistula, ___ is noted in the left ischioanal fat. No\ndefinite signs of adjacent drainable fluid collection though evaluation is\nlimited due to extensive streak artifact from bilateral hip arthroplasties. \nProminent lymph nodes in the right lower quadrant are not significantly\nchanged from the ___ exam and are most likely reactive, measuring up to 1 cm\nin short axis. No free air, no drainable fluid collection.\n\nPELVIS: Urinary bladder is partially distended appearing normal. No gross\nsigns of lymphadenopathy in the inguinal station or pelvic sidewall.\n\nREPRODUCTIVE ORGANS: Prostate is not well visualized though does not appear\nenlarged.\n\nLYMPH NODES: Mildly prominent lymph nodes in the right lower quadrant for\nexample on series 2, image 64 appear similar to the ___ CT exam and likely\nare reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: Bilateral hip arthroplasties are in place without definite evidence of\ncomplication. No worrisome lytic or blastic osseous lesion.\n\nSOFT TISSUES: There is laxity of the anterior abdominal wall with diastasis of\nthe rectus musculature likely reflecting prior surgery. Tiny fat containing\nsupraumbilical midline hernias appear uncomplicated.", "output": "1. Status post colectomy with ___ in place within the left ischioanal fat\nand no drainable fluid collection.\n2. Tiny fat containing hernias in the upper abdominal midline, appear\nuncomplicated.\n3. Mild thickening of the distal esophagus, correlate for reflux or\nesophagitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSmall bilateral renal cortical hypodensities are too small fully characterize\nbut likely represent simple renal cysts. Stable appearance of left-sided\nparapelvic cysts. No evidence of hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Mild thickening of the distal esophagus, appears unchanged\ncompared to ___. The stomach is unremarkable. Patient is status post\ncolectomy with ileoanal reconstruction. Small bowel loops are nondilated\nwithout evidence of mural edema or fat stranding. Patient has known history\nof perianal fistula, with ___ noted in the left ischioanal fat. No\nevidence of drainable fluid collection. No free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is not well-visualized secondary to streak\nartifact from bilateral hip arthroplasties.\n\nRETROPERITONEUM AND MESENTERY: Mildly prominent lymph node in the right lower\nquadrant (2:61) measures 1 cm and is grossly unchanged compared to ___.\nOtherwise, there is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. There is no abdominal aortic\naneurysm. No atherosclerotic disease is noted. The mesenteric vessels appear\npatent.\n\nBONES: Patient is status post bilateral hip arthroplasty. There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stable diastasis of the rectus musculature with small fat\ncontaining supraumbilical midline hernia.", "output": "1. Patient is status post colectomy with ileoanal reconstruction. No evidence\nof obstruction or CT evidence of pancreatitis. Otherwise no evidence to\nsuggest an acute intra-abdominal or intrapelvic process to explain patient's\nsymptoms.\n2. Stable appearance ___ placement in the left ischioanal fat.\n3. Mild thickening of the distal esophagus, appears unchanged compared to most\nrecent prior. ___ consider correlation for reflux or esophagitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. Probable fundal adenomyomatosis of the\ngallbladder, unchanged compared to multiple prior exams. The gallbladder is\notherwise unremarkable.\n\nPANCREAS: The pancreas demonstrates normal attenuation throughout. There is\nmild increased pancreatic ductal dilatation of the pancreatic body up to 5 mm,\nnew compared to prior exam (02:24). No definite pancreatic mass is seen.\n\nSPLEEN: The spleen is top normal in size and demonstrates homogenous\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nProminent bilateral peripelvic cysts are again seen. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status post total\ncolectomy with ileoanal reconstruction. There is no evidence of bowel\nobstruction. The remainder of the visualized small bowel loops demonstrate\nnormal caliber, enhancement, and wall thickness. There has been interval\nplacement of a second perianal ___. A third site of fistulization is seen\nalong the right gluteal fold, better assessed on prior pelvic MRI.\n\nPELVIS: Evaluation of the pelvis is limited secondary to metal artifact from\nbilateral total hip arthroplasties. The perirectal region is incompletely\nevaluated, however no organized or drainable fluid collection is identified. \nThere is no free fluid in the pelvis. The bladder appears somewhat under\ndistended.\n\nLYMPH NODES: A prominent right iliac lymph node measures up to 9 mm in short\naxis and is not appreciably changed compared to at least ___ (2:61). No\npathologically enlarged retroperitoneal or mesenteric lymph nodes are\nidentified. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: Patient is status post bilateral hip arthroplasty. Mild degenerative\nchanges of the thoracolumbar spine. No suspicious osseous lesions. No acute\nfractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild dilatation of the pancreatic duct up to 5 mm is new compared to prior\nexam. No pancreatic mass is seen. Recommend further evaluation with\nnonemergent MRCP.\n2. Stable postsurgical changes of a total colectomy and ileoanal\nreconstruction.\n3. Interval placement of a second ___ stent.\n4. No evidence of bowel obstruction." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is diffuse fatty atrophy of the pancreas. There is no\nevidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is wall\nthickening and mucosal hyperenhancement of the sigmoid and descending colon\nwith prominence of the surrounding Vasa recta, consistent with colitis. The\ninflammation extends likely to the mid to distal transverse colon. There is\ndiverticulosis with no evidence of acute diverticulitis. There is a small\narea of fat and soft tissue density in the left lower quadrant and a site of\npreviously seen diverticulitis, likely representing a torsed epiploic\nappendage (2:78). The appendix is surgically absent. There is no\nintra-abdominal fluid collection or free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild prominence of the soft tissue in the right\ninguinal canal, which may suggest a prior hernia repair. A left inguinal\nhernia containing fat is noted.", "output": "1. Colitis involving the sigmoid and descending colon, and likely extending to\nthe mid to distal transverse colon, is more likely infectious than\ninflammatory or ischemic. No intra-abdominal fluid collection or free air.\n2. Diverticulosis, with no evidence of acute diverticulitis." }, { "input": "LOWER CHEST: There is a small pleural effusion on the left, trace effusion on\nthe right. Bilateral dependent atelectasis is noted. The heart is enlarged. \nPartially-imaged sternotomy wires are seen.\n\nABDOMEN:\n\nHEPATOBILIARY: There is slightly inhomogeneous enhancement of the liver\nparenchyma which could be associated with hepatic congestion. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits. \nThere is trace perihepatic ascites extending to the right paracolic gutter.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a duplicated right renal collecting system, with 2 right\nureters which fuse proximally. Normal nephrogram is seen bilaterally. There\nis no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.\nThe colon and rectum are within normal limits. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted involving the abdominal aorta and iliacs\nbilaterally.\n\nBONES: Degenerative changes in the thoracolumbar spine are again noted, with\nredemonstration of bridging anterior osteophytes at L3-L4 and L4-L5. Linear\nlucency through anterior osteophyte at L5 is new since ___, but of\notherwise indeterminate age. Grade 2 spondylolisthesis of L5 over S1 is again\nseen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Small moderate left and trace right pleural effusions.\n2. Trace perihepatic ascites extending to the right paracolic gutter may\nrelate to third spacing.\n3. No bowel obstruction. No bowel wall thickening.\n4. Fracture of nonspecific chronicity of the anterior bridging osteophyte at\nL5, new from ___." }, { "input": "LOWER CHEST: Small left and trace right pleural effusions are noted. The\nheart is enlarged, in keeping with the patient's history of congestive heart\nfailure.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits. \nTrace ascites is seen extending into the right paracolic gutter, as seen on\nthe most recent comparison. There may be mild associated mesenteric edema.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and demonstrate normal nephrograms. \nNo solid renal lesions are identified. There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable aside from a small hiatal\nhernia. There are several nonspecific loops of fluid-filled small bowel in\nthe right lower quadrant, which are nondilated. The colon is unremarkable. \nThe appendix is not definitively visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate may be minimally enlarged. The seminal\nvesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is stable grade 2 anterolisthesis of L5 on S1, unchanged since the\nprior. Multilevel degenerative changes in the lower lumbar spine are\nunchanged.\n\nSOFT TISSUES: There is mild diffuse body wall edema.", "output": "-Small bilateral pleural effusions, trace ascites, and possible mild\nmesenteric edema, likely related to third spacing/fluid overload.\n-No bowel obstruction." }, { "input": "LOWER CHEST: There is a trace, dependent, layering, nonhemorrhagic left\npleural effusion with associated atelectasis. Patient is status post CABG the\nheart is enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas appears atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in shape and appearance. The left\nadrenal gland is mildly thickened.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are tiny cortically based hypodensities in the kidneys, too small to\nfully characterize. A duplicated right collecting system is redemonstrated. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There may be mild equivocal wall thickening of the pylorus\nversus decompressed appearance. Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is again severe degenerative changes seen in the lumbosacral\nspine with grade 2 spondylolisthesis of the L5-S1 vertebral level, similar to\nprior study from ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Apparent equivocal thickening of the pylorus is likely due to peristalsis. \nOtherwise, no acute CT findings in the abdomen or pelvis.\n2. Trace left pleural effusion with associated atelectasis." }, { "input": "LOWER CHEST: A 3 mm subpleural left lower lobe pulmonary nodule (2:5) is\nstable from at least ___. Visualized lung fields are otherwise within normal\nlimits. There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffusely low attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation. A prominent extrahepatic common hepatic duct measures 1.0\ncm, unchanged from prior examination and likely secondary to the patient's\npostcholecystectomy state. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A moderate-sized, axial hiatal hernia is noted. The\nstomach is unremarkable. Multiple loops of bowel are fluid-filled and some\ndemonstrate mild wall thickening. The colon is largely collapsed, but\ndemonstrates wall edema and adjacent inflammatory changes which are most\nnotable in the descending colon (2:45, 601b:30). The appendix is not\ndiscretely visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Fibroid\nuterus is noted. A 2.2 cm left adnexal cyst is noted, similar the prior\nexamination, which may represent a dominant follicle if the patient is still\npremenopausal. There is trace free fluid in the pelvis.\n\nMESENTERY AND LYMPH NODES: Trace mesenteric fluid is noted, in addition to\nsmall amounts of fluid along the bilateral pericolic gutters and adjacent to\nthe hepatic margin (02:17). There is no pathologically enlarged\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. Multiple focal regions of small bowel wall thickening with surrounding\ninflammatory changes, raise concern for enteritis.\n2. Mild descending colonic wall thickening and edema. While these findings\nmay be secondary to underdistention, the associated adjacent inflammatory\nchanges and mesenteric fluid suggest colitis. Findings may be secondary to\ninfectious, ischemic, or inflammatory causes.\n3. Moderate axial hiatal hernia.\n4. 2.2 cm left adnexal cyst may be physiologic if patient is premenopausal. \nIf patient is postmenopausal, recommend follow-up pelvic ultrasound for\nfurther assessment.\n\nRECOMMENDATION(S): 2.2 cm left adnexal cyst may be physiologic if patient is\npremenopausal. If patient is postmenopausal, recommend follow-up pelvic\nultrasound for further assessment." }, { "input": "LOWER CHEST: A 4 mm subpleural nodule in the left lower lobe is not\nsignificantly changed since at least ___. There is minimal\nbibasilar atelectasis. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\ndense calcification the right hepatic lobe is not significantly changed. \nThere is mild central intrahepatic biliary duct dilatation, slightly increased\nfrom prior, however likely related to prior cholecystectomy. The extrahepatic\ncommon bile duct is dilated up to 10.0 mm, not significantly changed and\nlikely related to prior cholecystectomy. The gallbladder is surgically\nabsent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not well visualized, however\nthere are no secondary signs of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable. Bilateral adnexal clips are\nconsistent with history of bilateral tubal ligation. Again seen is a 1.8 cm\ncyst in the left adnexa, not significantly changed.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "-No acute process in the abdomen or pelvis.\n-Mild central intrahepatic biliary duct dilatation is slightly more prominent\ncompared with prior, however likely secondary to prior cholecystectomy." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis. Otherwise, visualized lung fields\nare within normal limits. There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY Two subcentimeter hypoattenuating lesions the right lobe of the\nliver are re demonstrated, better characterized on prior liver MRI from ___, consistent with simple cysts. Otherwise, the liver is diffusely\nhypoattenuating, consistent with hepatic steatosis. There is no evidence of\nfocal concerning lesions. Previously seen pneumobilia has resolved. The main\nportal vein is patent. No pneumobilia or portal venous gas. There is mild\nperiportal edema.\n\nPANCREAS: Patient is status post ___'s procedure for adenocarcinoma of\nthe pancreatic head, with expected post surgical changes, including soft\ntissue stranding and subcutaneous edema adjacent to midline anterior abdominal\nwall skin staples, extending to soft tissues of the lateral abdominal wall and\npelvis bilaterally, as well as stranding and mesenteric edema within the\nsurgical bed. There are two abdominal surgical drains in place, terminating\nwithin the surgical bed in the right upper quadrant/ mid upper abdomen. There\nis atrophy of the remaining visualized pancreas with the main pancreatic duct\nmeasuring up to 3 mm. There is no rim enhancing or organized peripancreatic\nfluid collection identified. Several locules of free intraperitoneal gas are\nnoted in the right hemi abdomen, presumed to represent normal postsurgical\nchange.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Tiny left renal hypodensities, too small to further characterize,\nsimilar to prior exams, likely simple renal cysts. Otherwise, the kidneys are\nof normal and symmetric size with normal nephrogram. There is no evidence of\nfocal renal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: A percutaneous gastrojejunostomy tube is in place. Stomach\nand visualized small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. Otherwise, the colon\nand rectum are unremarkable. The appendix is normal. Moderate fecal loading.\nNo bowel obstruction. No pneumatosis. No free intraperitoneal air. Nodular\nhyper enhancement within the anus is consistent with hemorrhoids, similar to\nprior.\n\nPELVIS: The urinary bladder is distended. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not visualized. No adnexal abnormalities\nidentified.\n\nLYMPH NODES: There are multiple prominent mesenteric lymph nodes, not meeting\nCT size criteria for pathologic enlargement, likely reactive. There is no\nretroperitoneal, pelvic or inguinal lymphadenopathy\n\nVASCULAR: IVC filter is noted within the mid IVC. There is no abdominal\naortic aneurysm. Minimal atherosclerotic disease is noted.\n\nBONES: Multiple vertebral hemangiomas are noted. There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes involving the anterior abdominal wall. \nSkin staples are present. .", "output": "1. Status post Whipple procedure and percutaneous gastrojejunostomy tube with\nexpected postoperative changes. No drainable peripancreatic, intra-abdominal\nor intrapelvic fluid collection identified. Anastomotic sites appear grossly\nintact. Please note that anastomotic leak cannot be fully assessed in the\nabsence of oral contrast.\n2. Interval placement of an IVC filter, located within the mid IVC.\n3. Subcentimeter hypodensities in the right lobe of liver, as on prior MRI\nfrom ___, consistent with simple cysts.\n4. Tiny left renal cortical hypodensities are too small to further\ncharacterize, likely simple cysts." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions within limits of an unenhanced study. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout. There is no main\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 2.3 cm right adrenal nodule measuring <10 ___ on noncontrast imaging\nis compatible with an adenoma. The left adrenal gland is normal in size and\nshape.\n\nURINARY: The kidneys are of normal and symmetric size. There is a 2.2 x 1.7\ncm peripelvic cyst in the interpolar region of the right kidney. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. The remainder of the\nstomach is unremarkable. Small bowel loops are normal in caliber. The colon\nand rectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder is decompressed. There is extensive stranding and\nhematoma within the anterior pelvis and space of Retzius. There is also\nextensive subcutaneous fat stranding anterior to the pubic symphysis and\nwithin the right anterior pelvic wall, extending to the right groin. There is\na questionable small focal defect in the anterior superior bladder wall\n(602:77, 03:111) which raises the concern for bladder wall injury, and further\nevaluation with CT cystogram is recommended. The distal ureters are normal in\nappearance.\n\nREPRODUCTIVE ORGANS: The prostate appears enlarged. The seminal vesicles are\nsymmetric.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Bones are osteopenic which limits evaluation for acute nondisplaced\nfractures. There is a comminuted, nondisplaced fracture of the right\nposterior ilium (3:114, 604:94, 605:49) which extends into the right\nsacroiliac joint resulting in diastasis of the sacroiliac joint (3: 112). \nDiastasis of the pubic symphysis is also noted, measuring 1.8 cm in width. \nThere are no fractures of the sacrum, pubic rami or proximal femurs.\n\nSOFT TISSUES: As mentioned above there is extensive stranding and hematoma of\nthe of the lower abdominal wall anterior to the pubic symphysis, as well as\nthe right gluteal soft tissues.", "output": "1. Comminuted, nondisplaced fracture of the right posterior ilium extending to\nthe right sacroiliac joint resulting in right SI joint diastasis. 1.8 cm\ndiastasis of the pubic symphysis. Findings are compatible with an unstable,\nAP compression type pelvic fracture.\n2. Extensive stranding and hematoma within the anterior pelvis and space of\nRetzius. Questionable small focal defect in the anterior superior bladder\nwall which raises the concern for bladder wall injury, and further evaluation\nwith CT cystogram is recommended. Additionally, please note that in the\nabsence of intravenous contrast, this study does not assess for active\nextravasation.\n3. Extensive subcutaneous fat stranding and hematoma anterior to the pubic\nsymphysis and within the right anterior pelvic wall, extending to the right\ngroin.\n4. Cholelithiasis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:51 am, 1 minutes after\ndiscovery of the findings.\n\n The findings were discussed with ___, M.D. by ___, M.D. in\nperson on ___ at 8:20am, 1 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is distended and contains biliary sludge, without\nevidence of acute cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 2.3 cm right adrenal nodule measuring less than 10 Hounsfield units\non noncontrast imaging, no change from prior, likely adenoma. The left\nadrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. A 1.9 cm right renal\nsimple cyst is unchanged from prior. There is no evidence of focal renal\nlesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small hiatal hernia. Otherwise the stomach is unremarkable.\nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nThe colon and rectum are within normal limits. The appendix is not\nvisualized.\n\nPELVIS: Bladder is distended, air within the anterior aspect of the bladder is\nlikely post instrumental. Moderate soft tissue stranding and likely hematoma\nwithin the pelvis and perivesicular soft tissue is improved from prior.\n\nREPRODUCTIVE ORGANS: The prostate is moderately enlarged. The seminal vessels\nare symmetric.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Comminuted, nondisplaced fracture of the right posterior ilium (601:51)\nis not significantly changed from recent trauma CT scan, with extension into\nthe right SI joint. Diastasis of the pubic symphysis measures 1.5 cm,\nslightly decreased from prior. There is a fracture of the superior median\nsacral crest (2:61).\n\nSOFT TISSUES: There is extensive anterior soft tissue swelling which is\ndecreased from prior about the groin and anterior abdominal wall. Bilateral\ngluteal soft tissue stranding is again noted, slightly worsened from prior,\nand more prominent on the right.", "output": "1. No evidence for new or increased retroperitoneal hematoma. Mild decrease in\nsize of intrapelvic, anterior abdominal wall and perivesicular soft tissue\nstranding and likely hematoma. Slightly worsened bilateral gluteal soft\ntissue stranding.\n2. No significant change in the comminuted, nondisplaced fracture of the right\nposterior ilium. Diastasis of the pubic symphysis measures 1.5 cm, slightly\ndecreased from prior.\n3. Minimally displaced fracture of the superior median sacral crest." }, { "input": "LOWER CHEST: Please review same day dedicated chest CT report.\n\nABDOMEN:\n\nHEPATOBILIARY: Hyperdense lesion in segment 7, unchanged and likely represents\na hepatic cyst. No suspicious hepatic lesion or ductal dilation. Contracted\ngallbladder.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: Unchanged subcapsular inferolateral cystic splenic lesions with 23\nHounsfield units, possibly cysts/hemorrhagic cysts versus mucinous metastases\ninvolving the splenic capsule (pseudomyxoma peritonei)\n\nADRENALS: Unremarkable.\n\nURINARY: No nephrolithiasis or hydronephrosis.Simple right superior pole\nrenal cyst. Smaller left upper pole hypodense focus, too small to\ncharacterize.\n\nGASTROINTESTINAL: No intestinal obstruction. Fluid-filled dilated appendix up\nto 1.4 cm. No periappendiceal fat stranding or fluid collection. \nPeriappendiceal fluid seen from abdominal ascites. No pneumoperitoneum.\n\nDiffuse soft tissue omental metastases, not significantly changed. Mild\nabdominal fluid consistent with pseudomyxoma peritonei in a patient with known\nmucinous adenocarcinoma.\n\nPELVIS: Interval worsening of bilateral cystic ovarian masses. On right, a\nmeasures 9.4 x 12.6 cm (previously 5.7 x 6.5 cm) and extending along the right\ngonadal vein course to the level of the iliac bifurcation. On left, and\nmeasures 5.5 x 7.4 cm (previously 4.7 x 5.1 cm).The masses are predominantly\ncystic with septations. Free pelvic fluid.\n\nMildly compress uterus by the ovarian masses. Unremarkable bladder and\nrectum.\n\nLYMPH NODES: Prominent mesenteric and inguinal lymph nodes without adenopathy.\n\nVASCULAR: Patent aorta and major branches.\n\nBONES AND SOFT TISSUES: No acute fracture or suspicious osseous lesion. L2\nvertebral body hemangioma. No soft tissue mass.", "output": "1. Cystic bilateral ovarian masses have increased in size with no improvement\nin peritoneal metastases and pseudomyxoma peritonei.\n2. Dilated appendix up to 1.4 cm." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Hypodensities along the liver capsule are more prominent than\non the prior study including a posterior right hepatic lobe lesion measuring\n1.7 x 1.0 cm (02:16), and a left hepatic lobe lesion measuring 1.4 x 2.3 cm\n(02:22). The liver contour appears scalloped adjacent to multiple peritoneal\nimplants and perihepatic ascites. The portal vein is patent. There is no\nintra or extrahepatic biliary ductal dilation. The gallbladder is distended,\nbut otherwise unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Multiple cystic lesions in the peripheral spleen are larger compared\nto the prior study, measuring up to 3.4 x 2.7 cm (02:20).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAn interpolar right renal cyst is 2.6 cm in maximal dimension, unchanged. \nOther tiny hypodensities are noted in the left kidney, too small to\ncharacterize. There is no evidence of hydronephrosis or stones bilaterally. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is no evidence of bowel obstruction. The stomach is\nsurrounded by omental caking in the upper abdomen, extending into the\ngastrohepatic recess. The small bowel is likewise also tethered by omental\ncaking in the anterior abdomen and left upper quadrant. Where visualized, the\nappendix appears fluid filled and dilated, measuring up to 14 mm (601b:33).\n\nPELVIS: Mass effect upon the urinary bladder secondary to cystic masses in the\nright lower quadrant. Cystic masses in the bilateral adnexa have enlarged\nsince the prior study, including a very large multi cystic lobulated mass\narising from the right adnexa now approximately 12 x 14 cm (2:65), previously\n11 x 10 cm. Ovaries cannot be delineated from the cystic lesions.\n\nLYMPH NODES: Numerous enlarged mesenteric and ileocecal lymph nodes are noted,\nincluding a 1.5 x 1.0 cm right lower quadrant mesenteric lymph node (02:49).\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: L2 osseous hemangioma is unchanged. There is no evidence of fracture\nor lesion suspicious of infection or malignancy.\n\nSOFT TISSUES: A small umbilical hernia contains a loop of nonobstructed bowel.", "output": "1. Significant worsening of metastatic disease burden in the abdomen and\npelvis, with large predominantly cystic masses in the pelvis and widespread\nomental caking and peritoneal metastases.\n2. Parenchymal cystic lesions in the liver spleen of also enlarged since the\nprior study.\n3. No evidence of bowel obstruction or intraperitoneal free air." }, { "input": "LOWER CHEST: Mild dependent atelectasis is noted at the imaged lung bases.\nThe imaged portion of the heart is unremarkable.\n\n\nABDOMEN: The liver enhances normally without focal lesion. The gallbladder is\nnormal. No biliary ductal dilation. The main portal vein and central branches\nappear patent. The pancreas is normal though the pancreatic duct appears\ntop-normal in size measuring 4 mm. Please correlate clinically. The spleen is\nnormal. Adrenal glands are normal. The kidneys enhance symmetrically and\nexcrete contrast promptly. Small sub cm hypodensities are seen within the left\nkidney, likely cysts though too small to characterize. The abdominal aorta is\nnormal in course and caliber with widely patent major branches. No\nretroperitoneal lymphadenopathy or hematoma is seen. The stomach is\ndecompressed. The duodenum is normal.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction.\nThere is mild bowel wall edema involving the distal/terminal ileum extending\nto the level of the cecum. There is bowel wall thickening involving the\nascending and transverse colon with mild fat stranding and trace fluid\ntracking along the right pericolic gutter. Fibro fatty proliferation of the\nileocecal valve is again noted. The appendix is normal visualized extending\nmedially on series 601b image 23 through 32. Free fluid tracks in a small\nvolume into the deep pelvis. Uterus and adnexal structures appear normal.\nUrinary bladder is only partially distended with bilateral ureteral jets\ndemonstrated.\n\nBONES AND SOFT TISSUES: No worrisome bony lesions are seen. No fractures. No\nsignificant degenerative joint disease appear.", "output": "1. Bowel wall edema involving the distal ileum, ascending and transverse colon\nconcerning for acute colitis which may reflect an inflammatory, infectious,\nless likely ischemic etiology. No extraluminal collection or signs of\nperforation. Small volume free fluid.\n2. Normal appendix visualized." }, { "input": "LOWER CHEST:\nThere is mild bibasilar dependent atelectasis. There is no pulmonary nodule in\nthe imaged lung bases. There is no pleural or pericardial effusion. Heart size\nis within normal limits.\n\nABDOMEN:\nPostsurgical changes consistent with liver transplantation are demonstrated. A\npatent hepatic artery stent is visualized with no evidence of stenosis or\nthrombosis.\n\nThere are peripheral areas of the hypervascularity in segment VIII (04:13),\nsegment VII (04:21), segment ___ (04:22), and a larger peripheral wedge-shaped\narea of hyper enhancement spanning approximately 1.9 cm within segment II.\nEach of these areas of hyper enhancement case isointense to hepatic parenchyma\non more delayed phase imaging and likely represent transient hepatic intensity\ndifferences. There is no evidence of washout or pseudo capsule formation. 4 mm\nhypodensity at the junction of segments II and III is too small to accurately\ncharacterize, but unchanged and likely represents cyst versus biliary\nhamartoma. There is no ascites.\n\nThe hepatic, portal, splenic, and superior mesenteric veins are patent.\n\nGallbladder is absent. There is unchanged splenomegaly measuring 16.5 cm in\nlength. There is no evidence of varices. There is a 1.9 cm splenule. There is\nno evidence of pancreatic mass or pancreatic ductal dilatation.\n\nAdrenal glands are unremarkable. There is a 7 mm non-obstructing right upper\npole calculus. There are multiple bilateral small hypodensities within the\nrenal cortices which are too small to accurately characterize, including a new\n5 mm right lower pole hypodensity.\n\nVisualized bowel is normal in enhancement and wall thickness. There is no\nevidence of obstruction. There is minimal atherosclerotic calcification of the\nvisualized upper abdominal aorta. There is no evidence of aneurysmal dilation.\nThere is no suspicious osseous lesion.", "output": "1. No suspicious hepatic lesion.\n2. Patent hepatic artery stent.\n3. Multiple hypoattenuating structures in the kidneys bilaterally, many of\nwhich are too small to accurately characterize, including a new 5 mm right\nlower pole hypodensity. Attention on followup imaging.\n4. 7 mm non-obstructing right upper pole calculus." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post liver transplant with a stent noted\nwithin the common hepatic artery in similar position to the prior examination.\nThe hepatic artery appears patent. The portal vein is patent. There is no\nintrahepatic biliary ductal dilatation. The liver is homogeneous in\nattenuation and normal in size. Within segment II there is a 1.9 x 1.5 cm\narea of geographic, peripheral enhancement which does not display washout on\ndelayed imaging suggestive of a perfusion anomaly (04:23). No focal hepatic\nlesions are identified.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. A renal calculus in the right upper pole is\nunchanged.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis of the sigmoid colon without diverticulitis The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 1.9 cm area of geographic, peripheral hepatic enhancement within segment II\nwhich does not display washout on delayed imaging is suggestive of a perfusion\nanomaly. However, follow-up is recommended with multiphasic CT.\n\nRECOMMENDATION(S): Multiphasic CT in 3 months for further evaluation." }, { "input": "LOWER CHEST: Minimal subsegmental atelectasis is noted. There is no pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post liver transplant. A stent is again\nseen within the common hepatic artery, unchanged compared to previous. The\nhepatic artery, portal vein, and hepatic veins are patent. There is no\nintrahepatic biliary ductal dilatation. Within segment II, there is re-\ndemonstration of a 1.9 x 1.5 cm geographic area of peripheral arterial hyper\nenhancement with no correlate on the delayed phases, consistent with a\nperfusion anomaly. No suspicious focal lesions are identified. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A small accessory spleen is seen at the splenic\nhilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple tiny cortical hypodensities are seen in both kidneys, too small to be\ncharacterized, but likely represent simple cysts and are unchanged compared to\nprevious. There is no hydronephrosis or perinephric abnormality. Incidental\nnote is made of and retroaortic accessory left renal vein.\n\nGASTROINTESTINAL: The stomach is unremarkable. The visualized large and small\nbowel loops normal caliber, wall thickness, and enhancement throughout.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Stable area of geographic peripheral arterial enhancement within hepatic\nsegment II in keeping with a perfusional anomaly. There are no suspicious\nhepatic lesions and the vessels are patent." }, { "input": "LOWER CHEST: Mild bibasilar atelectasis. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a wedge-shaped area of hyperdensity surrounding an\napparent hypodense tubular structure in segment VIII, more pronounced than on\nprior study from ___, which could represent a thrombosed branch of\nthe middle hepatic vein, or less likely cholangitis about a dilated biliary\nduct. No new focal concerning hepatic lesions are seen. There is no evidence\nof extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is new right-sided mild hydroureteronephrosis with abrupt\ncaliber change of the distal right ureter near the region of phlegmonous\nchanges in the right lower quadrant (2:60). No focal renal lesion is\nidentified. No hydroureteronephrosis on the left. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Patient is status post appendectomy.\n\nPELVIS: A large 8.3 x 7.3 cm rim-enhancing collection within the midline\npelvis, just posterior to the bladder, previously measuring 7.4 x 7.1 cm, is\nconsistent with an abscess and tracks along the anterior aspect of the left\npelvis (2:75). There is associated inflammation and phlegmonous changes\nwithin the midline pelvis and left anterior pelvis as well as to a lesser\nextent within the appendectomy bed. Three pigtail catheters are in place,\nwith the right lower quadrant and midline pelvic collections markedly\ndecreased in size. The left lateral mid abdominal fluid collection is no\nlonger visualized. The urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Interval increase in size of midline pelvic abscess, now measuring 8.3 x\n7.3 cm which extends to the left anterior pelvis.\n2. Three pigtail catheters in place with interval resolution of the left-sided\nfluid collection and marked decrease in size of the two remaining collections.\nNo new fluid collections identified.\n3. New mild right-sided hydroureteronephrosis, with transition point in the\ndistal right ureter as it courses in the region of phlegmonous changes in the\nright lower quadrant.\n4. Wedge-shaped area of hyperdensity surrounding a hypodense tubular structure\nin segment VIII, more pronounced compared to prior study, which could\nrepresent a potentially thrombosed branch of the middle hepatic vein with\nthrombophlebitis, or less likely, cholangitis surrounding a dilated duct. \nThis could be further assessed with MRCP.\n\nRECOMMENDATION(S): MRCP is suggested for further assessment of the segment\nVIII hepatic abnormality." }, { "input": "LOWER CHEST: The partially imaged lower lungs are clear. No evidence of a\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. The\nwedge shaped hyperdensity in segment VIII on the prior exam is not clearly\nvisualized on today's exam. No evidence of focal lesions. No evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\ncontracted and within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of focal renal lesions or perinephric abnormality. Right\nhydronephrosis has resolved. No left hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is surgically absent. No bowel\nobstruction.\n\nA fluid collection in the anterior left lower abdomen within which a pigtail\ndrain was present on the prior CT is now smaller, measuring up to 1.6 x 1.2\ncm, previously up to 2.7 x 1.8 cm (series 5, image 61). Residual sub-3-mm\nhyperdense material within the dependent portion of the fluid collection is\nunchanged from the first post-operative CT on ___ (series 5, image 62). \nIn the absence of any prior exams with oral contrast and the presence of\nappendicoliths on the pre-operative CT, these are concerning for retained,\nmigrated appendicoliths (series 3, image 20). Surrounding fat stranding and\ndecompressed loops of small bowel persist.\n\nThe drain in the left lateral abdominal wall has been removed in the interim\nwithout evidence of a residual or recurrent fluid collection. Residual mild\nfat-stranding is noted.\n\nThe right lower abdominal fluid collection has now collapsed with unchanged\nposition of the right lower abdominal drain and no residual fluid collection\n(series 5, image 58).\n\nA right presacral drain has been placed since the prior CT with interval\ncollapse of the large fluid collection, now with minimal free fluid and no\nresidual drainable fluid collection (series 5, image 80). Residual fat\nstranding in the pelvis is moderate. No new fluid collections.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace residual free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: A periportal lymph node measures up to 6 mm in short axis,\nunchanged (series 5, image 25). Scattered retroperitoneal mesenteric lymph\nnodes are likely reactive. No pathologically enlarged Retroperitoneal or\nmesenteric lymph nodes. No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No significant calcified\natherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small, fat-containing paraumbilical hernia is unchanged\n(series 7b, image 55, 54). Abdominal drain in the right lower anterior\nabdomen is unchanged in position with no residual drainable fluid collections.\nThe left lateral abdominal wall and left anterior abdominal drains have been\nremoved in the interim. A right pelvis drain has been placed in the interim. \nFat-stranding along the prior drain tracks are noted.", "output": "1. No new fluid collections.\n2. Interval removal of the left lower abdominal drain with a residual, smaller\nnow 1.6 x 1.2 cm fluid collection. Persistent 3-mm hyperdense material within\nthe fluid collection is concerning for retained/migrated appendicolith given\nthere are no prior exams which used oral contrast.\n3. Interval collapse of the large right pelvis fluid collection after interval\nplacement of a pigtail drain. No residual drainable fluid collection.\n4. Interval removal of the left lateral abdominal wall drain without\nrecurrence of the fluid collection.\n5. Unchanged position of the right lower abdominal drain without a residual\nfluid collection.\n6. Interval resolution of right hydronephrosis.\n7. Segment VIII wedge-shaped hepatic hyperdensity on the prior exam is not\nclearly visualized on today's exam.\n8. Small fat-containing paraumbilical hernia, unchanged.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:15 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix contains two appendicoliths and\nis fluid-filled and dilated up to 2.2 cm, with a thick and hyper enhancing\nwall and surrounding fat stranding, consistent with acute appendicitis (2:60;\n601b:25). There is no extraluminal air or fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute appendicitis with two appendicoliths and extensive surrounding soft\ntissue stranding. No extraluminal air or drainable fluid collection.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ in\nperson on ___ at 2:56 ___, 1 minutes after discovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There are\nbilateral extrarenal pelvises. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\nwithin normal limits. There is a large amount of stool within the rectum. \nThe appendix is normal.\n\nPELVIS: The bladder wall appears mildly thickened, however this is likely due\nto underdistention. The distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Other than fecal loading within the rectum, no acute intra-abdominal\nprocess to explain abdominal pain.\n2. Mild bladder wall thickening is likely due to under distention." }, { "input": "LOWER CHEST: Please refer to concurrent CT chest examination for a complete\ndiscussion of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere has been interval increase in size and irregularity of numerous\nhypoattenuating, heterogeneous liver lesions with ill-defined borders,\nconsistent with worsening metastatic disease. The largest right hepatic lobe\nmetastasis in segment 8 now measures 2.1 x 3.7 cm compared to 1.2 x 2.4 cm on\nthe prior study. The largest left hepatic lobe metastasis in segment 3 now\nmeasures 2.9 x 4.1 cm compared to 2.5 x 1.9 cm on the prior study. There are\nno new hepatic lesions. The gallbladder is surgically absent. The\nhepaticojejunostomy is intact. Increased region of soft tissue density\nanterior to the portal vein measuring 2.4 x 2.9 cm likely represents worsening\ntumor recurrence in the surgical bed. Increased narrowing of the portosplenic\nconfluence is secondary to extrinsic compression from increasing tumor burden\n(2, 59).\n\nPANCREAS: The pancreaticojejunostomy is intact with mild atrophy of the\nremaining pancreatic body and tail. Interval increase in mild prominence of\nthe main pancreatic duct.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple, unchanged simple cysts in the right kidney, the largest of\nwhich is in the lower pole and measures 7.8 x 7.9 x 6.7 cm. 1.5 x 2.6 cm\npredominantly hypodense lesion with dependent hyperattenuating material that\narises from the posterior aspect of the right kidney likely represents a\nhemorrhagic cyst. 1.2 cm, round, hypodense lesion measuring 76 Hounsfield\nunits is smaller compared to the prior study. In ___, this lesion\nmeasured fluid density, suggesting interval hemorrhagic conversion of a simple\ncyst with subsequent partial collapse. Multiple simple cysts in the left\nkidney are unchanged. 1.2 cm lesion in the upper pole of the left kidney\nmeasures 56 Hounsfield units with unchanged attenuation in different phases\nsuggesting blood products compatible with a hemorrhagic cyst. This lesion\npreviously measured 1.5 cm. No evidence of hydronephrosis. There is\nunchanged, bilateral hydroureter of unclear etiology.\n\nGASTROINTESTINAL: The gastrojejunostomy is patent. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: Unchanged urinary bladder distension.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged with a central defect consistent\nwith prior TURP.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy. There is a prominent right mesenteric lymph node\nmeasuring 8.5 mm along the short axis. There are two enlarged portacaval\nlymph nodes measuring 1 cm and 1.1 cm along the short axes (2, 59-61).\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes throughout the spine, most pronounced at L5-S1.\n\nSOFT TISSUES: There is a small umbilical hernia containing a loop of small\nbowel. There is a 3.1 x 1 cm, irregular, soft tissue density structure with\nan enhancing rim at the site of prior indirect inguinal hernia repair on the\nleft consistent with postsurgical changes.", "output": "1. Increased irregularity and size of known hepatic metastases. No new\nhepatic metastases.\n2. Worsening tumor recurrence in the surgical bed with increased extrinsic\ncompression of the portosplenic confluence.\n3. Worsening portacaval lymphadenopathy.\n4. Bilateral renal cysts, some of which are hemorrhagic.\n5. Unchanged bilateral hydroureter of unclear etiology.\n6. Please refer to concurrent CT chest examination for a complete discussion\nof the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Interval increase in size and conspicuity of multiple irregular\nhypoattenuating, enhancing liver lesions consistent with worsening metastatic\ndisease. The largest right hepatic lobe metastasis in segment VIII now\nmeasures 2.7 x 4.2 cm (3: 53) compared to 2.1 x 3.7 cm previously. The\nlargest left hepatic lobe metastasis in segment III now measures 3.1 x 4.5 cm\n(3: 49), previously 2.9 x 4.1 cm. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent. The\nmain portal vein is patent. The previously noted encasement and focal\nextrinsic compression of portal-SMV confluence also appears stable. However,\nthere is increased encasement of common hepatic artery since the prior exam in\n___ (3:57-60).\n\nPANCREAS: Patient is post Whipple. There is interval enlargement in soft\ntissue density anterior to the portal vein measuring 2.7 x 4.4 cm (3: 60),\ncompared to 2.4 x 2.9 cm previously, reflecting disease progression. There is\nno new pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple simple cysts are seen in the bilateral kidneys. The largest\nin the right kidney is seen in the lower pole measuring 7.7 x 7.4 cm. The\nlargest simple cyst in the left is seen in the upper pole and measures 2.4 x\n3.1 cm. A 1.2 x 1.3 cm lesion is again seen in the posteromedial aspect of\nthe right lower renal pole with slightly higher attenuation than simple fluid,\nlikely a hemorrhagic cyst when compared to prior MRI. There is no evidence\nof hydronephrosis, however, bilateral hydroureters are again noted, possibly\nfrom bladder outlet obstruction. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia is identified. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged with a TURP defect.\n\nLYMPH NODES: There in relatively stable appearance of prominent mesenteric\nlymph nodes, with the largest measuring 9.8 mm (3: 67), previously 8.5 mm on\nprior exam. There is no retroperitoneal lymphadenopathy. There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. As previously noted, there\nis unchanged focal extrinsic compression and encasement of the portal-SMV\nconfluence. Interval increase in the encasement of the common hepatic artery\nby recurrent tumor and adjacent liver metastasis is identified. Moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere multilevel degenerative changes are noted in the lumbosacral spine with\ngrade 2 anterolisthesis of L4-L5 and Grade 1 1 L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. Small\nfoci of edema noted in the right anterior lower abdominal wall, likely\ninjection sites.", "output": "1. Interval enlargement of multiple hepatic metastatic lesions.\n2. Interval enlargement of recurrent tumor at the Whipple bed, with increased\nencasement of the common hepatic artery.\n3. Unchanged focal compression and encasement of the portal-SMV confluence.\n4. Unchanged bilateral hydroureter and distended bladder, suggestive chronic\noutlet obstruction.\n5. Small hiatal hernia.\n6. Please refer to same day CT chest exam for complete description of\nintrathoracic findings." }, { "input": "LOWER CHEST:\n\nFindings in the lower thorax will be reported separately by the thoracic\nimaging service.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous enhancement without focal\nlesion. Intra and extrahepatic bile ducts are nondilated. The gallbladder has\na normal appearance.\n\nPANCREAS: The pancreas is normal in attenuation without focal lesion or\npancreatic duct dilatation.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: The adrenal glands are normal bilaterally.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically, without\nhydronephrosis. Bilateral hypodense lesions in the kidneys, some representing\nsimple cysts and some too small to characterize, are mildly increased in size\nfrom prior studies but do not have concerning features.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber and distribution.\nOral contrast progresses without obstruction through distal small bowel. There\nare numerous diverticula along the sigmoid colon without findings of\ndiverticulitis. The normal appendix is visualized.\n\nLYMPH NODES: A prominent aortocaval lymph node measuring 8 mm in short axis\n(2:72) is not significantly changed back to ___. There are no\nabdominal lymph nodes meeting CT criteria for pathologic enlargement.\n\nVASCULAR: The abdominal aorta maintains its normal caliber through the\naortoiliac bifurcation. There is moderate atherosclerotic plaque throughout. \nFindings the\n\nPELVIS:\n\nThe urinary bladder is fully distended and shows normal wall thickness. The\nprostate gland is enlarged. No free fluid or lymphadenopathy is seen within\nthe pelvis.\n\nBONES AND SOFT TISSUES:\n\nDegenerative changes are noted throughout the thoracolumbar spine without\nfocal aggressive lytic or sclerotic lesion. A small fat containing\nperiumbilical hernia is again demonstrated.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Chronic findings including diffuse atherosclerotic disease and sigmoid\ncolon diverticulosis.\n3. Please refer to separate report by thoracic radiology for discussion of\nfindings in the chest." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver is normal in attenuation with a punctate hypodensity\nin the anterior aspect of hepatic segment ___ (2:62), which is new from the\nprior study, however is too small to characterize by CT. The portal vein is\npatent. The gallbladder is nondistended, normal-appearing.\nPANCREAS: The pancreas is slightly atrophic but does not demonstrate lesions\nare duct dilatation.\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys enhance and excrete contrast symmetrically with bilateral\ncortical hypodensities likely representing cysts. There is no hydronephrosis\nor concerning lesion.\nGASTROINTESTINAL: The distal esophagus, stomach, and small bowel are normal in\ncaliber. The appendix is air-filled with no surrounding stranding. The colon\ncontains an average amount of stool, with no evidence of colitis.\nLYMPH NODES: Right-sided retrocrural lymph nodes measure 14 x 6 mm (02:51),\nand 9 x 7 mm (02:57). Retroperitoneal lymph nodes at the level of the renal\nveins measure 19 x 9 mm (2:73) and 14 x 5 mm. No other pathologically\nenlarged mesenteric or retroperitoneal lymph nodes are appreciated.\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate\natherosclerotic plaque throughout the entire abdominal aorta and branch\nvessels, with calcified and noncalcified plaque identified. Ulcerating\nplaques are noted in the upper abdominal aorta. Major aortic branches are\npatent.\n\nPELVIS:\nThe urinary bladder is normal. The prostate is mildly enlarged with a central\ncalcification. There is no pelvic lymphadenopathy or free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions. Small fat containing umbilical\nhernia is noted.", "output": "1. Right retrocrural lymphadenopathy remain stable compared to the prior CT\nfrom ___. Prominent retroperitoneal lymph nodes at level of the renal\nveins are also unchanged in size.\n2. Punctate hypodense liver lesions in segment ___ is new since the prior\nstudy, and can be further characterized by MRI to rule out metastatic disease.\n3. Please see a separate report discussing findings within the chest." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas demonstrates mild atrophy but normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Unchanged cortical hypodensities likely representing cysts. The\nkidneys are otherwise of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, new focal renal lesions, or hydronephrosis.\nThere are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\n\nLYMPH NODES: There is a new small peridiaphragmatic nodule measuring 10 x 9\nmm (05:50). Right retrocrural lymph node measures 14 x 6 mm (05:47) and 12 X\n9 mm (05:52). Unchanged pericaval lymph node measuring 18 x 12 mm, and\nperiaortic node measuring 10 x 7 mm (05:68). No other enlarged\nretroperitoneal lymph nodes are identified.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.The prostate is mildly enlarged with some central calcification.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.\nAbdominal and pelvic wall is within normal limits. Fat containing umbilical\nhernia.", "output": "1. There is a new small peridiaphragmatic nodule measuring 10 x 9 mm, which\nmay represent small lymph node or metastatic implant. Other lymph nodes are\nnot significantly changed in size.\n2. Please see same day chest CT dictation for findings in the chest." }, { "input": "LOWER CHEST: In comparison to the CT abdomen/pelvis obtained ___,\nthere are increased bilateral pleural effusions. Please refer to separate\nreport for same-day CT chest for complete description of the thoracic\nfindings.\n\nABDOMEN:\nHEPATOBILIARY: A subtle hypodense lesion in segment II is stable and too\nsmall to completely characterize, likely a cyst or biliary hamartoma. The\nliver otherwise demonstrates homogenous attenuation throughout. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas is moderately fatty replaced and without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple bilateral simple renal cysts, the largest of\nwhich measures 8 x 13 mm in the superior pole of the left kidney. The kidneys\nare otherwise of normal and symmetric size with normal nephrogram. There is\nno hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis without evidence of diverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are calcifications in the prostate gland.\n\nLYMPH NODES: The previously identified prominent retrocrural lymph node is\nessentially stable and measures 7 mm in short axis (02:50). An additional\nretrocrural lymph node is unchanged measuring 7 mm in short axis (02:55). An\naortocaval lymph node is stable and measures 16 mm in short axis (02:71). A\nleft para-aortic lymph node is also stable and measures 8 mm in short axis\n(2:73).\n\nVASCULAR: There is no abdominal aortic aneurysm. Severe atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes of the lumbar spine and left SI joint.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "1. Stable retroperitoneal lymphadenopathy. No other evidence of metastasis\nwithin the abdomen or pelvis.\n2. Please refer to separate report for same-day CT chest for complete\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The bladder wall is diffusely thickened measuring 7 mm in maximal\nthickness. No adjacent fat stranding. No bladder calculi. The distal\nureters are unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits,\nspecifically no inguinal or femoral hernia.", "output": "1. Diffuse bladder wall thickening can be seen in the setting of cystitis. \nNormal kidneys. Clinical and and laboratory data correlation with urinalysis\nis recommended.\n2. No inguinal or femoral hernia.\n3. Normal appendix." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is an accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.", "output": "No acute findings in the abdomen or pelvis to explain the patient's abdominal\npain, nausea or vomiting. Normal appendix." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous low attenuation throughout\nconsistent with hepatic steatosis. Regions of fatty sparing are noted\nadjacent to the gallbladder fossa. There is no evidence of hepatic mass\nwithin the limitations of an unenhanced scan. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is normal in bulk and homogeneous in attenuation. \nThere is no pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is mild left-sided hydroureteronephrosis secondary to a 3 mm\nobstructing stone in the left ureterovesical junction (3:94). There is also\nmild left periureteral and perinephric stranding. An additional punctate,\nnonobstructing stone is seen within the left lower pole (05:45). Postsurgical\nchanges are noted in the right renal cortex. There is no evidence of renal\nmass within limitations of an unenhanced scan.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLimbus vertebra are again incidentally noted at L3 and L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild left-sided hydroureteronephrosis secondary to a 3 mm obstructing stone\nin the left ureterovesical junction.\n2. Additional punctate, nonobstructing stone is seen within the left lower\npole kidney.\n3. Postsurgical changes are noted in the right renal cortex.\n4. Hepatic steatosis.\n\nRECOMMENDATION(S): Radiological evidence of fatty liver does not exclude\ncirrhosis or significant liver fibrosis which could be further evaluated by\n___. This can be requested via the ___ (FibroScan) or the\nRadiology Department with either MR ___ or US ___, in\nconjunction with a GI/Hepatology consultation\" *\n\n* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver\ndisease: Practice guidance from the ___ Association for the Study of\nLiver Diseases. Hepatology ___ 67(1):328-357" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nCoarse calcifications are noted along the liver capsule posteriorly (04:25). \nA 1.7 x 1.8 cm hepatic segment VIII lesion with peripheral puddling of\ncontrast is compatible with a hemangioma (04:16). There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A double-J ureteral stent is in place within the right ureter,\nterminating within a bladder diverticulum on the right. There is mild right\nhydronephrosis. There is a 10 mm stone in the upper pole of the right kidney\n(601b:35), along with numerous other punctate stones (601b:38). A 3 mm left\nlower pole renal stone is also noted. The kidneys enhance symmetrically and\nexcrete contrast promptly, with no evidence of obstruction. Ureteral jets are\nnoted bilaterally. There is no evidence of perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nbone island is present in the L2 vertebral body (602b:43).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild right hydronephrosis with appropriately positioned indwelling double-J\nureteral stent which actively drains excreted contrast with no evidence of\nobstruction.\n2. Bilateral nonobstructing renal stones.\n3. Colonic diverticulosis.\n4. 1.8 cm hepatic segment VIII lesion is compatible with a hemangioma." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.5 cm hypodense lesion at the hepatic dome which displays progressive nodular\nperipheral enhancement is similar to prior and consistent with a hepatic\nhemangioma (2:44). There is new focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There has been interval removal of the right ureteral stent. The\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nevidence of focal renal lesions or hydronephrosis. A punctate nonobstructing\nstone the left kidney is not significantly changed (2:71). There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal (2:92).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. Patient's known cervical cancer is not well evaluated on CT.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: A round sclerotic lesions in the L2 vertebral body is unchanged and\nconsistent with a bone island. There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Stable hepatic hemangioma.\n3. Diverticulosis, with no evidence of acute diverticulitis.\n4. Punctate nonobstructing left renal stone is similar to prior. No\nhydronephrosis.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubtle 2.5 cm ill-defined hypodensity in the hepatic dome is indeterminate and\nnot completely characterized (2; 37). There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is mildly enlarged measuring 13.8 cm with normal\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Partially visualized enteric tube terminates within the\nproximal stomach, gastric fundus. The stomach is unremarkable. Fatty\ninfiltration of the wall of the terminal ileum is consistent with chronic\ninflammation. The remaining small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. There is possible wall thickening\nof the sigmoid/rectum, difficult to differentiate from adherent stool (2;\n117). The appendix is normal.\n\nPELVIS: The urinary bladder contains a foci of air, correlate with recent\ninstrumentation. The distal ureters are unremarkable. There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. 2.5 cm ill-defined hypodensity in the hepatic dome is indeterminate, while\nthis may represent an atypical hemangioma other etiologies cannot be excluded,\nconsider further evaluation with MRI liver.\n2. Possible focal wall thickening of the sigmoid/rectum, difficult to\ndifferentiate from adherent stool, consider proctoscopy or sigmoidoscopy for\nfurther evaluation.\n3. Mild splenomegaly.\n4. Enteric tube terminates in the gastric fundus and should be advanced\nfurther.\n\nRECOMMENDATION(S):\n1. MRI liver\n2. Advanced enteric tube\n3. Consider proctoscopy or sigmoidoscopy" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple bilateral renal hypodensities are too small to characterize.\nThe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of additional focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Focal\nunderdistention of the terminal ilium with fecalization of upstream small\nbowel. This may be suggestive of chronic inflammation of the terminal ilium. \nNo evidence of acute inflammation. The colon and rectum are within normal\nlimits. The appendix is surgically absent. No evidence of diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The appendix is surgically absent. No evidence of diverticulitis. Focal\nunderdistention and/or thickening of the terminal ilium with fecalization of\nupstream small bowel, may be suggestive of narrowing from chronic inflammation\nof the terminal ilium. No other imaging findings to suggest acute\ninflammation." }, { "input": "LOWER CHEST: Please refer to separately dictated CT chest for detailed\nassessment.\n\nHEPATOBILIARY: Segment 2 calcified hepatic hypodense lesions have minimally\nincreased in size, (4:50) measuring 2 x 1.2 cm compared to 1.9 x 1 cm and\n(4:47) 0.9 cm compared to 0.7 cm. Some other scattered hypodense lesions are\nmostly stable with 1 that increased in size (04:52) measures 0.5 cm compared\nto 0.2 cm. Portal vein is patent. Post sphincterotomy with pneumobilia.\n\nPANCREAS: The pancreas remains difficult to identify due to the large\nlobulated mass. The patient is reportedly post Whipple.\n\nSPLEEN: Unchanged multiple hypodense lesions scalloping and invading through\nthe spleen.\n\nADRENALS: Unremarkable.\n\nURINARY:Interval improvement of right-sided hydronephrosis. No\nnephrolithiasis.\n\nGASTROINTESTINAL: Unchanged tumoral mass effect on the stomach and small bowel\nloops. Some dilated loops of bowel in the mid abdomen are unchanged. No\nhigh-grade obstruction.\n\nPERITONEUM: Re-demonstration of extensive mucinous hypodense metastatic\nlesions along the left mesenteric root and extending along the left abdominal\nwall and into the pelvis. This has not significantly changed since the prior\nCT examination.\n\nLYMPH NODES: No enlarged retroperitoneal lymph nodes. Difficult to assess\nmesenteric lymph nodes given the bulkiness of this mucinous neoplasm.\n\nVASCULAR: No suspicious osseous lesions.\n\nPELVIS: Prostate is unremarkable. Urinary bladder is decompressed.\n\nBONES:No suspicious osseous lesions.\n\nSOFT TISSUES: Soft tissues are unremarkable.", "output": "1. Overall stable size and appearance of bulky mucinous peritoneal and\nmesenteric metastatic disease. There is unchanged mass effect on the bowel\nwithout high-grade obstruction.\n2. Interval minimal enlargement of two hepatic lesions, detailed above, with\nothers remaining unchanged.\n3. Improved right-sided hydronephrosis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post ___'s procedure. 1.9 x 1 cm\nhypodense lesion with internal calcifications along the anterior surface of\nthe liver in hepatic segment 4A is unchanged. Note is again made of\nscalloping of the left lateral segment of the liver secondary to extensive\nperitoneal metastases. There is a 6 mm hypodensity in hepatic segment 7\n(series 5, image 50) which is not seen on the prior study. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. Small amount of\npneumobilia is again noted. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is not well seen.\n\nSPLEEN: Numerous subcapsular masses within the spleen are consistent with\nmetastatic disease and remain grossly unchanged compared to the prior study.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Moderate right hydroureteronephrosis is unchanged. There is no focal\nrenal lesion. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical changes are again noted. There is mass effect\non the stomach and multiple loops of small and large bowel from peritoneal and\nmesenteric metastatic deposits. A dilated loop of bowel in the mid abdomen is\nsimilar to the prior study. The rectum is distended with stool seen along the\ndependent portion.\n\nPELVIS: The urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Bulky mesenteric and peritoneal mucinous masses prominently in\nthe left lateral abdomen and pelvis are grossly unchanged.\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Overall stable size and appearance of bulky mucinous peritoneal and\nmesenteric metastases with comparable mass effect as described.\n2. Multiple subcapsular splenic lesions are also unchanged.\n3. 6 mm hypodensity in hepatic segment 7 is indeterminate. Attention on\nfollow-up is recommended.\n4. Stable moderate right hydroureteronephrosis." }, { "input": "LOWER CHEST: Mild dependent atelectasis is noted along the since. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is mild periportal edema. There is no evidence of focal lesions. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged, measuring 14.6 cm in craniocaudal dimension.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastric bypass. No bowel obstruction\nor bowel wall thickening is seen. The appendix is not visualized, however,\nthere are no secondary signs in the right lower quadrant concerning for\nappendicitis. Moderate stool burden is noted throughout the colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No bowel obstruction or bowel wall thickening. Status post gastric bypass\nsurgery.\n2. Splenomegaly, with the spleen measuring up to 14.6 cm in craniocaudal\ndimension.\n3. Moderate to large stool burden is noted throughout the colon." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 2.0 cm posterior right hepatic lobe hypodensity likely represents a\nhepatic cyst. Additional subcentimeter hypodensities are visualized, too\nsmall to characterize and likely represent hepatic cysts versus biliary\nhamartomas. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is visualized otherwise the stomach is\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is a extensive stool burden throughout the\ncolon and rectum which is otherwise within normal limits the appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Probable uterine fibroid is noted. No adnexal\nabnormalities.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is narrowing of the\nproximal celiac axis potentially due to the diaphragmatic crus with mild\npoststenotic dilatation. Mild atherosclerotic disease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine. Total right hip\narthroplasty is visualized and appears to be in proper alignment. \nDegenerative changes noted at the left hip.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits besides a\nsmall fat containing umbilical hernia.", "output": "1. No acute intra-abdominal or pelvic findings to correlate with patient's\nsymptoms.\n2. Extensive stool burden is visualized throughout the colon and rectum.\n3. Narrowing of the proximal celiac axis which can be normal variant or\npotentially seen in median arcuate ligament syndrome, to be correlated\nclinically." }, { "input": "LOWER CHEST: There are new trace bilateral nonhemorrhagic pleural effusions\nwith adjacent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: There is stable pneumobilia in the left hepatic lobe. Unchanged\nmild biliary ductal dilatation is again seen in the right hepatic lobe. A\ncommon bile duct stent is in stable position terminating in the duodenum. \nHeterogeneous enhancement of the right hepatic lobe is probably a perfusion\ndefect. The gallbladder is chronically obstructed and contains stones and\nsludge. There remains trace high perihepatic ascites.\n\nPANCREAS: A locally advanced pancreatic head mass abutting the portal vein and\nsurrounding the a gastroduodenal artery is better evaluated on CT dated ___. The remainder of the pancreas is atrophic and there remains\nductal dilation. The degree of stranding surrounding the pancreatic head\nappears reduced compared to ___. A fluid collection anterior to the\ncommon hepatic artery with locule of air measures 4.3 x 2.4 cm, previously 4.2\nx 2.8 cm (05:48).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post gastrojejunostomy with a patent\nanastomosis. There is persistent circumferential wall edema in the stomach\nantrum to the second portion of the duodenum. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is diffuse osseous demineralization. Degenerative changes of the lumbar\nspine are again noted.\n\nSOFT TISSUES: Soft tissue density with areas of hyperdensity in the left\nrectus abdominal muscle measures up to 2.8 x 1.5 cm, and is grossly unchanged\n(5:65).", "output": "1. No significant change in the size of the 4.2 x 2.8 cm air and fluid\ncollection anterior to the common hepatic artery, which may represent a\nperforation/abscess arising from the stomach or duodenum.\n2. Interval stability in the size of the nonspecific hyperattenuating and soft\ntissue density in the left rectus abdominal muscle, which may represent a\nmetastatic implant.\n3. Stable left hepatic lobe pneumobilia and mild right intrahepatic biliary\ndilation.\n4. Chronically obstructed and distended gallbladder with gallstones and sludge\nis grossly unchanged.\n5. Known pancreatic head mass abutting the portal vein and gastroduodenal\nartery is better evaluated on CT from ___.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:41 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Please refer to dedicated CT chest report on same day for\nintrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 14.6 cm (06:36). There is no focal\nlesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia. Otherwise, the stomach\nis unremarkable. There is a duodenal diverticulum. Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: A fat containing focus adjacent to the sigmoid colon measuring\n1.2 cm (3:104) could represent epiploic appendagitis. There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are bilateral left greater than right inguinal fat\ncontaining hernias..", "output": "1. No acute abnormality in the abdomen or pelvis to explain patient's reported\nabdominal pain. No evidence of free air.\n2. Please refer to dedicated CT chest report on same day for intrathoracic\nfindings" }, { "input": "CHEST:\n\nHEART AND VASCULATURE: Pulmonary vasculature is well opacified to the\nsubsegmental level without filling defect to indicate a pulmonary embolus. \nThe thoracic aorta is normal in caliber without evidence of dissection or\nintramural hematoma. The heart, pericardium, and great vessels are within\nnormal limits. No pericardial effusion is seen.\n\nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar\nlymphadenopathy is present. No mediastinal mass.\n\nPLEURAL SPACES: No pleural effusion or pneumothorax.\n\nLUNGS/AIRWAYS: Aside from mild left basal atelectasis, lungs are clear without\nmasses or areas of parenchymal opacification. The airways are patent to the\nlevel of the segmental bronchi bilaterally.\n\nBASE OF NECK: Visualized portions of the base of the neck show no abnormality.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypoenhancing relative to the spleen,\nsuggestive of hepatic steatosis. There is no evidence of focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.No\nadrenal mass.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities in the kidneys are nonspecific, likely represent\nsmall cysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal. There is no free intraperitoneal fluid or\nfree air.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is of normal size and enhancement. There is no\nevidence of adnexal abnormality bilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. The abdominal and pelvic wall is within normal limits.", "output": "1. No acute pulmonary embolism.\n2. No acute intra-abdominal findings.\n3. Mild hepatic steatosis.\n4. No evidence of dissection in the thoracic or abdominal aorta." }, { "input": "LOWER CHEST: Minimal bibasilar atelectasis is noted. Visualized lung fields\nare otherwise within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple subcentimeter hyperdensities noted, with the largest\nmeasuring 8 x 4 mm in segment IV, compatible with likely simple cysts. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a hypodensity in the left adrenal gland measuring 1.4 x 1.0\ncm (02:28). The right adrenal gland is normal in size and shape.\n\nURINARY: There is an obstructive renal stone within the distal right ureter\nmeasuring approximately 9 mm x 6 mm x 5 mm (2:70, 601: 53), with upstream mild\nto moderate dilatation of the ureter, right collecting system, and kidney. \nThe right kidney is moderately enlarged with surrounding perinephric\nstranding. There is delayed excretion of contrast from the right kidney as\ncompared to the left. In addition, there is very subtle likely slightly\ndelayed perfusion of the right kidney as compared to the left. The left\nkidney is normal size with normal nephrogram.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. There is a hypodense mass\nwithin the left ovary measuring 1.8 x 1.0 cm (601:42). The right ovary is\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Moderate multilevel degenerative changes noted throughout the\nthoracolumbar spine, most notably including posterior osteophytes and mild\ndisc bulge most prominent at L1-L2 and L3-L4, causing mild central canal\nnarrowing.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 9 mm obstructive renal stone within the distal right ureter resulting in\nupstream right hydroureteronephrosis. Mild right perinephric stranding. \nDelayed excretion of contrast from the right kidney.\n2. 1.8 x 1.0 cm hypodensity is noted within the left ovary, likely\nrepresenting a simple cyst. However, a follow-up ultrasound is recommended in\n12 months given a lesion of this size in a postmenopausal woman.\n3. Mild central spinal canal stenosis at L1-L2 and L3-L4, secondary to\nposterior osteophytes and mild disc bulge.\n4. Hypodense lesion within the left adrenal gland measuring 1.4 x 1.0 cm. If\nthere is no history of malignancy, this is probably benign. Follow up\ndedicated adrenal CT in 12 months could be considered. If there is a history\nof malignancy, a dedicated adrenal CT is recommended.\n\nRECOMMENDATION(S): Incidentally discovered adrenal lesion without prior\nstudies for comparison measuring 1-2 cm. If there is no history of malignancy,\nthis is probably benign. Follow up dedicated adrenal CT in 12 months could be\nconsidered. If there is a history of malignancy, a dedicated adrenal CT is\nrecommended.\n\nRecommendations based on ___ ACR guidelines:\n___" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver transplant which demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nsurgically absent.\n\nPANCREAS: Annular pancreas which has normal attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is surgically absent with splenosis in the right upper\nquadrant (601b:59).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple bilateral renal cortical and parapelvic cysts, overall not\nsignificantly changed. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Sinus inversus of the stomach in the right upper quadrant. \nPossible duodenal atresia as seen on prior, otherwise remaining small bowel is\nnormal in appearance. The colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable. Multiple left\novarian follicles are identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Persistent thrombosis at the inferior azygous vein stent, with a\nsmall calcification noted (03:29). There is also minimal residual thrombus in\nthe superior IVC near the renal veins (601b:62). There is significant\ndecrease in clot burden and size of the left renal and left adrenal vein. \nAgain seen is extensive bilateral perirenal and lumbar vessel collaterals. \nAbdominal aorta and major branch vessels are normal in appearance.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Superior IVC atresia with unchanged persistent thrombus in the inferior\nazygos vein stent. There has been significant decrease of the thrombus and\nvessel size of the left renal, left adrenal, and IVC vein in this region, with\nno residual inflammatory changes.\n2. Persistent extensive bilateral ___ and lumbar collateral vessels.\n3. Chronic abdominal and pelvic findings as detailed above." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Scattered\ndiverticuli are noted throughout the sigmoid colon. Otherwise, the colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abdominopelvic pathology.\n2. Sigmoid diverticulosis, with no evidence of diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields demonstrate subsegmental atelectasis in\nboth lower lobes and the lingula and bilateral pleural effusions. There is\nmarked cardiomegaly. Partially imaged central catheter with its tip in the\nright atrium..\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates heterogeneous parenchymal enhancement\nthroughout. There is mild periportal edema. There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits. There is a moderate\namount of ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, with mild prominence\nof the pancreatic duct (measuring 5 mm) in the pancreatic head all the way to\nthe confluence with the CBD, not significantly changed compared to the prior\nCT from ___.\n\nSPLEEN: Surgically absent. There is a focal small fluid collection in the\noperative bed measuring 3.2 x 2.3 cm showing internal intermediate to\nhyperdense contents (39 ___ (series 5, image 40).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nKIDNEYS: Both kidneys are atrophic in appearance with cortical thinning and\nshow multiple cortical cysts. There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable, distal end of a feeding tube is\nseen in the proximal jejunum.. the small and large bowel loops are normal in\ncaliber. There is no evidence of bowel obstruction.\n\nPELVIS: The urinary bladder is decompressed with thick walls, not\nsignificantly changed compared to prior study from ___. There is a small\namount of free fluid in the pelvis. The visualized reproductive organs are\nunremarkable. Again seen is an intermediate attenuation lesion above the\nurinary bladder measuring approximately 3.0 x 2.0 cm, minimally larger\ncompared to the prior CT (series 5, image 74).\n\nLYMPH NODES: There is a prominent left para-aortic lymph node measuring 1.1\ncm, stable compared to prior.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. The portal vein and SMV are patent. The splenic vein is not seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSignificant degenerative disc disease involving the entire lumbar spine and\nthe visualized portions of the thoracic spine.\n\nSOFT TISSUES: There is evidence of bilateral gynecomastia. Diffuse\ngeneralized anasarca.", "output": "1. Status post splenectomy. Small intermediate attenuation area in the\noperative bed measuring 3.2 cm may represent evolving postsurgical\nchanges/hematoma.\n2. Moderate ascites. Bilateral pleural effusions and subsegmental\natelectasis. Generalized anasarca." }, { "input": "LOWER CHEST: The incompletely visualized lungs are clear. ___ pleural\neffusion. The heart size is normal. ___ pericardial effusion is seen.\n\nABDOMEN:\n\nHepatobiliary: Slight attenuation of the liver parenchyma is compatible with\nfatty infiltration. The hepatic lesion in the periphery of segment 6, by\nreport biopsied and demonstrated to be FNH on biopsy, is better seen on prior\nMR. ___ concerning focal hepatic lesion. ___ intrahepatic or extrahepatic\nbiliary ductal dilatation. The main portal vein appears patent. ___ ascites. \nSurgical clips in the gallbladder bed are compatible with history of\ncholecystectomy.\n\nPancreas: The pancreas is normal in attenuation throughout. ___ focal\npancreatic lesion, pancreatic ductal dilatation, peripancreatic stranding.\n\nSpleen: The spleen is normal in size and attenuation. ___ focal splenic\nlesion.\n\nAdrenals: The left and right adrenal glands are unremarkable.\n\nUrinary: The kidneys are normal in size and symmetric. Tiny cortical\nhypodensities bilaterally too small to characterize by CT, but statistically\nlikely cysts. ___ hydronephrosis. The urinary bladder is decompressed,\nlimiting evaluation.\n\nMesentery and Retroperitoneum: ___ mesenteric or retroperitoneal\nlymphadenopathy.\n\nGI: There is a small hiatal hernia. Small bowel loops are normal in caliber,\nwall thickness, and enhancement. There is scattered colonic diverticulosis. \nProminent uniform wall thickening, hyperemia, and prominent surrounding fat\nstranding with adjacent pockets of local free air in region of diverticuli in\nthe sigmoid colon are compatible with acute complicated sigmoid diverticulitis\nwith microperforation. ___ drainable fluid collection, distant free air or\nlarge pockets free air, bowel obstruction, or pneumatosis. ___ pneumobilia or\nevidence of portal venous gas or thrombus. The appendix is normal in\nthickness and caliber without adjacent fat stranding. The rectum is\nunremarkable.\n\nVascular: ___ abdominal aortic aneurysm. ___ significant calcified\natherosclerosis.\n\nPelvis: ___ free fluid in the pelvis. ___ pelvic or inguinal lymphadenopathy. \nThe uterus is surgically absent.\n\nBones and Soft tissues: ___ suspicious lytic or sclerotic bony lesion.", "output": "1. Acute sigmoid diverticulitis with microperforation. ___ drainable fluid\ncollection, bowel obstruction, or evidence of portal venous gas or thrombus.\n\n2. Previously biopsied hepatic lesion, by report shown to be FNH on biopsy,\nwas better seen on prior MR." }, { "input": "LOWER CHEST: Small bilateral pleural effusions, further evaluated on the\nconcurrently performed although separately dictated CT chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout significant pericholecystic fat stranding or gallbladder wall\nthickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is redemonstration of\nretroperitoneal, extraluminal fluid and air, centered posterior to the second\nportion the duodenum, and extending inferiorly along the right perirenal space\nThese are again most consistent with perforation of the duodenum, without\ndefect identified. There are multiple, likely communicating organizing fluid\ncollections throughout the abdomen, most pronounced in the right hemi abdomen\nwith new rim enhancement. The largest pocket measures approximately 5.8 x 2.6\ncm in the right lower abdomen (2:80). Additionally, there is enhancement of\nthe peritoneum, likely reflecting a degree of peritonitis.\n\nMultiple small hyperdensities are identified within the ascending colon, which\nmay reflect intraluminal gallstones, potentially related to gallstone ileus. \nThere is mild gaseous and fluid distention of multiple small bowel loops up to\n2.4 cm, with multiple air-fluid levels, further suggestive of ileus.\n\nMildly prominent fluid-filled loops of small bowel may reflect a reactive\nileus. Persistent thickening of the partially decompressed ascending and\ndescending colon may reflect inflammatory change. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Unchanged extraluminal retroperitoneal air and fluid posterior to the\nsecond portion of the duodenum and extending throughout the right perirenal\nspace, remaining suggestive of duodenum perforation.\n2. Moderate free fluid throughout the abdomen pelvis is slightly increased\nfrom prior with new rim enhancement suggestive of organizing fluid\ncollections/ early abscess formation. New peritoneal enhancement,\nparticularly in the pelvis, suggestive of peritonitis.\n3. Mildly prominent small bowel loops with air-fluid levels are suggestive of\nreactive ileus.\n4. Probable reactive colonic mucosal thickening.\n5. No definite CT evidence of acute cholecystitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A small region of focus of hypoattenuation in hepatic segment\nIV adjacent to the falciform ligament reflects a transient hepatic attenuation\ndifference. The liver otherwise demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. There is a small amount of\nintrahepatic pneumobilia, also seen on prior examinations and not unexpected\ngiven history ERCP and sphincterotomy. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. Fat stranding extending\ninferiorly and posteriorly from the pancreatic head with associated small,\nscattered fluid collections, including posterior to the right kidney, are\nunchanged since 2 weeks prior. No new fluid collection or peripancreatic fat\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Enlarged, fibroid uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted. Incidental note is made of a small accessory right inferior hepatic\nvein and a duplicated IVC below the level of the renal veins.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged sclerosis of the left iliac bone abutting the sacroiliac joint.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Retroperitoneal fat stranding and scattered small fluid collections\nextending inferiorly and posteriorly from the pancreatic head are unchanged\ncompared to 2 weeks prior.\n2. Cholelithiasis.\n3. A small amount of pneumobilia is not unexpected status-post ERCP with\nsphincterotomy." }, { "input": "LOWER CHEST: Marked centrilobular emphysematous changes the bases.\n\nHEPATOBILIARY: There are no suspicious hepatic masses. Portal veins are\npatent. There is no biliary ductal dilatation. There is gallbladder fundic\nadenomyomatosis.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious lesions.\n\nSPLEEN: There is no splenomegaly.\n\nADRENALS: Adrenals are unremarkable.\n\nURINARY:There is no hydronephrosis or nephrolithiasis. There are bilateral\nrenal cortical hypodensities the some of which are too small to characterize,\nlikely cysts.\n\nGASTROINTESTINAL: Stomach is unremarkable. Small bowel loops are normal in\ncaliber with no evidence of obstruction. Large bowel appears unremarkable\naside from the cecum being in the left lower abdomen. There are scattered\ncolonic diverticulosis without diverticulitis.\n\nPERITONEUM: There is no free air free fluid. There is no peritoneal\nstranding.\n\nLYMPH NODES: There is a prominent cecal access lymph node (05:19) measuring up\nto 0.8 cm compared to 0.6 cm previously and a second right periaortic lymph\nnode at the diaphragmatic crus (05:15) measuring 0.8 cm compared to 0.6 cm\npreviously.\n\nVASCULAR: There is moderate atherosclerotic calcifications of abdominal aorta\nwith patent intra-abdominal branches.\n\nPELVIS: Uterus is normal in size. There are no adnexal masses. Rectum is\nunremarkable. There are no pelvic or inguinal adenopathy.\n\nBONES:There are multilevel degenerative changes mainly at L5-S1 and L2-L3.\n\nSOFT TISSUES: Soft tissues are unremarkable", "output": "1. No acute intra-abdominal process.\n2. lymph nodes along the right celiac axis and right diaphragmatic crus are\nlarger than on prior studies but still overall normal in size. This is\ntherefore of uncertain, but likely no clinical significance. Attention will\nbe paid on follow up imaging" }, { "input": "LOWER CHEST: Multiple irregular-appearing nodules are seen in both lower\nlobes and right middle lobe concerning for metastatic disease. Atelectasis\nand trace pleural effusion is noted on the right. Septal thickening is\nsuggestive of mild fluid overload. A 1.7 cm right diaphragmatic lymph node is\nnoted (02:12). Heart size is mildly enlarged without pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A 6 mm ill-defined hypodensity in segment 8 is too small to\ncharacterize but is suspicious for metastatic disease (02:16). A 1.3 cm\nwell-defined hypodensity in segment 6 is likely a cyst or biliary hamartoma,\nas seen on the previous ultrasound. A focal wedge-shaped area of\nhypoattenuation with mild capsular retraction is detected in the anterior\naspect of segment 4B without a discrete mass noted (02:21). There is mild\nperiportal edema.\n\nA biliary stent extends from the common bile duct to the ampulla and appears\npatent. Pneumobilia is present within the left lobe. The gallbladder is\nsurgically absent.\n\nPANCREAS: An ill-defined hypodense mass involving the head of the pancreas\ncompletely encases and attenuates the SMA and abuts 180 degrees around the\nposterior aspect of the SMV. This mass measures approximately 2.8 x 2.7 x 2.4\ncm (2:33; 601b:24). The pancreatic duct demonstrates upstream dilatation to\n1.5 cm and the pancreatic body and tail are atrophied. Scattered\ncalcifications with in the pancreas likely represent chronic pancreatitis. \nThere is significant peripancreatic stranding and fluid about the pancreatic\nhead and uncinate. Multiple enlarged peripancreatic lymph nodes are also\nnoted.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis. A 2.2 cm cyst is seen in the\ninterpolar region of the left kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Distal esophagus appears slightly patulous with mild wall\nthickening which could suggest esophagitis. The stomach is unremarkable. The\nfat plane between the pancreatic mass and the second and third portion of the\nduodenum is obscured. The proximal duodenum and the proximal jejunum just\ndistal to the ligament of Treitz are mildly distended with fluid without\ndiscrete transition, possibly suggestive of a focal ileus. Remaining small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is not visualized. No\nsecondary signs of appendicitis. Remainder of the colon and rectum are within\nnormal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmild free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged to 5.6 cm.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild minimal atherosclerotic\ndisease is noted. Portal vein, splenic vein, and SMV are patent with the\nportal and splenic veins not involved by the pancreatic mass. Estimate is\nattenuated by the pancreatic mass but is patent. The celiac and inferior\nmesenteric artery are widely patent. Both renal arteries are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes are seen in the lumbar spine with mild grade L5\non S1 retrolisthesis.\n\nSOFT TISSUES: A 1.9 cm lipoma is seen in the left sartorius muscle. Small\namount of fluid is also seen within the left iliopsoas bursa (2:84).", "output": "1. Approximately 2.8 cm ill-defined hypodense mass within the head of the\npancreas is consistent with known pancreatic cancer. The mass completely\nencases and attenuates the SMA and abuts 180 degrees of the posterior aspect\nof the SMV. Loss of fat plane between the mass and the second and third\nportions of the duodenum is also demonstrated along with multiple enlarged\nperipancreatic lymph nodes. There is associated upstream pancreatic ductal\ndilatation and atrophy of the pancreatic parenchyma.\n2. Peripancreatic stranding and fluid about the head and uncinate process may\nreflect acute pancreatitis. Recommend correlation with lipase levels.\n3. Multiple ill-defined nodules at the lung bases concerning for metastatic\ndisease.\n4. Ill-defined subcentimeter hypodensity in segment 8 of the liver is\nconcerning for metastatic disease. Additional focal hypodense area with\nsubtle capsular retraction in segment 4B could possibly be due to an\nunderlying metastatic lesion as well.\n5. Biliary stent appears to be patent with expected pneumobilia. No\nintrahepatic biliary dilatation.\n6. Mild periportal edema, mild pulmonary edema, and small amount of pelvic\nfree fluid.\n7. Prostatomegaly.\n8. Colonic diverticulosis.\n\nRECOMMENDATION(S): MRI of the liver could be obtained for further assessment\nof the hepatic lesions.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:26 ___, 15 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Lung bases are clear.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. There is moderate fecal loading. The appendix is\nair-filled with no surrounding inflammation. There is no evidence of\nmesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nThere is no fracture. Abdominal and pelvic wall is within normal limits.", "output": "Moderate fecal loading, otherwise normal CT of the abdomen and pelvis. Normal\nappendix." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely low in attenuation with focal sparing\naround the gallbladder, indicative of fatty infiltration. No focal hepatic\nlesion is identified. Intra and extrahepatic bile ducts are nondilated. The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: The pancreas has normal attenuation without focal lesion or\npancreatic duct dilatation.\n\nSPLEEN: The spleen is normal in size with homogeneous attenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance and excrete contrast symmetrically. There is no\nhydronephrosis. No stone, focal renal lesion or urothelial abnormality is\nidentified.\n\nGASTROINTESTINAL: As before, a small bowel loop in the left lower quadrant\nprotrudes into a ventral abdominal hernia (2:88, 602:64). There is no upstream\nbowel dilatation, mesenteric edema, or pneumatosis to suggest obstruction or\nischemia related to the hernia.\nLYMPH NODES: Retroperitoneal and mesenteric lymph nodes are not well below\nsize criteria for pathologic enlargement.\n\nVASCULAR: The abdominal aorta is non aneurysmal. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nBeam hardening artifact from contact of the patient's body with the CT bore\nobscures fine anatomic detail in the pelvis. The urinary bladder and distal\nureters are unremarkable. A 5.8 cm elongated right adnexal cystic structure,\ncharacterized as hydrosalpinx on ___ pelvic ultrasound, is not significantly\nchanged from the prior exam (2:104). This structure appears separate from the\nright ovary. The uterus and left ovary have a normal appearance. No pelvic or\ninguinal lymphadenopathy is identified.\n\nBONES AND SOFT TISSUES:\n\nThere are no focal osseous lesions concerning for malignancy or infection.\nMultiple rents in the anterior abdominal wall, some with herniation of\nabdominal fat and one containing a loop of small bowel, as discussed above,\nare not significantly changed (2: 70, 75, 602:61).", "output": "1. No evidence of recurrent lymphoma in the abdomen or pelvis.\n2. Hepatic steatosis.\n3. Stable cystic structure in the right hemipelvis, characterized on prior\nultrasound as hydrosalpinx.\n4. Multiple ventral abdominal hernias, one of which contains a loop of small\nbowel, not significantly changed from CT of ___.\n5. Please refer to separate report for discussion of intrathoracic findings." }, { "input": "LUNG BASES: The tip of the Port-A-Cath is seen within the low SVC. There is\nslight narrowing of the SVC near the cavoatrial junction. The heart is normal\nin size though there is mitral annular and aortic valvular calcifications. \nThe imaged lung bases are clear aside from minimal right basal atelectasis.\n\nABDOMEN: The liver parenchyma appears normal and there is no concerning liver\nlesion. Trace perihepatic ascites is noted. Main portal vein is patent. No\nbiliary ductal dilation. The gallbladder is normal. The spleen is normal in\nsize. Adrenals are normal bilaterally. The pancreas appears slightly\natrophic though without signs of inflammation or focal abnormality. The\nkidneys enhance symmetrically. No hydronephrosis or worrisome renal lesion. \nThe abdominal aorta is mildly calcified and normal in caliber. The stomach\nand duodenum appear normal.\n\nPELVIS: There are dilated, fluid-filled loops of small bowel, measuring up to\n4 cm. There is a left paraumbilical hernia containing small bowel loops. A\ndilated loop enters and exits this hernia sac and can be traced to a second\nentry point of small-bowel into this hernia sac, seen best on series 2 image\n59, likely representing the point of bowel obstruction as there is complete\ndecompression of small bowel distal to this point. Decompressed small bowel\nexits the hernia on series 2 image 59 through 64, and can be traced directly\nto the terminal ileum. Appendix is not definitively visualized though there\nare no secondary signs of appendicitis. The colon is unremarkable containing\na mild fecal load. The uterus is grossly unchanged with slight prominence of\nthe endometrium, as stated on prior, measuring up to 2.8 cm, series 2, image\n82 which can be further evaluated by a nonemergent pelvic ultrasound. There\nis a right adnexal cystic lesion measuring 8.0 x 5.4 x 8.8 cm, previously\ncharacterized as a hydrosalpinx. No left adnexal abnormality. No pelvic free\nfluid. The urinary bladder is mostly decompressed. No pelvic sidewall or\ninguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion.\n\nSoft tissues: In addition to the small bowel containing large left\nperiumbilical hernia, there are multiple defect in the anterior body wall,\ncontaining fat, series 2, image 36 series 2, image 45, series 2, image 48,\nseries 2, image 51, and series 2, image 63.", "output": "1. Small-bowel obstruction due to a left periumbilical small bowel containing\nhernia. Please correlate for reducibility. No free fluid, free air or bowel\nwall thickening.\n2. Multiple additional fat containing abdominal wall hernias.\n3. Right adnexal cystic lesion, previously characterized as hydrosalpinx.\n4. Thickened endometrium, measuring up to 2.8 cm, consider nonemergent pelvic\nultrasound to further assess.\n\nRECOMMENDATION(S): Nonemergent pelvic ultrasound to further assess\nendometrium." }, { "input": "Lower chest:\nThere is no evidence of pulmonary nodule or mass in the visualized lung bases.\nThere is no pleural or pericardial effusion. Heart size is within normal\nlimits.\n\nThere is a soft tissue nodule in the inferior aspect left breast, better\ncharacterized on same day dedicated CT chest examination.\n\nAbdomen/pelvis:\nThere is no evidence of hepatic mass. There is no intrahepatic or extrahepatic\nbiliary ductal dilatation. The gallbladder is unremarkable.\n\nThe spleen is not enlarged. There is no evidence of pancreatic mass or\npancreatic ductal dilatation.\n\nThere is symmetric renal enhancement and excretion of intravenous contrast.\nThere is no evidence of hydronephrosis. There is no evidence of renal mass. \nThe adrenal glands are unremarkable. Urinary bladder is moderately distended\nwithout gross abnormality. Unchanged 6.3 x 4.2 cm low attenuation structure in\nthe right adnexal region likely represents hydrosalpinx.\n\nThere are no dilated or distended loops of bowel. There is a small segment of\nin mild wall common nonspecific small bowel wall thickening in the anterior\nmid abdomen (2:76). There is no intraperitoneal free air or free fluid. There\nis unchanged fat containing in the right anterior abdominal wall hernia. \nPreviously seen small bowel containing midline anterior abdominal wall hernia\nhas been reduced and contains a small amount of fat in the current\nexamination.\n\nThere are no enlarged inguinal, iliac chain, retrocrural, retroperitoneal\nlymph nodes. Abdominal aorta has a normal course and caliber with minimal\natherosclerotic calcification. There is no suspicious osseous lesion.", "output": "1. No evidence of recurrent disease in the abdomen or pelvis.\n2. Soft tissue nodule in the inferior medial left breast as described in same\nday CT chest report. Please see separate dictation for dedicated CT chest\nreport.\n3. Short segment of nonspecific small bowel wall thickening in the mid\nabdomen. Attention on followup imaging." }, { "input": "LOWER CHEST: Heart size is top normal without significant pericardial\neffusion. There is moderate left and mild right base atelectasis with small\nbilateral nonhemorrhagic pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The transplant liver demonstrates homogenous attenuation\nthroughout. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is absent. \nThe portal vein is patent.\n\nPANCREAS: There is moderate pancreatic atrophy without focal lesion or duct\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring up to 17 cm without focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Small region of cortical scarring in the right upper pole kidney is\nunchanged. The kidneys are otherwise of normal and symmetric size with normal\nnephrogram. There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable. There is mild\ndistension of the visualized distal esophagus with ingested oral contrast. \nThere is diffuse distention of small bowel with maximum caliber of 3.7 cm with\nmultiple air-fluid levels, coming to a single transition point in the right\nlower quadrant at the distal ileum (2:68). The large bowel is mainly\ndecompressed with small areas of fluid. There is fatty infiltration of the\ndistal sigmoid colon and rectum suggesting chronic inflammation.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThe bones are diffusely demineralized. Mild anterior wedging of the T12\nvertebral body is unchanged. Few small scattered Schmorl's nodes are seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild distension of the small bowel up to a maximum caliber of 3.8 cm with\nair-fluid levels coming to a single transition point at the distal ileum\ncompatible with small-bowel obstruction.\n2. Unremarkable appearance of the orthotopic liver transplant.\n3. Splenomegaly to a maximum dimension of 17 cm.\n4. Small bilateral pleural effusions with adjacent compressive atelectasis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:13 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST:\n\nSubsegmental atelectasis is present in the dependent lung bases bilaterally,\nas well as the lingula. There is no pleural effusion. Trace air is in the\nright ventricle, presumably from intravenous access.\n\nABDOMEN:\n\nHEPATOBILIARY: The transplanted liver is unremarkable. No focal lesions are\nidentified. The gallbladder is surgically absent.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN: Splenomegaly is again noted, measuring up to 17cm in craniocaudal\ndimension.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: A focal cortical defect along the posterior interpolar right kidney\n(02:32) is unchanged compared to the prior study. Otherwise, kidneys present\nsymmetric nephrograms excretion of contrast. A subcentimeter hypodensity in\nthe lower pole of the right kidney is too small to characterize, but is also\nunchanged. There is no hydronephrosis.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Portions of the colon are collapsed\nlimiting evaluation for wall thickening. Mild wall thickening and surrounding\ninflammatory fat stranding about the rectum ( 2:82) is noted. Appendix\ncontains air, has normal caliber without evidence of fat stranding.\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no abdominal aortic aneurysm. Eccentric partially\ncalcified atheromatous plaque in the mid abdominal aorta (02:46) is unchanged\ncompared to the prior study.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.", "output": "1. Slight wall thickening and surrounding inflammatory fat stranding about the\nrectum is compatible with mild proctitis.\n2. Normal appendix.\n3. Splenomegaly." }, { "input": "LOWER CHEST: Visualized lung fields are notable for small left pleural\neffusion with mild left lower lobe atelectasis. The heart is normal in size. \nNo pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Status post liver transplant with expected postsurgical\nchanges. Main portal vein, SMV, splenic vein are patent. There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic. There is no peripancreatic stranding.\n\nSPLEEN: The spleen is mildly enlarged measuring 13.6 cm. No focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: No significant change in a 0.9 x 0.8 cm right lower pole hypodensity.\nRight renal scarring noted. No hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: No hiatal hernia. The stomach is unremarkable. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Equivocal mucosal hyper enhancement of the sigmoid and proximal\ntransverse colon is noted, question early colitis. Normal terminal ileum. No\nfat stranding. No diverticulosis. The appendix is normal without evidence of\nacute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Mild multilevel degenerative changes are noted throughout the\nthoracolumbar spine. There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Equivocal mucosal hyper enhancement of the sigmoid and proximal transverse\ncolon are likely related to underdistention, correlate for possibility of an\nearly colitis.\n2. Status post liver transplant with expected postsurgical changes. Patent\nmain portal vein.\n3. Stable mild splenomegaly.\n4. 0.9 cm right lower pole renal hypodensity is better characterized on prior\nMRCP as benign." }, { "input": "Heart size is normal without significant pericardial fluid. Severe coronary\nartery calcifications are noted. There is a large right-sided pleural\neffusion measuring simple density with adjacent mild compressive atelectasis. \nThe left lung base is clear.\n\nCT abdomen with contrast: The liver enhances homogeneously without focal\nlesion or biliary dilatation. Gallbladder is absent. Portal vein is patent.\n\nSpleen, atrophied pancreas and adrenal glands are unremarkable. There is a\nsimple 1.4 cm right lower pole renal cyst. Kidneys otherwise present\nsymmetric nephrograms without focal solid lesion or hydronephrosis.\n\nA 3.8 cm gastric diverticulum is noted arising from the posterior aspect of\nthe fundus. Stomach is otherwise grossly unremarkable. Duodenum and small\nbowel loops are normal caliber without evidence of obstruction. The distal\nlarge bowel is mainly decompressed, however the proximal large bowel appears\ndistended to a maximum diameter of roughly 8 cm at the level of the cecum and\nthere is a gradual transition down to a normal caliber at roughly the level of\nthe splenic flexure. The distal large bowel contains gas and fluid. There is\ntrace diverticulosis without evidence of diverticulitis. There is otherwise\nno pericolonic fat stranding or fluid collection.\n\nThere are severe atherosclerotic calcifications along a normal caliber\nabdominal aorta. There is no mesenteric or retroperitoneal lymphadenopathy by\nCT size criteria. There is no ascites, pneumoperitoneum or ventral abdominal\nhernia.\n\nCT pelvis with contrast: Bladder, prostate and rectum are unremarkable. There\nis a large fat containing right-sided inguinal hernia. There is no free\npelvic fluid or air. There is no inguinal or pelvic sidewall lymphadenopathy\nby CT size criteria.\n\nBones and soft tissues: There is no suspicious focal bone lesion. There is\nextensive a lumbar fusion hardware extending from the level of L2 through L5\nas seen previously with prominent surrounding degenerative change.", "output": "1. Prominent distention of the large bowel with gradual transition to a normal\ncaliber at the approximate level of the splenic flexure, without obstructing\nlesion identified most suggestive ___ syndrome. Adynamic ileus is\nunlikely given normal caliber small bowel loops.\n2. 3.8 cm gastric diverticulum.\n3. Severe atherosclerotic disease." }, { "input": "LOWER CHEST: Volume loss in the right lower lobe may represent atelectasis or\ninfection. There is a moderate right pleural effusion. No left pleural or\npericardial effusion. Coronary artery calcifications are severe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. There is no nephrolithiasis. Mild bilateral perinephric\nstranding is likely secondary to known medical renal disease.\n\nGASTROINTESTINAL: A posterior gastric diverticulum is again noted (02:25). \nSmall bowel loops demonstrate normal caliber throughout. Gaseous distention\nof the proximal colon is similar to prior. The colon and rectum are otherwise\ngrossly unremarkable. The appendix is not visualized.\n\nNo free intra-abdominal fluid. No retroperitoneal hematoma.\n\nPELVIS: The bladder contains intermediate density fluid, which may represent\nexcreted iodinated contrast from a prior CT study or hemorrhage products. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There are no aggressive appearing osseous lesions. No acute fracture. \nPost-operative changes in the lumbar spine.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.", "output": "1. Volume loss in the right lower lobe may represent atelectasis or infection.\nPlease correlate with clinical status.\n2. No retroperitoneal hematoma or free intra-abdominal fluid.\n3. Intermediate density fluid in the bladder may represent delayed excretion\nof iodinated contrast from prior CT study or hemorrhage products. Please\ncorrelate with visual inspection of the urine or urinalysis.\n4. Moderate right pleural effusion." }, { "input": "LOWER CHEST: Re-demonstrated partially visualized hydropneumothorax of the\nright appears unchanged from the prior examination. Rounded consolidation\nadjacent to the pleural effusion may represent rounded atelectasis and is\nunchanged. Ground-glass opacifications in the visualized central left lower\nand anterior left upper lobe are nonspecific and may reflect and infectious or\ninflammatory process.\n\nABDOMEN: The study is limited for evaluation of the parenchyma and visceral\norgans due to lack of IV contrast.\n\nHEPATOBILIARY: The gallbladder is absent. Liver is unremarkable. No intra or\nextrahepatic biliary ductal dilatation\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Enlarged. Small splenules along the anterior aspect of the spleen are\nunchanged.\n\nADRENALS: Unremarkable bilaterally.\n\nURINARY: No hydronephrosis or nephrolithiasis. The ureters are unremarkable\n\nGASTROINTESTINAL: Gastric fundal diverticulum is re-demonstrated. The small\nbowel is normal caliber. Again seen is a marked distension of the ascending\nand transverse colon with smooth tapering at the mid to proximal descending\ncolon the distension measures up to approximately 8.1 cm which is mildly\nincreased since the prior study findings are again suggestive ___\nsyndrome. No stricturing is seen. Air-fluid levels within the colon suggests\na diarrheal state.\n\nPELVIS: Bladder is mostly decompressed. Multiple pelvic phleboliths. \nProstate and seminal vesicles are within normal limits.\n\nPERITONEUM/RETROPERITONEUM: Fat containing right inguinal hernia is unchanged.\nNo ascites or pneumoperitoneum.\n\nLYMPH NODES: No adenopathy\n\nVASCULAR: Moderate atherosclerotic calcifications of the aorta which is normal\ncaliber. The IVC is normal caliber.\n\nBONES: Lumbar spinal hardware is re-demonstrated. The overall appearance of\nthe lumbar and lower thoracic spine is unchanged. No suspicious osseous\nlesion\n\nSOFT TISSUES: There is a moderate to large fat containing right inguinal\nhernia.", "output": "1. Colonic distension is minimally increased since the prior study measures\napproximately 8.1 cm, previously measured 7 cm with smooth tapering in the\nproximal descending colon is suggestive ___ syndrome. No gross\nstricture identified.\n2. Small bowel is normal caliber. No evidence of bowel obstruction.\n3. Air-fluid levels within the colon suggests a diarrheal state.\n4. Partially visualized known right hydropneumothorax.\n5. Ground-glass opacifications in the visualized central left lower and\nanterior left upper lobe are nonspecific and may reflect an infectious or\ninflammatory process.\n6. Additional findings as above." }, { "input": "LOWER CHEST: Mild basal atelectasis is noted posteriorly. The imaged portion\nof the heart is unremarkable.\n\nABDOMEN: The liver appears mildly fat replaced without focal lesion of\nconcern. Main portal vein is patent. Gallbladder is surgically absent. No\nbiliary ductal dilation. The spleen is normal. The adrenals are normal. The\npancreas is unremarkable. There is a periampullary duodenal diverticulum. \nOtherwise the stomach and duodenum appear normal. The abdominal aorta is\ndensely calcified though non aneurysmal. No retroperitoneal adenopathy. No\nfree air or free fluid.\n\nPELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe secondary signs of appendicitis. The colon notable for diverticulosis and\nno evidence of diverticulitis. Anterior midline hernias contain portions of\nthe mid transverse colon and several small bowel loops which do not appear\nobstructed. A small amount of anterior mesh is seen just deep to the\numbilicus. The uterus is surgically absent. No adnexal mass is seen. No\npelvic free fluid. Urinary bladder is decompressed. No lymphadenopathy.\n\nBONES: Bilateral hip osteoarthritis appears mild to moderate. No fracture or\nalignment abnormality in the imaged spine.", "output": "1. Midline anterior abdominal wall hernias containing fat and bowel, without\nevidence of complication, similar in overall appearance from prior CT exam.\n2. Colonic diverticulosis without diverticulitis.\n3. Hepatic steatosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.Mild coronary artery\ncalcifications\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates mild steatosis. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple cysts are seen in bilateral kidneys the largest measuring 2.4 cm in\nthe upper pole of the right kidney. There is no evidence of hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. A duodenal diverticulum is\nnoted. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. Extensive sigmoid diverticulosis. The rectum is\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes of the thoracolumbar spine and bilateral hip\njoints noted.\n\nSOFT TISSUES: Re-demonstrated are 2 midline, ventral abdominal wall hernias. \nA supraumbilical hernia contains nonobstructed loops of transverse colon. The\numbilical hernia contains a loop of nonobstructed small bowel as well as a\nsmall amount of fluid. Just inferior to the umbilicus, hernia repair mesh\nscarring is seen, similar to the prior study", "output": "1. Re-demonstrated are 2 midline, ventral abdominal wall hernias-the hernia\nlocated more cranially contains a small segment of the nonobstructed\ntransverse colon, while the hernia located caudally contains a small portion\nof a small bowel loop. There is trace fluid within the hernial sac containing\nthe small bowel however no transition point or other evidence to suggest bowel\nobstruction noted. There has been prior mesh repair of the ventral abdominal\nwall and the mesh is located inferior to the latter hernial sac.\n2. Mild hepatic steatosis, extensive sigmoid diverticulosis, severe\natherosclerotic calcification of the abdominal aorta and its branches with\nfocal narrowing (up to 50%) at the origin of the celiac artery are additional\nincidental findings.\n\nNOTIFICATION: The findings were discussed with ___ by ___\n___, M.D. on the telephone on ___ at 11:06 am, 20 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Patient status post splenectomy with splenosis in the splenectomy bed\nand seen throughout the peritoneum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is mild\ndilatation of the colon with a transition point in the proximal sigmoid\nregion, in the region of the previously diagnosed diverticulitis. There is no\nevidence of acute inflammation. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Mild dilatation of the colon with a transition point in the proximal\nsigmoid in the region of prior diverticulitis. This may represent stricture\n(spasm is less likely) and correlation with colonoscopy is suggested. No\nevidence of acute diverticulitis.\n2. Status post splenectomy with splenosis." }, { "input": "LOWER CHEST: There is mild atelectasis in the right lung base. No pleural or\npericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality. A left nephroureteral stent is in unchanged\nposition.\n\nGASTROINTESTINAL: The stomach is unremarkable. A small duodenal diverticulum\nmedial to the descending portion is again noted (4:31). Patient is status\npost low anterior resection for rectal cancer. Rectal anastomosis sutures, a\ndiverting ileostomy in the right lower quadrant and evolving postsurgical\nchanges are noted. There is no gastrointestinal obstruction. The appendix is\nnormal.\n\nRectal contrast is seen to the level of the cecum. There is no evidence of\nextraluminal leak. Presacral fluid is simple without high attenuation to\nsuggest extravasation of enteric contents.\n\nPELVIS: The urinary bladder is collapsed around a Foley balloon. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Evolving postsurgical changes are noted in the anterior\nabdominal wall.", "output": "1. No rectal contrast leak seen. No evidence of abscess. Presacral fluid is\nsimple in attenuation without suggestion of extravasation.\n2. Left nephroureteral stent is in unchanged position.\n3. Evolving postsurgical changes." }, { "input": "LOWER CHEST: Other than mild bibasilar atelectasis, the partially imaged lower\nlungs are clear. No evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Tiny hypodensity in the hepatic dome is too small to\naccurately characterize, statistically likely a cyst (series 601b, image 14). \nThe liver parenchyma otherwise demonstrates homogenous attenuation throughout.\nNo evidence of concerning focal lesions. No evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo evidence of focal renal lesions or hydronephrosis. No perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is distended by ingested food contents. Small\nbowel loops are filled with fluid throughout its course but are not abnormally\ndistended and the bowel wall is normal thickness and enhancement throughout. \nThe colon is not decompressed and contains a normal amount of stool. There is\na small amount of fluid in the ascending colon. No transition points or\nevidence of bowel obstruction are identified. No intra-abdominal fluid\ncollection. No free air. No secondary signs of acute appendicitis. No\nevidence of diverticulosis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: A aortocaval lymph node measures up to 5 mm in short axis\n(series 2 a, image 48). No retroperitoneal or mesenteric lymphadenopathy. No\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. No atherosclerotic disease is noted.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic process. Stomach distended by\nrecently-ingested food.\n2. No intra-abdominal or intrapelvic fluid collections." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate OA of the left hip, with subchondral sclerosis and geodes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No intra-abdominal malignancy.\n2. Severe left hip osteoarthritis." }, { "input": "LOWER CHEST: The lung bases are clear. There is no pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is top normal in size measuring 13.5 cm in craniocaudal\ndimension.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of a solid renal lesion or hydronephrosis. There is no\nperinephric abnormality. The urinary bladder and distal ureters are\nunremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is mild bowel wall\nthickening and submucosal edema in the ileum, which may represent developing\nenteritis. The transverse colon and multiple loops of small bowel abuts the\nanterior abdominal wall defect. Irregularity of the anterior abdominal wall\nadjacent to the mid transverse colon may represent a small colocutaneous\nfistula (2:42). There is no evidence of contrast leak. There are\npostsurgical changes from partial sigmoid resection with anastomotic sutures\nat the rectosigmoid junction and surgical clips in the lower abdomen. \nScattered colonic diverticula are noted. Fluid within the colon most likely\nrepresents diarrhea. The appendix is normal.\n\nOTHER: There is no free fluid or air in the abdomen or pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic\ncalcifications are noted.\n\nBONES: There is no suspicious osseous lesion or acute fracture.\n\nSOFT TISSUES: There are postsurgical changes from ventral hernia repair with a\nlarge anterior abdominal wall defect. There has been interval placement of\nsurgical drains along the superior aspect of the defect. The fluid collection\nalong the left lateral margin of the defect has nearly resolved. The\ntransverse colon and multiple loops of small bowel abut the anterior abdominal\nwall defect.", "output": "1. Postsurgical changes from ventral hernia repair with a large anterior\nabdominal wall defect.\n2. Interval placement of surgical drains along the superior margin of the\nabdominal wall defect with near complete resolution of the fluid collection\nalong the left lateral margin.\n3. Multiple loops of small bowel and transverse colon abuts the anterior\nabdominal wall defect. A focal irregularity of the anterior abdominal wall\nadjacent to the mid transverse colon may represent a small colocutaneous\nfistula.\n4. New bowel wall thickening and submucosal edema involving the ileum, which\nmay represent developing enteritis. New fluid within the colon most likely\nrepresents diarrhea." } ] }